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1.
N Engl J Med ; 389(4): 309-321, 2023 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-37494485

RESUMO

BACKGROUND: Narcolepsy type 1 is caused by severe loss or lack of brain orexin neuropeptides. METHODS: We conducted a phase 2, randomized, placebo-controlled trial of TAK-994, an oral orexin receptor 2-selective agonist, in patients with narcolepsy type 1. Patients with confirmed narcolepsy type 1 according to clinical criteria were randomly assigned to receive twice-daily oral TAK-994 (30 mg, 90 mg, or 180 mg) or placebo. The primary end point was the mean change from baseline to week 8 in average sleep latency (the time it takes to fall asleep) on the Maintenance of Wakefulness Test (range, 0 to 40 minutes; normal ability to stay awake, ≥20 minutes). Secondary end points included the change in the Epworth Sleepiness Scale (ESS) score (range, 0 to 24, with higher scores indicating greater daytime sleepiness; normal, <10) and the weekly cataplexy rate. RESULTS: Of the 73 patients, 17 received TAK-994 at a dose of 30 mg twice daily, 20 received 90 mg twice daily, 19 received 180 mg twice daily, and 17 received placebo. The phase 2 trial and an extension trial were terminated early owing to hepatic adverse events. Primary end-point data were available for 41 patients (56%); the main reason for missing data was early trial termination. Least-squares mean changes to week 8 in average sleep latency on the MWT were 23.9 minutes in the 30-mg group, 27.4 minutes in the 90-mg group, 32.6 minutes in the 180-mg group, and -2.5 minutes in the placebo group (difference vs. placebo, 26.4 minutes in the 30-mg group, 29.9 minutes in the 90-mg group, and 35.0 minutes the 180-mg group; P<0.001 for all comparisons). Least-squares mean changes to week 8 in the ESS score were -12.2 in the 30-mg group, -13.5 in the 90-mg group, -15.1 in the 180-mg group, and -2.1 in the placebo group (difference vs. placebo, -10.1 in the 30-mg group, -11.4 in the 90-mg group, and -13.0 in the 180-mg group). Weekly incidences of cataplexy at week 8 were 0.27 in the 30-mg group, 1.14 in the 90-mg group, 0.88 in the 180-mg group, and 5.83 in the placebo group (rate ratio vs. placebo, 0.05 in the 30-mg group, 0.20 in the 90-mg group, and 0.15 in the 180-mg group). A total of 44 of 56 patients (79%) receiving TAK-994 had adverse events, most commonly urinary urgency or frequency. Clinically important elevations in liver-enzyme levels occurred in 5 patients, and drug-induced liver injury meeting Hy's law criteria occurred in 3 patients. CONCLUSIONS: In a phase 2 trial involving patients with narcolepsy type 1, an orexin receptor 2 agonist resulted in greater improvements on measures of sleepiness and cataplexy than placebo over a period of 8 weeks but was associated with hepatotoxic effects. (Funded by Takeda Development Center Americas; TAK-994-1501 and TAK-994-1504 ClinicalTrials.gov numbers, NCT04096560 and NCT04820842.).


Assuntos
Narcolepsia , Receptores de Orexina , Orexinas , Humanos , Cataplexia/complicações , Cataplexia/tratamento farmacológico , Cataplexia/epidemiologia , Método Duplo-Cego , Narcolepsia/tratamento farmacológico , Narcolepsia/complicações , Narcolepsia/epidemiologia , Receptores de Orexina/agonistas , Receptores de Orexina/uso terapêutico , Sonolência/efeitos dos fármacos , Resultado do Tratamento , Orexinas/análise , Orexinas/deficiência , Orexinas/farmacologia , Química Encefálica/efeitos dos fármacos , Administração Oral , Doença Hepática Induzida por Substâncias e Drogas/etiologia
2.
Int J Mol Sci ; 23(7)2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35409208

RESUMO

Mitragynine (MTR), the main indole alkaloid of the well-known plant kratom (Mitragyna speciosa), is one of the most studied natural products nowadays, due to its remarkable biological effects. It is a partial agonist on the opioid receptors, and as such relieves pain without the well-known side-effects of the opioids applied in the clinical practice. MTR and its derivatives therefore became novel candidates for drug development. The poor aqueous solubility and low bioavailability of drugs are often improved by cyclodextrins (CyDs) as excipients through host-guest type complex formation. Among the wide variety of CyDs, sulfobutylether-beta-cyclodextrin (SBEßCyD) is frequently used and official in the European and U.S. Pharmacopoeia. Herein, the host-guest complexation of MTR with ßCyD and SBEßCyD was studied using chiroptical and NMR spectroscopy. It was found by NMR measurements that MTR forms a rather weak (logß11 = 0.8) 1:1 host-guest complex with ßCyD, while the co-existence of the 2MTR∙SBEßCyD and MTR∙SBEßCyD species was deducted from 1H NMR titrations in the millimolar MTR concentration range. Sulfobutylation of ßCyD significantly enhanced the affinity towards MTR. The structure of the formed inclusion complex was extensively studied by circular dichroism spectroscopy and 2D ROESY NMR. The insertion of the indole moiety was confirmed by both techniques.


Assuntos
Ciclodextrinas , Mitragyna , Alcaloides de Triptamina e Secologanina , beta-Ciclodextrinas , Ciclodextrinas/química , Espectroscopia de Ressonância Magnética , Mitragyna/química , Solubilidade
3.
Int J Mol Sci ; 23(22)2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36430926

RESUMO

Acid-base properties of cyclodextrins (CDs), persubstituted at C-6 by 3-mercaptopropionic acid, sualphadex (Suα-CD), subetadex (Suß-CD) and sugammadex (Suγ-CD, the antidote of neuromuscular blocking steroids) were studied by 1H NMR-pH titrations. For each CD, the severe overlap in protonation steps prevented the calculation of macroscopic pKa values using the standard data fitting model. Considering the full symmetry of polycarboxylate structures, we reduced the number of unknown NMR parameters in the "Q-fitting" or the novel "equidistant macroscopic" evaluation approaches. These models already provided pKa values, but some of them proved to be physically unrealistic, deceptively suggesting cooperativity in carboxylate protonations. The latter problem could be circumvented by adapting the microscopic site-binding (cluster expansion) model by Borkovec, which applies pairwise interactivity parameters to quantify the mutual basicity-decreasing effect of carboxylate protonations. Surprisingly, only a single averaged interactivity parameter could be calculated reliably besides the carboxylate 'core' microconstant for each CD derivative. The speciation of protonation isomers hence could not be resolved, but the optimized microscopic basicity parameters could be converted to the following sets of macroscopic pKa values: 3.84, 4.35, 4.81, 5.31, 5.78, 6.28 for Suα-CD; 3.82, 4.31, 4.73, 5.18, 5.64, 6.06, 6.54 for Suß-CD and 3.83, 4.28, 4.65, 5.03, 5.43, 5.81, 6.18, 6.64 for Suγ-CD. The pH-dependent charge of these compounds can now be accurately calculated, in support of designing new analytical methods to exploit their charge-dependent molecular recognition such as in cyclodextrin-aided chiral capillary electrophoresis.


Assuntos
Ciclodextrinas , Ciclodextrinas/química , Espectroscopia de Ressonância Magnética , Imageamento por Ressonância Magnética , Eletroforese Capilar/métodos
4.
Phys Chem Chem Phys ; 23(28): 15150-15158, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34259270

RESUMO

Excited-state symmetry breaking is investigated in a series of symmetric 9,10-dicyanoanthracenes linked to electron-donating groups on the 2 and 6 positions via different spacers, allowing for a tuning of the length of the donor-acceptor branches. The excited-state properties of these compounds are compared with their dipolar single-branch analogues. The changes in electronic structure upon their optical excitation are monitored by transient electronic spectroscopy in the visible and near-infrared regions as well as by transient vibrational spectroscopy in the mid-infrared. Our results reveal that, with the shortest branches, electronic excitation remains distributed almost symmetrically over the molecule even in polar environments. Upon increasing the donor-acceptor distance, excitation becomes unevenly distributed and, with the longest one, it fully localises on one branch in polar solvents. The influence of the branch length on the propensity of quadrupolar dyes to undergo excited-state symmetry breaking is rationalised in terms of the balance between interbranch coupling and solvation energy.

5.
Chemphyschem ; 21(15): 1718-1730, 2020 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-32415748

RESUMO

Upon photoexcitation, a majority of quadrupolar dyes, developed for large two-photon absorption, undergo excited-state symmetry breaking (ES-SB) and behave as dipolar molecules. We investigate how the change of quadrupole moment upon S1 ←S0 excitation, ΔQ, influences the propensity of a dye to undergo ES-SB using a series of molecules with a A-π-D-π-A motif where D is the exceptionally electron-rich pyrrolo[3,2-b]pyrrole and A are accepting groups. Tuning of ΔQ is achieved by appending a secondary acceptor group, A', on both sides of the D core and ES-SB is monitored using a combination of time-resolved IR and broadband fluorescence spectroscopy. The results reveal a clear correlation between ΔQ and the tendency to undergo ES-SB. When A is a stronger acceptor than A', ES-SB occurs already in non-dipolar but quadrupolar solvents. When A and A' are identical, ES-SB is only partial even in highly dipolar solvents. When A is a weaker acceptor than A', the orientation of ΔQ changes, ES-SB is observed in dipolar solvents only and involves major redistribution of the excitation over the D-π-A and D-A' branches of the dye.

6.
Phys Chem Chem Phys ; 20(15): 10155-10164, 2018 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-29589611

RESUMO

The excited state processes in N-propyl-4-piperidinyl-1,8-naphthalimide have been studied by measuring its fluorescence spectra and decay curves in solvents of different polarity and viscosity and also in a frozen solvent glass. The results unanimously proved the formation of a dark twisted intramolecular charge transfer (TICT) state from the emissive charge transfer (CT) species, the direct product of excitation. The rate coefficients of the TICT process and the deactivations of the CT and TICT species were determined, using a reversible two-state kinetic model. The temperature dependence of the kinetic data was consistent with a kinetic barrier consisting of three terms, the inherent barrier of the reaction, and the contributions of the solute-solvent interactions related to the solvent viscosity and polarity. The potential energy surfaces were calculated in the S0 and the S1 states along the coordinate of turning motion which was conclusive concerning the direction of the twisting and indicated a possible conformational change of the piperidinyl unit. The theoretical calculations confirmed that the TICT species is dark and has a stronger charge transfer character compared to the CT state.

7.
Ideggyogy Sz ; 71(5-06): 169-177, 2018 May 30.
Artigo em Húngaro | MEDLINE | ID: mdl-29889459

RESUMO

BACKGROUND AND PURPOSE: After routine workup, 23-25% of ischemic strokes etiology remains unknown, i.e. cryptogenic. However, according to international results pathogenic patent foramen ovale (PFO) reveals in 25% of these cases. Aim of our retrospective study to prove the substantial etiological role of PFO-related stroke (PFO-RS) in cryptogenic strokes (CS), and to identify age related differences in stroke etiology. METHODS: All new ischemic strokes of 2014-2015 were classified by ASCOD (Atherosclerosis, Small-vessel disease, Cardiac pathology, Other, Dissection) phenotyping. CS was defined when the etiology was unknown. With the help of special ultrasound techniques and RoPE (Risk of Paradoxical Embolism) score the portion of PFO-RS were determined in the examined CS population. Moreover, etiological distribution and differences between age groups (<40, 40-60, >60 years) were described. RESULTS: During the examined period, 8.12% of 985 new ischemic strokes were categorized as CS. 41.38% of examined CS were found to be PFO-related. PFO-RS were considerably more frequent in the younger age groups than in the older age groups. The probability of appearance of PFO-RS were significantly higher in younger age than in case of age independency. Our results verify the substantial etiological role of PFO-RS in CS, and confirm the essential role of contrast enhanced functional transcranial Doppler in the routine diagnostic workup. Age related differences in stroke etiology were found to be statistically significant (p=0.000, df=14), in which small-vessel disease, cardiac pathology, dissection, other pathologies, CS and PFO-RS were contributed significantly. CONCLUSION: Based on our results, till in young age rare etiologies are typical, while in older age classical etiologies are mainly characteristic.


Assuntos
Isquemia Encefálica/etiologia , Forame Oval Patente/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Fatores Etários , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Ultrassonografia Doppler Transcraniana
8.
Ideggyogy Sz ; 70(9-10): 349-353, 2017 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-29870627

RESUMO

Introduction - Among antidotes in development for reversal of novel oral anticoagulants, dabigatran-specific idarucizumab was the first one to reach the market. Case presentation - We present the first Hungarian case of intracerebral hemorrhage under treatment with dabigatran, where idarucizumab was administered to suspend anticoagulation. Discussion - Our report is concordant with prior publications, confirming the efficacy of the antidote in reversing the effect of dabigatran, and thus, preventing intracerebral hematoma progression in the acute phase. Conclusion - Since there is no proven alternative to idarucizumab, conducting randomized clinical trials would be unethical. Therefore, besides case reports, positive results of prospective studies could help us revise therapeutic guidelines, and thus, improve the prognosis of dabigatran-associated intracerebral hemorrhages.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antídotos/uso terapêutico , Antitrombinas/farmacologia , Hemorragia Cerebral/tratamento farmacológico , Dabigatrana/antagonistas & inibidores , Antitrombinas/uso terapêutico , Dabigatrana/uso terapêutico , Humanos
9.
Ideggyogy Sz ; 70(7-8): 284-288, 2017 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-29870643

RESUMO

Introduction - Expanding indications have resulted in an increasing number of patients taking novel oral anticoagulants, posing a major treatment dilemma in acute ischemic stroke. Case presentation - We present a successful intravenous thrombolysis in a dabigatran-treated patient with acute ischemic stroke after the administration of idarucizumab. Discussion - According to current guidelines, systemic thrombolysis is contraindicated under treatment with novel oral anticoagulants (taken within 48 hours). In this scenario, idarucizumab offers a solution by reversing the anticoagulant effect of dabigatran. Conclusion - Although there have only been case reports published so far, the dabigatran-antidote idarucizumab seems to give new therapeutic opportunities in the treatment of acute ischemic stroke.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antídotos/uso terapêutico , Isquemia Encefálica/tratamento farmacológico , Dabigatrana/antagonistas & inibidores , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Dabigatrana/uso terapêutico , Fibrinolíticos/uso terapêutico , Humanos
10.
Ideggyogy Sz ; 70(3-4): 105-113, 2017 Mar 30.
Artigo em Húngaro | MEDLINE | ID: mdl-29870615

RESUMO

BACKGROUND AND PURPOSE: Obstructive sleep apnea syndrome (OSAS) without treatment can cause serious cardiovascular, cardiorespiratory, neurological and other complications. Family physicians have an important role in recognizing the disease. The aim of the study is to assess the knowledge and attitude of family physicians related to sleep apnea. Whether OSAS screening is realized during the general medical checkup for drivers. METHODS: In the cross-sectional study we used a validated OSAKA questionnaire in mandatory continuous medical education courses, supplemented with four additional questions. RESULTS: 116 family physicians and 103 family medicine residents filled out the questionnaire. Hungarian family physicians, especially male doctors lack the adequate knowledge of sleep apnea. The average score of female physicians was significantly higher than that of males (13.4±1.8 vs. 11.7±2.6, p=0.005). The more specializations the doctor has, the higher the score. Zero or one special examination holders reached 12.5±2.3 points, two special examination holders 12.7±2.2 points. three or four special examination holders reached 14.0±2.1 (p=0.05). Residents' average score was 12.1±2.4 points, which is higher than that of family doctors (p=0.012). Female residents also had higher average points than male residents (12.6±2.0 vs. 11.3±2.7; p=0.008). The size, location and type of the practice or the doctor's age did not show any statistically significant correlation with the number of points achieved. According to our regression analysis, corrected to variables in the model, we found correlation between gender and medical knowledge, but there was no correlation between age, number of specialities, body mass index and the theoretical knowledge of the doctors. In terms of attitude female GPs had higher average scores than male GPs (3.5±0.6 vs. 2.9±0.6, p<0.001). Despite the modification of the 13/1992 regulation only 39% of the practices carried out regularly the required OSAS screening as part of the medical examination for a driving licence. CONCLUSION: Despite the high prevalence and clinical importance of OSAS, GPs often do not recognize sleep apnea and they have difficulty in treating their patients for this problem.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Médicos de Família , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Hungria , Internato e Residência , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
Angew Chem Int Ed Engl ; 56(30): 8742-8745, 2017 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-28548374

RESUMO

Continuous-flow multistep synthesis is combined with quasi-continuous final-product purification to produce pure products from crude reaction mixtures. In the nucleophilic aromatic substitution of 2,4-difluoronitrobenzene with morpholine followed by a heterogeneous catalytic hydrogenation, the desired monosubstituted product can be continuously separated from the co- and by-products in a purity of over 99 % by coupling a flow reactor sequence to a multiple dual-mode (MDM) centrifugal partition chromatography (CPC) device. This purification technique has many advantages over HPLC, such as higher resolution and no need for column replacement or silica recycling, and it does not suffer from irreversible adsorption.

12.
Photochem Photobiol Sci ; 15(2): 219-27, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26738442

RESUMO

The photolysis reactions of 4'-diethylamino-3-hydroxyflavone (D), a versatile fluorescent probe showing excited-state intramolecular proton transfer (ESIPT), and the magnesium chelate of D (MgD(2+)) have been studied in acetonitrile solution. Upon UV irradiation both species were oxidized into O-4-diethylaminobenzoyl salicylic acid, differently from the photoreaction of the parent compound 3-hydroxyflavone (3HF) which was described to undergo rearrangement to 3-hydroxy-3-phenyl-indan-1,2-dione. The photooxygenation of the Mg(2+) complex was found to be significantly faster than the reaction of the pure dye. As the kinetic analysis of the absorption spectra of samples under irradiation showed, the rate coefficients for the oxygenations of the excited state dye and complex have close values, kox(D*) = 2.4 × 10(7) min(-1), kox(MgD(2+)*) = 3.9 × 10(7) min(-1); the difference arises from the higher photooxygenation quantum yield of the complex, Φ(MgD(2+)) = 2.3 × 10(-3), than the respective value for the pure dye, Φ(D) = 1.5 × 10(-4). The potential energy surface of the photooxygenation of D was calculated assuming a reaction path in which the phototautomer formed from Dvia ESIPT, reacts in its triplet state with triplet molecular oxygen O2, a mechanism similar to that suggested for the photoreaction of the parent 3HF. The moderate values for the transition state energies confirmed the plausibility of the hypothetical mechanism.

13.
Bioorg Med Chem Lett ; 26(3): 914-920, 2016 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-26748694

RESUMO

As a result of our exploratory programme aimed at elaborating dually acting compounds towards the serotonin (5-HT) transporter (SERT) and the 5-HT2C receptor a novel series of 3-amino-1-phenylpropoxy substituted diphenylureas was identified. From that collection two promising compounds (2 and 3) exhibiting highest 5-HT2C receptor affinity strongly inhibited the 5-HT2C receptor agonist 1-(3-chlorophenyl)piperazine (mCPP) induced hypomotility in mice. In further pursuance of that objective (2-aminoethyl)(benzyl)sulfamoyl diphenylureas and diphenylpiperazines have also been elaborated. Herein we report the synthesis of potent multiple-acting compounds from this new class. However, when two optimized representatives (6 and 14) possessing the desired in vitro profile were tested neither reduced the motor activity of mCPP treated animals. Comparative albeit limited in vitro structure-activity relationship (SAR) analysis and detailed in vivo studies are discussed and explanation for their intricate behaviour is proposed.


Assuntos
Ligantes , Receptor 5-HT2A de Serotonina/química , Receptor 5-HT2C de Serotonina/química , Proteínas da Membrana Plasmática de Transporte de Serotonina/química , Animais , Humanos , Fígado/efeitos dos fármacos , Fígado/metabolismo , Camundongos , Permeabilidade/efeitos dos fármacos , Piperazinas/química , Piperazinas/farmacologia , Receptor 5-HT2A de Serotonina/metabolismo , Receptor 5-HT2C de Serotonina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Serotonina/metabolismo , Agonistas do Receptor de Serotonina/química , Agonistas do Receptor de Serotonina/farmacologia , Relação Estrutura-Atividade
14.
Bioorg Med Chem Lett ; 26(4): 1249-52, 2016 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-26774652

RESUMO

High throughput screening of our corporate compound library followed by hit-to-lead development resulted in a 4-aryl-3-arylsulfonyl-quinoline derivative lead (2) with mGluR5 negative allosteric modulator activity. During the lead optimization process, our objective was to improve affinity and metabolic stability. Modifications at the three targeted regions of the lead structure resulted in compounds with nanomolar affinity and acceptable metabolic stability. One of the most promising compounds (3), showing excellent in vivo efficacy, was selected for preclinical development and subsequent phase I clinical studies.


Assuntos
Quinolinas/química , Receptor de Glutamato Metabotrópico 5/química , Regulação Alostérica , Animais , Doenças do Sistema Nervoso Central/etiologia , Ensaios de Triagem em Larga Escala , Humanos , Ligação Proteica , Quinolinas/síntese química , Quinolinas/metabolismo , Quinolinas/toxicidade , Ratos , Receptor de Glutamato Metabotrópico 5/metabolismo , Relação Estrutura-Atividade
15.
Neurol Neurochir Pol ; 50(5): 370-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27591063

RESUMO

An estimated 25-40% of ischemic strokes are classified as cryptogenic, which means the cause of the cerebral infarction remains unidentified. One of the potential pathomechanisms - especially among young patients with no cardiovascular risk factors - is paradoxical embolism through a patent foramen ovale. Pregnancy, cesarean delivery and the postpartum period are associated with an increased risk of cerebrovascular events. Factors that may contribute to ischemic strokes during gestation and puerperium include classic cardiovascular risk factors, changes in hemostaseology/hemodynamics, and pregnancy-specific disorders such as pre-eclampsia, eclampsia, postpartum cerebral angiopathy or peripartum cardiomyopathy. In this case report, we present a 36-year-old thrombolysis candidate undergoing mechanical thrombectomy 3 weeks after a cesarean section due to HELLP-syndrome. After evaluation of anamnestic and diagnostic parameters, closure of the patent foramen ovale has been performed. In the absence of specific guidelines, diagnostic work-up for cryptogenic stroke should be oriented after the suspected pathomechanism based on patient history and clinical picture. As long as definite evidences emerge, management of cryptogenic stroke patients with pathogenic right-to-left shunt remains individual based on the mutual decision of the patient and the multidisciplinary medical team.


Assuntos
Período Pós-Parto , Acidente Vascular Cerebral/etiologia , Adulto , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral , Cesárea , Feminino , Síndrome HELLP/fisiopatologia , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Gravidez , Fatores de Risco , Stents , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia , Tomografia Computadorizada por Raios X
16.
Orv Hetil ; 157(23): 892-900, 2016 Jun 05.
Artigo em Húngaro | MEDLINE | ID: mdl-27233832

RESUMO

Obstructive sleep apnea is the most frequent sleep-disordered breathing. The prevalence of sleep apnea in the general population is 2-4% and the main characteristics of the disease are the intermittent cessation or substantial reduction of airflow during sleep, which is caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. Untreated patients are 4-6 times more likely to cause traffic accidents than their healthy counterparts. The aims of the obstructive sleep apnea screening are to prevent and reduce the incidence of serious car accidents, which are often caused by one of the most dangerous sleep disorders. Since April 1, 2015 a modification of the 13/1992 regulation has been in force in Hungary which orders screening of obstructive sleep apnea during medical checkup of drivers. The Hungarian Society for Sleep Medicine made a guideline according to the regulation which was adapted to national circumstances and family doctors, occupational health specialists can more easily screen obstructive sleep apnea in suspected patients. In sleep ambulances the disease can be diagnosed and effective treatment can be started. Patients receiving appropriate treatment and with appropriate compliance can get their driving licence under regular care and control.


Assuntos
Acidentes de Trânsito/prevenção & controle , Condução de Veículo , Medicina de Família e Comunidade , Programas de Rastreamento/métodos , Apneia Obstrutiva do Sono/diagnóstico , Condução de Veículo/legislação & jurisprudência , Medicina de Família e Comunidade/métodos , Medicina de Família e Comunidade/normas , Humanos , Hungria , Polissonografia , Autorrelato , Inquéritos e Questionários
17.
Ideggyogy Sz ; 69(3-4): 129-32, 2016 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-27188005

RESUMO

INTRODUCTION: There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. CASE PRESENTATION: We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. DISCUSSION: There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines--while considering pregnancy as a relative exclusion criterion--do not deal with the postpartum state. CONCLUSION: As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.


Assuntos
Isquemia Encefálica/complicações , Procedimentos Endovasculares/métodos , Fibrinolíticos/uso terapêutico , Período Pós-Parto , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/cirurgia , Terapia Trombolítica/métodos , Adulto , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Estenose das Carótidas/complicações , Angiografia Cerebral , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Chemistry ; 21(32): 11495-508, 2015 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-26119910

RESUMO

A series of [Au2 (nixantphos)2](X)2 (nixantphos=4,6-bis(diphenylphosphino)-phenoxazine; X=NO3, 1; CF3 COO, 2; CF3 SO3, 3; [Au(CN)2], 4; and BF4, 5) complexes that exhibit intriguing anion-switchable and stimuli-responsive luminescent photophysical properties have been synthesized and characterized. Depending on their anions, these complexes display yellow (3), orange (4 and 5), and red (1 and 2) emission colors. They exhibit reversible thermo-, mechano-, and vapochromic luminescence changes readily perceivable by the naked eye. Single-crystal X-ray studies show that the [Au2 (nixantphos)2](2+) cations with short intramolecular Au⋅⋅⋅Au interactions are involved as donors in an infinite N-H⋅⋅⋅X (X=O and N) hydrogen-bonded chain formation with CF3 COO(-) (2 C) and aurophilically linked [Au(CN)2](-) counterions (4 C). Both crystals show thermochromic luminescence; their room temperature red (2 C) and orange (4 C) emission turns into yellow upon cooling to 77 K. They also exhibit reversible mechanochromic luminescence by changing their emission color from red to dark (2 C), and orange to red (4 C). Compounds 1-5 also display reversible mechanochromic luminescence, altering their emission colors between orange (1) or red (2) to dark, as well as between yellow (3) or orange (4 and 5) to red. Detailed photophysical investigations and correlation with solid-state structural data established the significant role of NH⋅⋅⋅X interactions in the stimuli-responsive luminescent behavior.

19.
Commun Chem ; 7(1): 86, 2024 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-38637664

RESUMO

Cariprazine-the only single antipsychotic drug in the market which can handle all symptoms of bipolar I disorder-involves trans-4-substituted cyclohexane-1-amine as a key structural element. In this work, production of trans-4-substituted cyclohexane-1-amines was investigated applying transaminases either in diastereotope selective amination starting from the corresponding ketone or in diastereomer selective deamination of their diasteromeric mixtures. Transaminases were identified enabling the conversion of the cis-diastereomer of four selected cis/trans-amines with different 4-substituents to the corresponding ketones. In the continuous-flow experiments aiming the cis diastereomer conversion to ketone, highly diastereopure trans-amine could be produced (de > 99%). The yield of pure trans-isomers exceeding their original amount in the starting mixture could be explained by dynamic isomerization through ketone intermediates. The single transaminase-catalyzed process-exploiting the cis-diastereomer selectivity of the deamination and thermodynamic control favoring the trans-amines due to reversibility of the steps-allows enhancement of the productivity of industrial cariprazine synthesis.

20.
Nanomaterials (Basel) ; 14(1)2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-38202575

RESUMO

Nanomaterials are integrated within consumer products to enhance specific properties of interest. Their release throughout the lifecycle of nano-enabled products raises concerns; specifically, mechanical strains can lead to the generation of fragmented materials containing nanomaterials. We investigated the potential release of single-walled carbon nanotubes (SWCNTs-brand TUBALL™) from epoxy composite materials. A pin-on-disk-type tribometer was used for the accelerated mechanical aging of the nanocomposites. A pristine nanocomposite material, abraded material and debris obtained from the abrasion in the tribometer were analyzed by Raman spectroscopy. The airborne-produced particles were captured using particle collectors. Stat Peel's Identifier C2 system was used to monitor the SWCNT content of respirable particles produced during the abrasion test. The SWCNT amounts found were below the LoQ. The Raman spectra conducted on the Stat Peel filters helped identify the presence of free SWCNTs released from the epoxy matrix, although they were notably scarce. Raman spectroscopy has been proved to be a crucial technique for the identification, characterization and assessment of structural changes and degradation in SWCNTs that occurred during the abrasion experiments.

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