ABSTRACT
Non-occlusive mesenteric ischemia (NOMI) is a rare but well-known life-threatening disease. However, reports on NOMI following trans-catheter aortic valve implantation (TAVI) are limited. This report presents a case of NOMI after trans-apical (TA) TAVI with thyroid storm. A 73-year-old man was admitted for a planned aortic valve surgery. Because he had severe aortic calcification and a right renal tumor that was suspected to be malignant, TA-TAVI was performed. At 61â¯h after TAVI, the patient complained of abdominal pain, and contrast-enhanced computed tomography showed ischemic necrosis of the cecum to the ascending colon. An ileocecal resection was performed emergently. He was extubated 61â¯h postoperatively, but severe delirium, high fever, and atrial fibrillation persisted. Due to a history of Basedow's disease, he was diagnosed with thyroid storm and treated with thiamazole and supportive care. The general status gradually improved, and he was transferred to the rehabilitation unit on the 17th postoperative day. We encountered a case of NOMI following TA-TAVI with a thyroid storm, which made it difficult to understand the patient's medical condition. Learning objective: The occurrence of non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation is rare but possible, and a thyroid storm could occur even after a less invasive surgery. It is important to perform postoperative management while considering the possible occurrence of this condition.
ABSTRACT
The voltage gated sodium channel NaV1.8 has been postulated to play a key role in the transmission of pain signals. Core hopping from our previously reported phenylimidazole leads has allowed the identification of a novel series of benzimidazole NaV1.8 blockers. Subsequent optimization allowed the identification of compound 9, PF-06305591, as a potent, highly selective blocker with an excellent preclinical in vitro ADME and safety profile.
Subject(s)
Benzimidazoles/pharmacology , NAV1.8 Voltage-Gated Sodium Channel/metabolism , Voltage-Gated Sodium Channel Blockers/pharmacology , Benzimidazoles/chemical synthesis , Benzimidazoles/chemistry , Benzimidazoles/pharmacokinetics , Drug Design , HEK293 Cells , Humans , Molecular Structure , Solubility , Structure-Activity Relationship , Voltage-Gated Sodium Channel Blockers/chemical synthesis , Voltage-Gated Sodium Channel Blockers/chemistry , Voltage-Gated Sodium Channel Blockers/pharmacokineticsABSTRACT
Throw your hat in the ring: A highly diastereoselective synthesis of the ABC rings of (-)-norzoanthamine has been achieved starting from the (-)-Hajos-Parrish ketone (see scheme). Three asymmetric quaternary carbon centers on the C ring were constructed by a 1,4-addition, and an intramolecular Diels-Alder reaction provided a trans-decalin scaffold on the AB rings.
Subject(s)
Azepines/chemical synthesis , Quinolines/chemical synthesis , Alkaloids/chemical synthesis , Alkaloids/chemistry , Azepines/chemistry , Cyclization , Heterocyclic Compounds, 4 or More Rings/chemical synthesis , Heterocyclic Compounds, 4 or More Rings/chemistry , Quinolines/chemistry , StereoisomerismABSTRACT
No bones about it: (-)-Norzoanthamine, a promising candidate for an anti-osteoporotic drug, was the target of a total synthesis (see scheme). The final bisaminal formation with AcOH/H(2)O gave the DEFG ring, while the cyclization precursor was prepared by installing the remaining bisaminal unit after oxidative cleavage of the cyclopentanol moiety.
