Monitoring the roles of prothrombin activation fragment 1 and 2 (F1 + 2) in patients with atrial fibrillation receiving rivaroxaban and apixaban.

Factor Xa (FXa) inhibitors are recommended for use in fixed doses without laboratory monitoring. However, prior studies reported the importance of establishing biomarkers representing anticoagulation intensity related to bleeding or thrombotic events. To test the hypothesis that prothrombin activation fragment 1 and 2 (F1 + 2), a non-specific marker of thrombin generation, could be altered during FXa inhibitor treatment in patients with atrial fibrillation. We conducted the study in two different clinical settings. First, the interrelations among biomarkers representing coagulation/fibrinolysis were investigated in 80 patients in an outpatient clinic. Second, these biomarkers were evaluated in 75 patients who underwent radiofrequency catheter ablation. Plasma concentration of FXa inhibitors was evaluated using an anti-FXa chromogenic assay (C-Xa). In the outpatient study, only F1 + 2 exhibited a significant and negative association with C-Xa (rS = - 0.315, p = 0.026), and 37% of the variance could be explained by C-Xa levels. F1 + 2 levels above the reference range (> 229 pmol/L) could be considered as a cut-off to identify poor patient compliance or under-dosing. In the peri-ablation study, increased F1 + 2 levels were associated with decline of C-Xa levels after periprocedural discontinuation of FXa inhibitors, which was greater in the rivaroxaban group than in the apixaban group. F1 + 2 showed modest and inverse association with plasma concentration of rivaroxaban and apixaban in patients with atrial fibrillation. Larger study to test the hypothesis that continued thrombin generation despite anticoagulation is associated with a heightened risk of clinical events is required.

[New Guidelines for Hematuria Diagnosis and Future Perspectives on Urinalysis -Chairmen's Introductory Remarks -].

Although microscopic hematuria examinations to obtain information on erythrocyte morphology tend to be influenced by subjective views, these views can be corrected to some extent according to the procedures stated in the JCCLS GP1-P4, standards guideline for urinary sediment examination 2010. Since the accura- cy of FCM (flow cytometry) technology is high, FCM-based assessment should be further promoted in rou- tine practice. Furthermore, technicians in charge of urine tests should exert efforts to achieve a better understanding of the diagnostic guidelines for hematuria and respond to clinicians' requests. The new diagnostic guidelines for hematuria are an achievement at an international level, although they are several challenges to be addressed, and routine practice in laboratories and the active involvement of clini- cians are expected to significantly contribute to hematuria diagnosis and treatment. [Review].

Electroreductive intramolecular coupling of aromatic imino esters: is four-membered cyclization much more favorable than six-membered cyclization?

[reaction: see text] The electroreduction of an aromatic imino ester prepared from (S)-glutamic acid in the presence of chlorotrimethylsilane and triethylamine afforded a four-membered cyclized product, a mixed ketal of cis-2,4-disubstituted azetidine-3-one, stereospecifically. Calculations for the transition states by the DFT method support the predominant formation of the azetidine. The electroreduction of an aromatic imino ester prepared from (S)-aspartic acid gave almost equal amounts of a diastereomerically pure mixed ketal of cis-2,4-disubstituted azetidine-3-one and a diastereomeric mixture of 2,5-disubstituted pyrollidine-3-one.