Age, creatinine and ejection fraction (ACEF) score: a simple risk-stratified method for infective endocarditis.

BACKGROUND: Older age, renal dysfunction and low left ventricular ejection fraction are accepted predictors of poor outcome in patients with infective endocarditis (IE). This study aimed to investigate the prognostic significance of the age, creatinine and ejection fraction (ACEF) score in IE. METHODS: The study involved 1019 IE patients, who were classified into three groups according to the tertiles of ACEF score: low ACEF (<0.6, n = 379), medium ACEF (0.6-0.8, n = 259) and high ACEF (>0.8, n = 381). The ACEF score was calculated as follows: age (years)/ejection fraction (%)+1 (if serum creatinine value was >2 mg/dL). The relationship between ACEF score and adverse events was analyzed. RESULTS: In-hospital mortality was 8.2%, which increased with the increase of ACEF score (4.2% vs. 5.0% vs. 14.4% for the low-, medium- and high-ACEF groups, respectively; P < 0.001). ACEF score had a good discriminative ability for predicting in-hospital death [areas under the curve (AUC), 0.706, P < 0.001]. The predictive value of ACEF score in surgical treatment was significantly higher than in conservative treatment for predicting in-hospital death (AUC, 0.812 vs. 0.625; P = 0.001). Multivariable analysis revealed that ACEF score was independently associated with in-hospital mortality (adjusted odds ratio, 2.82; P < 0.001) and long-term mortality (adjusted hazard ratio, 2.51; P < 0.001). CONCLUSION: ACEF was an independent predictor for in-hospital and long-term mortality in IE patients, and it could be considered as a useful tool for risk stratification. ACEF score was more suitable for surgical patients in terms of assessing the risk of in-hospital mortality.

Prediabetes and diabetes are both risk factors for adverse outcomes in infective endocarditis.

AIM: Diabetes is a risk factor in infective endocarditis. However, few studies have focused on the prognostic value of prediabetes in infective endocarditis. This analysis aimed to explore the relationship between prediabetes and outcomes for people with infective endocarditis. METHODS: Diabetes and prediabetes definitions were based on the American Diabetes Association 2014 criteria. A total of 866 people who had been consecutively diagnosed with infective endocarditis between January 2009 and July 2015 were included in the analysis. They were divided into three groups: normoglycaemia (n = 469), prediabetes (n = 246) and diabetes (n = 151). Univariate and multivariate analyses were used to identify risk factors for adverse outcomes. RESULTS: Overall in-hospital mortality was 8.5% (74 of 866), and differed significantly among the normoglycaemia, prediabetes and diabetes groups (3.4%, 12.6% and 17.9%, respectively; P < 0.001). Compared with the normoglycaemia group, the adjusted odds ratio for in-hospital death was 2.42 [95% confidence interval (CI) 1.11-5.31; P = 0.027) for prediabetes and 3.39 (95% CI 1.48-7.80; P = 0.004) for diabetes. The cumulative long-term death rate was significantly higher in the prediabetes or diabetes groups than in the normoglycaemia group (log-rank = 34.82; P < 0.001). CONCLUSION: In addition to diabetes, prediabetes was also associated with a higher risk of in-hospital and long-term mortality among people with infective endocarditis. Therefore, attention should be paid to this population.

Total synthesis of natural product (R)-4-phenyl-2-O-[beta-D-xylopyranosyl(1-->6)-beta-D-glucopyranosyl]butane and its epimer.

The new compound (R)-4-phenyl-2-O-[beta-d-xylopyranosyl(1 --> 6)-beta-D-glucopyranosyl]butane (1) and its epimer (2), together with (R)-4-phenyl-2-O-beta-D-glucopyranosyl butane (24) and (S)-4-phenyl-2-O-beta-D-glucopyranosyl butane (25) were firstly synthesized from 4-phenylbutan-2-one and glucose. The absolute configuration of C-2 for 1 was confirmed as R. Their anti-tumour activities were evaluated.

Synthesis of three natural diosgenyl glycosides.

Three well-known natural diosgenyl glycosides which have the same sugar chains but different sequence, ophipogonin C', polyphillin C and prosapogenin B, were synthesised by a facile approach. A method using the levulinyl group as a protecting group to selectively mask the C3-OH of diosgenyl 4,6-O-benzylidene-beta-D-glucopyranoside is described.

1H-NMR signal assignments and secondary structure analysis of martentoxin.

Martentoxin is a peptide of 37 amino acid residues purified from the venom of the Chinese scorpion Buthus martensi Karch, which has been demonstrated to be an inhibitor of voltage-dependent sodium channel and voltage-dependent delayed rectifier potassium channel. To elucidate the molecular mechanism of this interaction, the structure of martentoxin was studied by 2D-NMR. The secondary structure of martentoxin consists of a triple-stranded beta-sheet connected to a alpha-helical structure. This helix encompasses 10 residues from Ser11 to Lys20. The three strands of beta-sheet probably comprise residues Gly2-Asp5, Q27-N30 and Glu33-Cys36, Cys30-Asn33 with a type I'beta turn centered on Asn31-Asn32. The results indicate that martentoxin possesses the conserved beta alpha beta beta structure of all the potassium channel toxins.

Total synthesis and biological evaluation of (+)- and (-)-Butyl ester of rosmarinic acid.

An efficient method for the synthesis of the natural product (+)-(R)-butyl ester of rosmarinic acid (+)-(R)-1 and its enantiomer ( - )-(S)-1 has been developed by chemical resolution of its phenyl lactic acid precursors 4 with ( - )-menthol. Their antioxidative and anti-tumor activities were evaluated.

Purification and characterization of a new peptide with analgesic effect from the scorpion Buthus martensi Karch.

Anew peptide, designated as Buthus martensi Karch (BmK) AngM1, with an isoelectric point (pI) of 5.8 was purified and characterized from the venom of Buthus martensi Karch. The molecular mass was calculated as 7040.5 Da from multiple-charged ions by elelctrospray ionization mass spectroscopy (ESI/MS). The complete amino acid sequence of BmK AngM1 of 64 amino acid residues was determined by automatic sequencing of N-terminal part of the native peptide and the fragments of reduced and S-carboxymethylated (RCM)-peptide degraded by Staphylococcus aureaus V(8) protease and TPCK(N-p-Tosyl-L-phenylalanine chloromethyl ketone)-treated trypsin. Bioactivity tested using mouse-twisting model showed an evident analgesic effect with 63.0% (P < 0.001) inhibition efficiency at the dose of 0.8 mg/kg, but the LD(50) was larger than 50 mg/kg. Electrophysiological studies showed that BmK AngM1 at the concentration of 1 microm obviously inhibit voltage-dependent Na(+) current (I(Na)) and voltage-dependent delayed rectifier K(+) current (I(K)) but had no effects on transient K(+) current.

A new bislabdane-type diterpenoid from the roots of cunninghamia lanceolata

Lanceolatic acid (1), a new bislabdane-type diterpenoid, has been isolated from the roots of Cunninghamia lanceolata. Its structure was elucidated on the basis of spectroscopic data interpretation and confirmed by single-crystal X-ray diffraction analysis.

Alkaloids from the roots of goniothalamus griffithii

Three new alkaloids-griffithazanone A (1), griffithdione (2), and griffithinam (3)-were isolated from the roots of Goniothalamus griffithii, along with six known compounds, 4-methyl-2,9, 10-(2H)-1-azaanthracenetrione (4), velutinam, aristololactam BI, aristololactam BII, aristololactam AII, and norcepharanone B. Their structures were elucidated on the basis of spectral and chemical methods. The absolute configuration of griffithazanone A (1) was determined by the preparation of Mosher's esters.

Donnaienin, a New Acetogenin Bearing a Hydroxylated Tetrahydrofuran Ring

A novel Annonaceous acetogenin, donnaienin (1), was isolated from the roots of Goniothalamus donnaiensis. Its structure and stereochemistry were elucidated on the basis of spectral data and chemical evidence. This compound represents an unusual type of Annonaceous acetogenin, bearing a hydroxylated tetrahydrofuran ring.

New Quinoid Glycosides from Forsythia suspensa

Three novel compounds, suspenolic acid (1), forsythenside A (2), and forsythenside B (3), have been isolated from the fruits of Forsythia suspensa. Their structures were elucidated by spectral methods and chemical reactions.