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A Novel Approach for Determining the Orientation of 3-Hydroxyl Group of Some steroids by CIMS

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Chinese Chemical Letters 1999年第2期10卷 143-144页

作者： Yuan Jiang PAN Yao Zu CHEN(Department of Chemistry, Zhejiang University, Hangzhou 310027) Department of Chemistry Zhejiang University Hangzhou 310027 China

Trimethylchlorosilane was used as a stereoselective reagent to determine the e or a orientation of 3-hydroxyl group of some steroids by chemical ionization mass spectrometry.

关键词： orientation of 3-hydroxyl group steroids mass spectrometric determination

Corticosteroid-induced bradycardia in multiple sclerosis and maturity-onset diabetes of the young due to hepatocyte nuclear factor 4-alpha mutation:A case report

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World Journal of Clinical Cases 2022年第21期10卷 7415-7421页

作者： Sung-Yeon Sohn Shin Yeop Kim In Soo Joo Department of Neurology Ajou University School of MedicineAjou University Medical CenterSuwon 16499South Korea

BACKGROUND Intravenous steroid pulse therapy is the treatment of choice for acute exacerbation of multiple sclerosis(MS).Although steroid administration is generally welltolerated,cases of cardiac arrhythmia have been reported.Herein,we describe a young woman who developed marked sinus bradycardia and T-wave abnormalities after corticosteroid administration.We also present plausible explanations for the abnormalities observed in this patient.CASE SUMMARY An 18-year-old woman experienced vertiginous dizziness and binocular diplopia 1 wk prior to admission.Neurological examination revealed left internuclear ophthalmoplegia with left peripheral-type facial palsy.The initial laboratory results were consistent with those of type 2 diabetes.Brain magnetic resonance imaging revealed multifocal,non-enhancing,symptomatic lesions and multiple enhancing lesions.She was diagnosed with MS and maturity-onset diabetes of the young.Intravenous methylprednisolone was administered.On day 5 after methylprednisolone infusion,marked bradycardia with T-wave abnormalities were observed.Genetic evaluation to elucidate the underlying conditions revealed a hepatocyte nuclear factor 4-alpha(HNF4A)gene mutation.Steroid treatment was discontinued under suspicion of corticosteroid-induced bradycardia.Her electrocardiogram changes returned to normal without complications two days after steroid discontinuation.CONCLUSION Corticosteroid-induced bradycardia may have a significant clinical impact,especially in patients with comorbidities,such as HNF4A mutations.

关键词： steroids Bradycardia Multiple sclerosis Maturity-onset diabetes of the young Hepatocyte nuclear factor 4-alpha Case report

Synthesis of Clionastatins A and B through Enhancement of Chlorination and Oxidation Levels of Testosterone

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Chinese Journal of Chemistry 2022年第23期40卷 2747-2755页

作者： Hao Cui Yang Shen Ruifeng Wang Haoxiang Wei Xin Lei Yanyu Chen Pengfei Fu Haoxiang Wang Ruihao Bi Yandong Zhang Department of Chemistry and Key Laboratory of Chemical Biology of Fujian Province iChEMCollege of Chemistry and Chemical EngineeringXiamen UniversityXiamenFujian 361005China

A full account of semisyntheses of polychlorinated marine steroids clionastatins A and B is described.We have developed a unique two-stage chlorination-oxidation strategy that enabled concise and divergent semisyntheses of clionastatins A and B in 16 steps from inexpensive testosterone.Key transformations in chlorination stage include(a)conformationally controlled,stereospecific dichlorination through an unusualβ-chloronium intermediate to install the diequatorial C1,C2-dichloride;(b)C4-OH directed C19–H oxygenation followed by challenging neopentyl chlorination to install the C19–Cl.The high oxidation level was constructed through(a)the desaturation at C6–C7 through one-pot photochemical dibromination–reductive debromination;(b)regioselective anti-Markovnikov oxidation of the C6–C7 double bond by photoredox-metal dual catalysis to forge the B ring enone;(c)late-stage desaturation with SeO_(2)to introduce C8–C9 double bond.Wharton transposition was used to forge the D-ring enone,and thermodynamically driven epimerization secured the cis-fused C/D ring system.Furthermore,we also provided a 14-step approach to clionastatin A by optimizing the construction of the D-ring enone with a dehydration-oxidation sequence.

关键词： steroids Semisynthesis Chlorination Oxidation Photochemistry

Anabolic androgenic steroid-induced liver injury:An update

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World Journal of Gastroenterology 2022年第26期28卷 3071-3080页

作者： Ana Petrovic Sonja Vukadin Renata Sikora Kristina Bojanic Robert Smolic Davor Plavec George Y Wu Martina Smolic Department of Pharmacology and Biochemistry Faculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Pharmacology Faculty of Medicine OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Dental Medicine Faculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Dental Medicine Health Center Osijek-Baranja CountyOsijek 31000Croatia Department of Otorhinolaryngology Neurosurgery and RadiologyFaculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Biophysics and Radiology Faculty of Medicine OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia Department of Radiology Health Center Osijek-Baranja CountyOsijek 31000Croatia Research Department Srebrnjak Children's HospitalZagreb 10000Croatia Department of Medicine Division of Gastrenterology/HepatologyUniversity of Connecticut Health CenterFarmingtonCT 06030United States

Anabolic androgenic steroids(AASs)are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects.These properties make them therapeutically beneficial in medical conditions such as hypogonadism.However,they are commonly bought illegally and misused for their anabolic,skeletal muscle building,and performanceenhancing effects.Supraphysiologic and long-term use of AASs affects all organs,leading to cardiovascular,neurological,endocrine,gastrointestinal,renal,and hematologic disorders.Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse.Testosterone and its derivatives have been most often shown to induce a specific form of cholestasis,peliosis hepatis,and hepatic benign and malignant tumors.It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors,upregulation of bile acid synthesis,and induction of hepatocyte hyperplasia.Most toxicity cases are treated with supportive measures and liver function normalizes with discontinuation of AAS.However,some long-term consequences are irreversible.AAS-induced liver injury should be taken in consideration in patients with liver disorders,especially with the increasing unintentional ingestion of supplements containing AAS.In this paper,we review the most current knowledge about AAS-associated adverse effects on the liver,and their clinical presentations,prevalence,and pathophysiological mechanisms.

关键词： Androgens steroids Cholestasis Fibrosis Liver Chemical and drug induced liver injury

Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation

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世界心脏病学杂志:英文版(电子版) 2023年第9期15卷 427-438页

作者： Chukwuemeka A Umeh Heather Maoz Jessica Obi Ruchi Dakoria Smit Patel Gargi Maity Pranav Barve Internal Medicine Hemet Global Medical CenterHemetCA 92543United States

BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)patients.Antiviral medications and steroids are used to treat viral myocarditis,but their effect in patients with elevated troponin,possibly from myocarditis,has not been studied.AIM To evaluate the effect of dexamethasone,remdesivir,and angiotensin-converting enzyme(ACE)inhibitors(ACEI)on mortality in COVID-19 patients with elevated troponin.METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California,United States.We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population.Additionally,we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin,comparing survival in patients that received dexamethasone,remdesivir,and ACEI with those that did not.RESULTS The mean age was 66 years(range 20-110),troponin elevation was noted in 11.5%of the patients,and 29.9%expired.The patients'age[hazard ratio(HR)=1.02,Psteroids,and ACEI did not show any effect on mortality in these patients.

关键词： Coronavirus disease 2019 Troponin elevation Remdesevir Ace inhibitor steroids

Postpartum hemophagocytic lymphohistiocytosis:A case report

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世界临床病例杂志 2023年第26期11卷 6183-6188页

作者： Ju Ho An Jung Hwan Ahn Department of Emergency Medicine Ajou University School of MedicineSuwon 16499Gyeonggi-doSouth Korea

BACKGROUND Postpartum hemophagocytic lymphohistiocytosis(HLH)is a rare disease with unclear pathophysiology.It is a secondary HLH diagnosed using the pediatric diagnostic criteria;however,the clinical diagnosis of postpartum HLH remains challenging.Hence,HLH may remain undiagnosed,leading to poor patient prognosis.Therefore,improvements in the accuracy of postpartum HLH diagnoses and treatments are necessary.CASE SUMMARY We report the case of a 40-year-old female with postpartum HLH.The patient attended the postpartum care center for 3 wk after giving birth and underwent needle aspiration due to thyroid gland enlargement 11 d before an emergency department visit precipitated by fever and abdominal pain.Since no abnormal emergency room findings were noted,the patient was discharged with a prescription for broad-spectrum antibiotics.Three days later,she returned to the emergency room in a hemodynamically unstable state and was admitted to the intensive care unit with suspected sepsis or hematologic disease.The patient was treated,without effect,for sepsis using broad-spectrum antibiotics,and for suspected hematologic disease with steroid therapy.However,she died due to rapidly worsening symptoms.CONCLUSION Rapid recognition and appropriate treatment of postpartum HLH are needed to improve the prognosis.

关键词： Bone marrow Pregnancy Lymphohistiocytosis Infection steroids Case report

Emerging concepts in the care of patients with cirrhosis and septic shock

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World Journal of Hepatology 2023年第4期15卷 497-514页

作者： Jose Victor Jimenez Guadalupe Garcia-Tsao Saad Saffo Section of Digestive Diseases Yale School of MedicineNew HavenCT 06520United States

Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review,we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.

关键词： Cirrhosis Septic shock Intravenous fluids Vasopressors Antibiotics steroids

Extraction,Purification,and Anti-Inflammatory Activity of Steroid Fraction from Physalis Alkekengi L.Var.Franchetii(Mast.)Makino

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World Journal of Traditional Chinese Medicine 2023年第2期9卷 167-177页

作者： Tian-Yi Xia Yi Wang Yan-Ni Yang Wu-Jing Wang Zi-He Ding Ren-Xing Zhong Ying Chen Wei Li Ming-Ming Peng Chuan-Qiu Li Li-Feng Shang Bing Liu Zhen-Yue Wang Chong-Rong Shi Zun-Peng Shu Guangdong Standardized Processing Engineering Technology Research Center of Traditional Chinese Medicine Guangdong Pharmaceutical UniversityGuangzhouP.R.China Department of Traditional Chinese Medicine Guangdong Pharmaceutical UniversityGuangzhouPR.China Guangdong Andao Medical Equipment Co.Ltd GuangzhouPR.China Department of Pharmacy Heilongjiang University of Chinese MedicineHeilongjiangPR.China Macao Association of Chinese Medicine(AIPPMCM) Macao SARPR.China

Objective: As a traditional medicinal plant listed in the Chinese Pharmacopeia, Physalis alkekengi L. var. franchetii(Mast.) Makino(PAF) has a long medicinal history and high economic value. PAF has immunomodulatory properties and can be used to treat acute lung injury and eczema.The aim of this study is to solve the problems of extraction and purification of active components from PAF. Materials and Methods: The solvent to be used for extraction and its concentration, the solid-to-liquid ratio, and extraction duration were investigated using a single-factor experiment.An orthogonal design(L_(9)[3^(4)]) was used to determine the optimum extraction conditions. After optimization, the sample’s concentrations and flow velocity, the eluents and their velocity, adsorption time, and the removed water volume were measured. The content of the five steroids in the sample was determined by high-performance liquid chromatography(HPLC). We also investigated the anti-inflammatory property of PAF calyxes before and after purification. Results: The optimum extraction and purification processes were determined by single-factor analysis.AB-8 was identified as the best macroporous adsorption resin for enrichment. After optimization, the average total steroid content was 71.83%,and the average recovery was 90% after purification. Among the five steroid components detected by HPLC, physalin F showed the highest content. Furthermore, the sample obtained after purification could significantly inhibit paw edema by egg whites induced. Conclusions: An environmentally-sustainable, efficient, and stable process was first optimized for enriching and purifying total steroids from PAF. The process has the potential for further development and utilization in the pharmaceutical industry.

关键词： Anti-inflammatory activity extraction and optimization process physalins Physalis alkekengi L.var.francheti(Mast.)Makino steroids

steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

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Open Journal of Stomatology 2017年第9期7卷 397-407页

作者： Li Fong Low Harshinie Audimulam Hui Woon Lim Kalpana Selvaraju Sathesh Balasundram Department of Oral and Maxillofacial Surgery Hospital Sultanah Nora Ismail Batu Pahat Johor Malaysia

Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

关键词： Maxillofacial Space Infections Abscess Odontogenic Infections Systemic steroids Adjunctive Management