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排序方式: 共有165条查询结果,搜索用时 15 毫秒
121.
John L. Struthers 《BMJ (Clinical research ed.)》1972,2(5804):51-52
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N. D. Gillespie G. McNeill T. Pringle S. Ogston A. D. Struthers S. D. Pringle 《BMJ (Clinical research ed.)》1997,314(7085):936-940
OBJECTIVE: To assess the comparative contribution of clinical assessment, electrocardiography, and chest radiography to the diagnosis of left ventricular systolic dysfunction in patients admitted to a general medical ward with acute dyspnoea. DESIGN: Prospective cross sectional study. SETTING: Acute medical admissions ward of a teaching hospital. SUBJECTS: 71 randomly selected patients admitted with acute dyspnoea. MAIN OUTCOME MEASURES: Sensitivity and specificity of each investigation and logistic regression analysis of each variable in identifying left ventricular systolic dysfunction. RESULTS: Clinical assessment in this cohort of patients with severe dyspnoea was generally sensitive (sensitivity 81%). Patients were divided into three groups on the basis of clinical assessment. In the first group (37 patients) the diagnosis of systolic dysfunction was clear, in the second (22) it was in doubt, and in the third (12) it was unlikely. The sensitivity of clinical assessment in identifying left ventricular systolic dysfunction was 81% and the specificity was 47%. The specificity of diagnosis was improved by electrocardiography (69%) and chest radiography (92%). Logistic regression analysis showed that isolated pulmonary crepitations were a comparatively poor predictor of left ventricular systolic dysfunction chi 2 = 10.215, P = 0.0014) but that a full clinical examination had reasonable predictive value (chi 2 = 24.82, P < 0.00001). The combination of clinical assessment and chest radiography improved the accuracy of diagnosis (chi 2 = 28.08, P < 0.00001), as did the combination of clinical assessment and electrocardiography (chi 2 = 32.41, P < 0.00001). CONCLUSION: Clinical assessment in patients admitted with acute dyspnoea is comparatively accurate. Patients with abnormal results on chest radiography, electrocardiography, and clinical examination have a high likelihood of having left ventricular systolic dysfunction. Echocardiography contributes little more to the diagnosis in these patients and may be more efficiently directed towards patients in whom the diagnosis is still in doubt after clinical assessment, chest radiography, and electrocardiography. 相似文献
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Morriello GJ Wendt HR Bansal A Di Salvo J Feighner S He J Hurley AL Hreniuk DL Salituro GM Reddy MV Galloway SM McGettigan KK Laws G McKnight C Doss GA Tsou NN Black RM Morris J Ball RG Sanfiz AT Streckfuss E Struthers M Edmondson SD 《Bioorganic & medicinal chemistry letters》2011,21(6):1865-1870
A novel class of human β3-adrenergic receptor agonists was designed in effort to improve selectivity and metabolic stability versus previous disclosed β3-AR agonists. As observed, many of the β3-AR agonists seem to need the acyclic ethanolamine core for agonist activity. We have synthesized derivatives that constrained this moiety by introduction of a pyrrolidine. This unique modification maintains human β3 functional potency with improved selectivity versus ancillary targets and also eliminates the possibility of the same oxidative metabolites formed from cleavage of the N-C bond of the ethanolamine. Compound 39 exhibited excellent functional β3 agonist potency across species with good pharmacokinetic properties in rat, dog, and rhesus monkeys. Early de-risking of this novel pyrrolidine core (44) via full AMES study supports further research into various new β3-AR agonists containing the pyrrolidine moiety. 相似文献
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Tucci FC Zhu YF Guo Z Gross TD Connors PJ Struthers RS Reinhart GJ Wang X Saunders J Chen C 《Bioorganic & medicinal chemistry letters》2002,12(23):3491-3495
A new class of small molecule GnRH antagonists, the 7-aryl-8-fluoro-pyrrolo[1,2-a]pyrimid-4-ones, was designed and a novel synthesis for these compounds was developed. The synthesis utilizes a base-catalyzed intramolecular cyclization of fluoromethyl pyrimidone 5 to generate the bicyclic core. Amongst the compounds synthesized, we discovered some highly potent GnRH receptor antagonists (e.g., 12, K(i)=9 nM), which showed enhanced stability towards acidic physiological conditions compared to the des-fluoro analogues. 相似文献
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Inès J Goossens-Beumer Jan Oosting Wim E Corver Marjolein JFW Janssen Bart Janssen Wilbert van Workum Eliane CM Zeestraten Cornelis JH van de Velde Hans Morreau Peter JK Kuppen Tom van Wezel 《BMC genomics》2015,16(1)