Metab. of Trichoderma inflatum NRRL 8044 (previously Trichoderma polysporum). Also Fusarium solani and Tolypocladium sinense
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Hematopoietic stem cell transplantation (HSCT) and immunosuppressive therapy (IST) with antithymocyte globulin (ATG) and cyclosporine (CsA) have been widely accepted as the standard first-line treatments for severe aplastic anemia (SAA). However, most of the patients with SAA had a slim chance to access these strategies in developing countries. Here, we reported 10-year results in a cohort of 232 patients with SAA who received a novel IST of CsA, levamisole, and danazol (CsA&LMS-based regimen). The cumulative incidence of response was 52.1% at 6 months, 66.4% at 12 months, and 77.1% at 24 months. The 10-year overall survival (OS) and failure-free survival was 60.2% and 48.3%, respectively. Positive predictors of OS in multivariate analysis were higher pretreatment ANC, younger age, higher pretreatment absolute reticulocyte count (ARC), and response within 6 months. The probability of CsA&LMS discontinuation was 50.2% at 10 years. With a slow CsA&LMS taper, the actuarial risk for relapse was only 9.5%. The cumulative incidence of MDS/AML was 8.2% at 10 years. The long-term follow-up information demonstrated that the CsA&LMS regimen could be a promising strategy for patients with SAA in developing countries.
Cyclosporine; Danazol; Immunosuppressive strategy; Levamisole; Severe aplastic anemia.
Long-term follow-up of a novel immunosuppressive strategy of cyclosporine alternatively combined with levamisole for severe aplastic anemia
Jiali Huo 1, Xingxin Li 1, Yingqi Shao 1, Xiang Ren 1, Meili Ge 1, Yahong You 1, Jinbo Huang 1, Jing Zhang 1, Min Wang 1, Neng Nie 1, Peng Jin 1, Yizhou Zheng 2
Eight patients were observed with a rare combination of thymoma and pure red cell aplasia of bone marrow (PRCA), of which seven women were between 44 to 68 years old. The diagnosis of PRCA was established before the detection of thymoma in 1 patient, simultaneously in 3, after – in 4. Seven patients underwent timomectomy. The weight of removed thymomas was from 200 to 780 grams. Morphological type A thymoma variant (spindle cell) was installed in 2 patients, type B1 – in 2, type B2 – in 2, type B3 – in 2. Complete remissions were obtained using cyclophosphamide and cyclosporin in 5 patients, lasting from 6 months to 7 years. The results of immunological studies with the identification of non – hemolytic antibodies to the proteolytic antigen (Pr1d) on the erythrocyte membrane in 4 patients are presented. Of these, two studied patients simultaneously detected antibodies to the Pr1d antigen and the interspecific antigen of mammalian erythroblasts (IAME). It is shown that the lifespan of red blood cells are not changed. The direct Coombs test was negative in 5 patients, but with the help of aggregate hemaglutination test and enzyme immunoassay, antibodies were detected on the surface of erythrocytes. The pathogenesis of this combination of diseases remains unclear and needs to be elucidated.
anemia; partial red cell aplasia of the bone marrow; reticulocytopenia; thymoma.
[Pure red cell aplasia of the bone marrow in combination with thymoma. A literature review and own data]
A A Petrenko 1, A V Pivnik 1 2, G A Dudina 1, M G Dubnitskaya 1
2019 Jul 15
Cyclosporine A: a valid candidate to treat COVID-19 patients with acute respiratory failure?
Martin Cour 1 2, Michel Ovize 2 3, Laurent Argaud 4 5
2020 Jun 2;