[Transperineal targeted prostate puncture combined with rapid pathological examination in the diagnosis of prostate cancer].

Exploring the clinical value of multiparametric magnetic resonance (Mp-MRI)-cognitive fusion method of targeted transperineal prostate puncture combined with rapid pathological diagnosis. Patients with suspected prostate cancer admitted to our hospital from 2022.01 to 2023.05 were selected as the study subjects, and Mp-MRI was performed and the suspected lesions were scored by the Prostate Imaging Reporting and Data System (PI-RADS). The enrolled patients were randomly divided into the transperineal prostate targeted puncture plus rapid pathology group (experimental group) and the transperineal prostate systematic combined targeted puncture plus conventional pathology group (control group), and the positive puncture rate, pathological findings, and complications were analyzed to compare the differences between the two groups. A total of 100 patients were enrolled, 53 in the experimental group [age 55-89 years, (73.17±7.79) years; tPSA 7.01-100 µg/L, mean 21.34 (12.38, 44.42) µg/L]and 47 in the control group [age 60-87 years, (71.96±7.07) years; tPSA 6.11-98.82 µg/L, mean 18.77 (9.04, 38.09) µg/L], and there was no significant difference between the two groups in the diagnostic positivity rate of overall PCa and clinically significant PCa (P>0.05); there was no significant difference in the highest Gleason score of pathological tissues between the two groups (P>0.05); the number of cases of medically induced sarcoid hematuria in the experimental group were significantly reduced compared with the control group (P<0.05). In terms of biopsy pain score (VAS), patients in the experimental group experienced less pain than those in the control group (P<0.05). The Mp-MRI-cognitive fusion method of transperineal targeted prostate puncture combined with rapid frozen section pathological examination can provide rapid and accurate pathological results, reduce the chance of post-puncture complications, and alleviate the pain caused by puncture sampling, which has high clinical value.

[Efficacy and safety of Montgomery T-tube placement for benign complex subglottic tracheal stenosis: a retrospective analysis of 29 cases].

Objective: To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. Methods: A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.1%), including 21 cases (72.4%) of tracheal stenosis after tracheotomy, 6 cases (20.7%) of tracheal stenosis after tracheal intubation], cervical post-traumatic tracheal stenosis (1 case, 3.4%) and tuberculous tracheal stenosis (1 case, 3.4%), respectively. Three-dimensional reconstruction of tracheal computerized tomography (CT) and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention. The degree of stenosis was Cotton-Myer grade Ⅱ (7 cases, 24.1%), grade Ⅲ (11 cases, 37.9%) and grade Ⅳ (11 cases, 37.9%), respectively. All cases received placement of T-tubes and follow-up. Fisher's exact test was used for comparison between groups. Results: T-tube placement was performed 39 times in 29 patients. T-tubes were successfully placed for 24 cases (82.8%). The main complication during the operation was tracheal mucosal tear (6 cases, 20.7%), which resolved in all cases within 2 weeks. The main postoperative complication was secretion retention (27 cases, 93.1%), which was relieved after home nebulization treatment in 26 cases; and followed by granulation hyperplasia, especially located in T-tube upper margin (12 cases, 41.4%), of which 8 cases were cured after bronchoscopic intervention. None of the patients had T-tube migration. There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis. After 18 months to 24 months of follow-up, attempt was made to remove the T-tube in 9 patients but failed in 4 patients. The failure was due to collapse of the airway after the T-tube was removed. Conclusion: T-tube placement is a safe and reliable treatment for benign complex subglottic tracheal stenosis with high efficiency and manageable complications.

[Efficacy and influencing factors of interventional bronchoscopy for the treatment of scarring airway stenosis: a multicenter retrospective investigation from China].

Objectives: To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate. Methods: Between January 2013 to December 2016, 301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively. The methods of interventional bronchoscopy included electric knife cutting, laser cauterization, balloon dilation, cryotherapy, local drug usage and/or stenting. Airway stenosis characteristics and patients' performance status at baseline and after interventional bronchoscopy were recorded. The interval days between the first two interventional bronchoscopy treatment (maintained patency time) and the final treatment efficacy were recorded. Results: The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8% (204/301) . Stenosis sites (OR 1.548; 95% CI: 1.038-2.307, P=0.032) , dyspnea index (OR 2.140; 95% CI: 1.604-2.855, P<0.001) , and interventional method (OR 0.458; 95% CI: 0.267-0.787, P=0.005) were independent predictors associated with the efficacy of interventional bronchoscopy treatment. Stenosis sites (OR 1.508; 95% CI: 1.273-1.787, P<0.001) , stenosis grade (OR 1.581; 95% CI: 1.029-2.067, P=0.001) , anesthesia method (OR 1.581; 95% CI: 1.029-2.067, P<0.001) , and local drug usage (OR 1.304; 95% CI: 1.135-1.497, P<0.001) were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment. Conclusion: Interventional bronchoscopy is a useful treatment method for scarring airway stenosis. Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.

[A preliminary study of different methods of anesthesia for painless bronchoscopy].

Objective: This study aimed to explore a feasible method of anesthesia for painless bronchoscopy. Methods: A total of 120 patients receiving flexible bronchoscopy in Beijing Tiantan Hospital during the period from February, 8, 2018 to May, 4, 2018, were randomly divided into 3 groups, including group A (using lidocaine for local anesthesia), group B (using lidocaine + midazolam + fentanyl), and group C (using lidocaine + propofol + sufentanil). There were 41 patients in group A, 38 in group B and 41 in group C. The changes in systolic blood pressure, diastolic blood pressure, heart rate and pulse oxygen saturation(SpO(2)) in each group were recorded in different points of time. The safety of different methods of anesthesia was observed by recording vital signs and adverse events. Moreover, the visual analogue scale (VAS) was used to observe the patient's tolerance and satisfaction of the operation. Results: The intraoperative systolic blood pressure and diastolic blood pressure in group C were significantly lower than those in group A and B (P<0.05). Six cases in group C had hypotension, 3 of whom required vasoactive drugs. The differences of SpO(2) between the 3 groups showed no statistical significance (P>0.05), while patients in group C were prone to decrease in SpO(2). Eighteen patients in group C had hypoxemia during operation. But after treated with improving ventilation, the SpO(2) of those patients could be restored to normal. Compared with those in group C, patients in group A and group B showed significant discomfort, cough, and more pharyngeal pain (P<0.05). However, there were no significant differences in the degree of cough and pain between group A and group B (P>0.05). Most patients in group C had no uncomfortable sensation during the operation (P<0.05), and the willingness to re-examination was significantly higher than that in group A and group B (P<0.05). Conclusion: Propofol combined with sufentanil could achieve better painless effect, improve patient comfort and tolerance, and reduce intraoperative memory, but was prone to causing hypoxemia and hypotension. The decline of intraoperative SpO(2) could be corrected by establishing artificial airway, while the decrease of blood pressure could be corrected by applying vasoactive drugs, which were relatively safe.

[Advantages and disadvantages of preoperative artificial pneumothorax for medical thoracoscopy].

Objective: To expolre the indications, safety, advantages and disadvantages of performing artificial pneumothorax prior to medical thoracoscopy. Methods: Data of 152 patients undergoing medical thoracoscopy for pleural diseases in the Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2007 to September 2014 were studied through retrospective analysis. According to the performance of artificial pneumothorax prior to medical thoracoscopy, the pleural space adhesions and the pleural effusions, patients were grouped into artificial pneumothorax group (107 cases) and non-artificial pneumothorax group (45 cases), adhesion group (102 cases) and non-adhesion group (50 cases), and few or no pleural effusion group (94 cases) and massive pleural effusion group (58 cases), respectively. The incidence of complications such as subcutaneous emphysema, pleural reaction, infection, aeroembolism and pulmonary injury/hemorrhage in different groups were compared, and the vital signs of patients were observed. Results were compared using the Chi square test. Results: After thoracoscopic examination, the definite diagnosis rates of artificial pneumothorax group and non- artificial pneumothorax group were 83.2% (89/107) and 93.3% (42/45) respectively, which showed no significant difference (χ(2)=2.744, P=0.098). Three cases of subcutaneous emphysema occurred in the artificial pneumothorax group, while all these 3 cases belonged to adhesion group, and one of them belonged to few or no pleural effusion group, and 2 of them belonged to massive pleural effusion group. No subcutaneous emphysema cases were observed in the non-adhesion group. In the non-artificial pneumothorax group, one case of lung trauma caused by trocar was observed, which belonged to adhesion group and few or no pleural effusion group; no lung puncture wound cases were observed in massive pleural effusion group and non-adhesion group. Other complications related to artificial pneumothorax and thoracoscopy, such as pleural reaction, infection, air embolism and pulmonary injury/hemorrhage, were not observed. No significant changes were found between the vital signs of patients before and after artificial pneumothorax. Conclusion: For pleural effusion or pleural disease patients with pleural space adhesion, the performance of artificial pneumothorax prior to operation was recommended. Artificial pneumothorax was not recommended for patients without pleural space adhesions.

Isolation and identification of phase I metabolites of butyrolactone I in rats.

1. Butyrolactone I (BL-I), one of the major secondary metabolites of fungus Aspergillus terreus, is a selective cdc2 kinase inhibitor. In the present study, the metabolism of BL-I in male Wistar rats was investigated by characterizing metabolites excreted into feces. 2. Following an oral dose of 40 mg/kg BL-I, 10 phase I metabolites were isolated from the feces of rats, and their structures were identified on the basis of a range of spectroscopic data and ICD analysis. These metabolites were fully characterized as butyrolactone VI (M1), aspernolide E (M2), 7''S-hydroxy-9''-ene-butyrolactone I (M3), 7''R-hydroxy-9''-ene-butyrolactone I (M4), 7″S, 8″R-dihydroxy-aspernolide E (M5), 7″R, 8″S-dihydroxy-aspernolide E (M6), 7″R-acetyl-8″S-hydroxy-aspernolide E (M7), 7″S-acetyl-8″R-hydroxy-aspernolide E (M8), 7″R-methoxy-8″S-hydroxy-aspernolide E (M9), butyrolactone V (M10), respectively. It is the first time to describe the metabolites of BL-I in vivo, and metabolites M3 to M9 are new compounds. 3. BL-I and metabolites M2 to M10 were evaluated for their antimicrobial activity and in vitro antiproliferative activities. Only M-3 and M-4 showed inhibitory effect against staphylococcus aureus both with MIC of 125 µg/ml. BL-I and metabolites M-4 and M-5 exhibited potent cancer cell growth inhibitory activities against HL-60 (human leukemia) cell lines with the IC50 values of 13.2, 28.8 and 35.7 µM, respectively. 4. On the basis of metabolites profile, a possible metabolism pathway for BL-I in rats has been proposed. This is the first systematic study on the phase I metabolites of BL-I.

[Experimental study scavenging effect of paraquat by hemoperfusion].

Objective: To determine the scavenging effect and the change of metabolism of paraquat (PQ) using hemoperfusion (HP) once and twice within 12 hours after intoxication and explore the better scheme of HP. Methods: 18 beagles were randomly divided into 3 groups. Single HP group, Double HP group and Control group. Peripheral veins blood was collected at different times within 48 hours after exposure in each group. Toxin concentration was measured, analyzed and compared among 3 groups. Results: 6 hours after exposure, Single HP group and Double HP group has finished the first HP treatment, and the concentration of PQ was lower than that of the control group, the difference was statistically significant (P<0.05) . 10 hours after exposure, there was no statistical difference of toxin concentration among 3 groups (P>0.05) . 12 hours after exposure, Double HP group has finished the second HP treatment, the concentration of PQ was significantly lower than that of Single HP group and Control group (P<0.05) . 24 hours and 48 hours after exposure, there was no statistical difference of toxin concentration among 3 groups (P>0.05) . Statistical difference were not observed in toxicokinetical parameters among 3 groups (P>0.05) . Conclusion: HP treatment once and twice within 12 hours after intoxication could effectively reduce the toxin concentration in the peripheral veins blood after HP for about 4 hours, then the toxin concentration would return to the same level as Control group quickly. It was suggested that at the beginning of poisoning, HP treatment once or twice could not significantly change the metabolism of paraquat.

[Effect of self-expanding bare metal stents of different diameters on the trachea of dogs].

Objective: To study the effect of self-expanding bare metal stents on the trachea of dogs, and therefore to provide useful information for choice of airway stents by interventional physicians. Methods: In this experiment, 8 beagles were randomly divided into 4 groups. Four self-expanding metal stents of different diameters (16, 18, 20 and 22 mm, respectively) were placed in the trachea of these beagles for 3 months and their impacts on normal trachea were observed. Results: In the 16 mm stent group (stent-to-airway diameter ratio 103%), good epithelialization was observed and the tracheal structure had no significant damage. In the 18 mm stent group (stent-to-airway diameter ratio 116%), slight granulation tissues were observed, but the cartilage and outer membrane were normal. In the 20 mm stent group (stent-to-airway diameter ratio 129%), severe granulation tissues were observed. Cartilage was damaged but outer membrane was normal. In the 22 mm stent group (stent-to-airway diameter ratio 142%), no obvious granulation tissues were found. Cartilage was normal, but outer membrane was ruptured. Conclusion: In a certain range, tracheal granulation tissues increased as the stent diameter increased. However, if the stent diameter continued to increase, a decreasing trend of tracheal granulation was observed, but severe tracheal injury by stent expansion force would occur.

[Airway metal stents removal by rigid bronchoscopy].

OBJECTIVE: To explore the techniques and related complication management of airway metal stents removal with rigid bronchoscope under general anesthesia. METHODS: We reviewed 20 patients who had received rigid bronchoscopic stents removal under general anesthesia from Jan. 2008 to Jan. 2015. The clinical data were analyzed retrospectively. The indications for stents removal and potential difficulties encountered, the relationship between techniques and related complications of stents removal were discussed and analyzed, and our experiences were summarized. RESULTS: The indications for airway metal stents removal included stent migration, fracture, and granulation related in-stent restenosis. Nineteen airway metal stents were removed from 20 patients, which included 9 covered metal stents, 6 without fragmentation and 3 with fragmentation. The average duration of stenting before removal was (7.4±6.9)months (5 days-24 months). Of the 11 uncovered metal stents, which had stayed in the airway for (10.2±7.0) months (20 days-24 months), 10 were removed successfully and 1 failed. Three of them were removed intact and 7 fragmented. Complications were as follows: airway bleeding requiring management (n=11), airway collapse (n=6), re-obstruction requiring temporary stent placement (n=5), postoperative tracheal intubation (n=1), mucosal tear with tracheoesophageal fistula (n=1), airway firing (n=1), airway obstruction, and death as a result of attempted stent removal (n=1). CONCLUSIONS: Airway metal stent removal is a high-risk operation. Indications for stents removal should be evaluated thoroughly and all the advantages and disadvantages should be evaluated. Once stent removal is decided, the type of the metal stent, the position of the stent implanted, the duration of stenting, and the extent of the stent embedded in granulation tissue should be carefully considered to assess the difficulty of the procedure. Dissection of the stent from the airway wall before extracting it can reduce complications such as airway bleeding, mucosal tear and airway obstruction. At the same time, a standby stent is needed to deal with possible airway collapse after stent removal. Removal of metal airway stents should only be performed by a proficient and experienced interventional pulmonology team to ensure successful operation and to improve patient safety.

[An empirical correlation between optical rotation and absolute configuration of optically active alpha-methylbutyrylphloroglucinols and its synthesis].

Fourteen new compounds were synthesized of which twelve are (S)-(+)-alpha-methylbutyrylphloroglucinols. On the basis of optical rotation data and theoretical analysis, an empirical correlation between optical rotation and absolute configuration of optically active alpha-methylbutyrylphloroglucinols has been established by means of Brewster's rule of atomic asymmetry. It can be served as a means of absolute configuration assignment of optically active alpha-methylbutyrylphloroglucinols.

[Studies on the chemical constituents from the root-sprouts of Agrimonia pilosa Ledeb].

Five compounds were isolated from the petroleum ether extract of the root-sprouts of Agrimonia pilosa Ledob. A new compound, (R)-(-)-agrimol B (III), was elucidated by means of physical and chemical properties, spectroscopy (MS, IR, PMR, UV) and total synthesis. Four known compounds were identified as agrimophol (I), n-nonacosane (II), beta-sitosterol (IV) and pseudo-aspidin (V), the last one being previously known only as a synthetic entity. (S)-(+)-Agrimol B also was synthesized.

[Studies on the structure of a new isocoumarin glucoside of the root sprouts of Agrimonia pilosa Ledeb].

Trans-p-hydroxycinnamic esters VI and an isocoumarin glucoside VII were isolated from the benzene and acetone extracts of the root sprouts of Agrimonia pilosa Ledeb. On the basis of physicochemical properties, spectral data (UV, IR, NMR, MS, CI-MS-MS), GC and chemical degradation, VI was elucidated as trans-p-hybroxycinnamic esters of n-C22, n-C24-32, n-C34, alcohols, VII was elucidated as agrimonolide-6-Q-beta-D-glucopyranoside. VII and trans-p-hydroxycinnamic esters of n-C29-32 and n-C34 alcohols are new compounds.

[Studies on the structure of a new ellagic acid glycoside from the root-sprouts of Agrimonia pilosa Ledeb].

Four compounds were isolated from the root-sprouts of Agrimonia pilosa Ledeb. On the basis of physico-chemical properties, spectroscopy (UV, IR, NMR, MS) and chemical degradation, a new compound was elucidated as ellagic acid-4-O-beta-D-xylopyranoside (XV), and three known compounds were identified as agrimonolide (XIII), tormentic acid (XIV), and ellagic acid (XVI).

[Studies on the structure of a new flavanonol glucoside of the root-sprouts of Agrimonia pilosa Ledeb].

Three compounds were isolated from benzene and acetone extracts of the root-sprouts of Agrimonia pilosa Ledeb. On the basis of physicochemical properties, spectroscopy (UV, IR, NMR, MS, CD, GC) and chemical degradation, two known compounds were identified as palmitic acid (VIII) and daucosterol (IX), one new compound was elucidated as (2S,3S)-(-)-taxifolin-3-O-beta-D-glucopyranoside (X).

[Isolation and structure elucidation of qianhucoumarin A].

Seven compounds were isolated from the traditional Chinese Medicine Qianhu, roots of Peucedanum praeruptorum Dunn. Their structures were identified as psoralen (II), 5-methoxypsoralen (III), 8-methoxypsoralen (IV), pteryxin (V), peucedanocoumarin II (VI), beta-sitosterol (VII) and qianhucoumarin A (VIII) by physico-chemical constants and spectral analyses (UV, IR, 1HNMR, 13CNMR, EIMS). VIII is a new compound with the structure of 3'(R)-hydroxy-4'(R)-tigloyloxy-3',4'-dihydroseslin. Its absolute configurations were determined by chemical correlation with known compounds. II, III, IV and VII were first isolated from this plant.

[The isolation and identification of qianhucoumarin B and qianhucoumarin C from Peucedanum praeruptorum].

Five compounds were isolated from the traditional Chinese medicine Qianhu, roots of Peucedanum praeruptorum. Their structures were identified as 3'-angeloyloxykhellactone (IX), qianhucoumarin B (X), qianhucoumarin C (XI), Pd-III (XIII) and peucedanocoumarin III (XV). Among them, X and XI are new compounds, their absolute configurations were elucidated by chemical correlation with khellactones, as 3'(S)-acetoxy-4'(S)-hydroxy-3',4'-dihydroseselin(X) and 3'(S)-hydroxy-4'(S)-acetoxy-3',4'-dihydroseselin (XI). Compound IX was isolated from plants for the first time.

[Structure determination of the constituents from Citrus grandis Osbeck].

OBJECTIVE: To isolate the chemical constituents of the peelings of Citrus grandis and determine their structure. METHOD: Column chromatography and PTLC were applied to isolating and purifying the chemical constituents, and 1H NMR and 13C NMR were used to elucidate their structure. RESULT: 4 compounds were isolated as meranzin hydrate(1), roseoside(2), 8-(3-beta-D-syl-2-hydrox-3-methylbutyl)-7-methoxycoumarin(3) and glucose(4). CONCLUSION: Compound 2 was isolated as a carotenoid from this genus for the first time.

A new cucurbitacin from Bolbostemma paniculatum Franguent.

A new cucurbitacin with an unusual ring A, isocucurbitacin D 25-O-acetate (1), was isolated from Bolbostemma paniculatum Franguent together with one known compound, cucurbitacin E (2). The structure of new compound was established by spectroscopic methods.

Norisoprenoids from Ulva lactuca.

Five norisoprenoids were isolated from the green marine alga Ulva lactuca. Two new compounds were assigned to (3R,5R,6R,7E)3,5,6-trihydroxy-7-megastigmen-9-one (1) and (3S,5R,6S,7E)3,5,6-trihydroxy-7-megastigmen-9-one (2). The structures and absolute configurations of the five compounds were determined by analyses of NMR, MS and circular dichroism (CD).