Photoinduced Decarboxylative Difluoroalkylation and Perfluoroalkylation of α-Fluoroacrylic Acids.

Herein, a novel and practical methodology for the photoinduced decarboxylative difluoroalkylation and perfluoroalkylation of α-fluoroacrylic acids is reported. A wide range of α-fluoroacrylic acids can be used as applicable feedstocks, allowing for rapid access to structurally important difluoroalkylated and polyfluoroalkylated monofluoroalkenes with high Z-stereoselectivity under mild conditions. The protocol demonstrates excellent functional group compatibility and provides a platform for modifying complex biologically active molecules.

Severe/critical COVID-19 early warning system based on machine learning algorithms using novel imaging scores.

BACKGROUND: Early identification of severe/critical coronavirus disease 2019 (COVID-19) is crucial for timely treatment and intervention. Chest computed tomography (CT) score has been shown to be a significant factor in the diagnosis and treatment of pneumonia, however, there is currently a lack of effective early warning systems for severe/critical COVID-19 based on dynamic CT evolution. AIM: To develop a severe/critical COVID-19 prediction model using a combination of imaging scores, clinical features, and biomarker levels. METHODS: This study used an improved scoring system to extract and describe the chest CT characteristics of COVID-19 patients. The study also took into consideration the general clinical indicators such as dyspnea, oxygen saturation, alternative lengthening of telomeres (ALT), and androgen suppression treatment (AST), which are commonly associated with severe/critical COVID-19 cases. The study employed lasso regression to evaluate and rank the significance of different disease characteristics. RESULTS: The results showed that blood oxygen saturation, ALT, IL-6/IL-10, combined score, ground glass opacity score, age, crazy paving mode score, qsofa, AST, and overall lung involvement score were key factors in predicting severe/critical COVID-19 cases. The study established a COVID-19 severe/critical early warning system using various machine learning algorithms, including XGBClassifier, Logistic Regression, MLPClassifier, RandomForestClassifier, and AdaBoost Classifier. The study concluded that the prediction model based on the improved CT score and machine learning algorithms is a feasible method for early detection of severe/critical COVID-19 evolution. CONCLUSION: The findings of this study suggest that a prediction model based on improved CT scores and machine learning algorithms is effective in detecting the early warning signals of severe/critical COVID-19.

Stereoselective Synthesis of Monofluoroalkenylphosphine Oxides via Photoinduced Decarboxylative Coupling of α-Fluoroacrylic Acids with P(O)H Compounds.

Herein, a practical and efficient method for synthesizing monofluoroalkenyl phosphine oxides via photoinduced decarboxylative/dehydrogenative coupling of α-fluoroacrylic acids with phosphine oxides and phosphonates has been developed. Various α-fluoroacrylic acids and P(O)H compounds containing relevant functional groups, including tetrafluorobenzene and pentafluorobenzene, were converted into corresponding products with excellent E-stereoselectivity in satisfactory yields. This method can be extended to achieve the synthesis of monofluoroalkenyl silanes under similar conditions.

Tilt and decentration with various intraocular lenses: A narrative review.

We find that tilt and decentration of intraocular lens (IOL) commonly cause visual quality deterioration after cataract surgery. Multiple factors affect IOL tilt and decentration in the pre-, mid-, and post-operation phases. Moreover, the tilt and decentration of 1-piece IOL are less correlated with internal ocular HOAs than those of 3-piece IOL. Aspherical IOLs are more sensitive to decentration or tilt than spherical IOLs. Furthermore, the optical performance of toric IOLs with an accurate axis remains stable irrespective of tilt and decentration. The optical quality of asymmetric multifocal IOLs varies significantly after decentration and tilt in different directions. The image quality enhances or deteriorates in the direction of the decentered IOL. An extended depth of focus IOL can achieve good visual acuity in the distant, intermediate, and near range. Additionally, its tilt and decentration have less impact on the vision than bifocal and trifocal IOL. This is the first review that compares the effect of IOL tilt and decentration on image quality for various IOL designs. The result indicates that a deeper understanding of tilt and decentration of various IOLs can help achieve a better visual effect to visually improve refractive cataract surgery.

Epibulbar osseous choristoma: Two case reports.

BACKGROUND: Choristoma is a rare, benign, congenital proliferative tumor, with osseous choristoma being the rarest. Although the tumor is benign, effective identification is needed for its diagnosis and treatment. Here, we report the diagnosis and successful surgical treatment of two patients with osseous choristoma. CASE SUMMARY: Two patients, a young female and young male patient, were found to have a mass on the ocular surface. The tumor presented on the superior temporal bulbar conjunctiva in the first patient and on the upper eyelid in the second patient. Ultrasound biomicroscopy detected a strong echo with clear boundaries covering the lower echo, and computed tomography examination revealed calcification. Both patients underwent surgery, and histopathological evaluation of the mass showed osseous choristoma. They were treated by excision and subsequently cured. CONCLUSION: Osseous choristomas are usually asymptomatic. Our patients were cured immediately after surgery, suggesting that surgical treatment is an effective strategy.

Associations Between the Use of Renin-Angiotensin System Inhibitors and the Risks of Severe COVID-19 and Mortality in COVID-19 Patients With Hypertension: A Meta-Analysis of Observational Studies.

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) share a target receptor with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The use of ACEIs/ARBs may cause angiotensin-converting enzyme 2 receptor upregulation, facilitating the entry of SARS-CoV-2 into host cells. There is concern that the use of ACEIs/ARBs could increase the risks of severe COVID-19 and mortality. The impact of discontinuing these drugs in patients with COVID-19 remains uncertain. We aimed to assess the association between the use of ACEIs/ARBs and the risks of mortality and severe disease in patients with COVID-19. A systematic search was performed in PubMed, EMBASE, Cochrane Library, and MedRxiv.org from December 1, 2019, to June 20, 2020. We also identified additional citations by manually searching the reference lists of eligible articles. Forty-two observational studies including 63,893 participants were included. We found that the use of ACEIs/ARBs was not significantly associated with a reduction in the relative risk of all-cause mortality [odds ratio (OR) = 0.87, 95% confidence interval (95% CI) = 0.75-1.00; I 2 = 57%, p = 0.05]. We found no significant reduction in the risk of severe disease in the ACEI subgroup (OR = 0.95, 95% CI = 0.88-1.02, I 2 = 50%, p = 0.18), the ARB subgroup (OR = 1.03, 95% CI = 0.94-1.13, I 2 = 62%, p = 0.48), or the ACEI/ARB subgroup (OR = 0.83, 95% CI = 0.65-1.08, I 2 = 67%, p = 0.16). Moreover, seven studies showed no significant difference in the duration of hospitalization between the two groups (mean difference = 0.33, 95% CI = -1.75 to 2.40, p = 0.76). In conclusion, the use of ACEIs/ARBs appears to not have a significant effect on mortality, disease severity, or duration of hospitalization in COVID-19 patients. On the basis of the findings of this meta-analysis, there is no support for the cessation of treatment with ACEIs or ARBs in patients with COVID-19.

[Clinical effect of white noise combined with glucose in reducing the pain of retinopathy screening in preterm infants].

OBJECTIVE: To study the clinical effect of white noise combined with glucose in reducing the procedural pain of retinopathy screening in preterm infants. METHODS: A total of 396 preterm infants with a gestational age of 28-34 weeks and a birth weight of ≤2 000 g were randomly divided into 4 groups according to the intervention method for reducing pain in retinopathy screening: control group with 100 infants (no white noise or glucose intervention), white noise group with 96 infants, glucose group with 98 infants and white noise + glucose group with 102 infants. The Premature Infant Pain Profile (PIPP) was used to determine pain score during retinopathy screening, and the four groups were compared in terms of PIPP score before and after retinopathy screening. RESULTS: There were no significant differences in PIPP score, heart rate and blood oxygen saturation between the four groups at 3 minutes before screening (P>0.05). At 1 and 5 minutes after screening, the white noise, glucose and white noise + glucose groups had significantly lower heart rate and PIPP score but significantly higher blood oxygen saturation than the control group (P<0.05).The white noise + glucose group had significantly lower heart rate and PIPP score but significantly higher blood oxygen saturation than the white noise and glucose groups (P<0.05). CONCLUSIONS: White noise combined with glucose can reduce the procedural pain of retionopathy screening and keep vital signs stable in preterm infants.

[Study on breeding and pollination characteristics of Gleditsia sinensis].

To study the breeding system and pollination characteristics of Gleditsia sinensis, we observed the development of flower development and the processing of pollination, and determined the pollen viability and stigma acceptability by TTC and benzidine-hydrogen peroxide method and detected its breeding system using OCI value, P/O ratio and artificial pollination.The results showed that: ①G. sinensis are racemes, divided into bisexual inflorescences (only a small amount of inactive pollen) and male inflorescences (occasionally a few bisexual flowers), flowers hermaphrodite. ②Male flowers had the strongest pollen activity 4 h after flowering; the stigma receptivity of bisexual was the highest at 1 h after flowering, and pollination was the best in this time. ③The pollen tube had a few elongation when the bisexual flower is half-opened. The number of pollen tube and length significantly increased when blooming. The flower reaches the ovary and even enters the ovule to complete the fertilization. ④When the OCI=4 and P/O=11 684, it means that the breeding system was facultative, outcrossing, and requiring pollinators based on the results of the bagging experiment.There was parthenogenesis. ⑤The characteristics of saponin pollination were wind pollination and insect vector pollination, and pollinators were initially identified as Apis mellifera ligustica. All these results provides a theoretical and technical foundation for the new germplasm of G. sinensis.

An Exfoliated 2D Egyptian Blue Nanosheet for Highly Selective Enrichment of Multi-phosphorylated Peptides in Mass Spectrometric Analysis.

Phosphopeptide enrichment is essential for the phosphoprotein profiling, due to the low abundance in complex biological samples. Moreover, selective binding of multi-phosphopeptides over mono-phosphopeptides is rarely established, but strongly needed in real sample analysis, especially for the investigation of cell behaviors with the multisite phosphorylation cascades. Here two-dimensional (2D) nanosheets were synthesized of Egyptian blue (CaCuSi4 O10 ), the well-known ancient pigment, and its analogues (SrCuSi4 O10 and BaCuSi4 O10 ), which were employed in the enrichment of phosphopeptides for the first time. Surprisingly, the 2D CaCuSi4 O10 nanosheet was highly selective towards multi-phosphopeptides without enriching the mono-phosphorylated peptides in a wide range of acidic conditions or buffer compositions. Meanwhile, the SrCuSi4 O10 and BaCuSi4 O10 nanosheet analogues do not exhibit this unique selectivity. Moreover, the ultrathin and well-defined 2D morphology, with abundant CaII , of Egyptian blue nanosheet was applied in cortical samples of forebrain specific PDK1 conditional knockout mice and their age-matched littermate controls, that are associated with Alzheimer's disease. The as-prepared 2D CaCuSi4 O10 nanosheet not only showed specific selectivity, but also exhibited high sensitivity (detection limit of 4×10-7 m).

Design, synthesis, biological evaluation, and 3D-QSAR analysis of podophyllotoxin-dioxazole combination as tubulin targeting anticancer agents.

The advancement of cancer-fighting drugs has never been a simple linear process. Those drug design professionals begin to find inspiration from the nature after failing to find the ideal products by creative drug design and high-throughput screening. To obtain new molecules for inhibiting tubulin, podophyllotoxin was adopted as the leading compound and 1,3,4-oxadiazole was brought in to the C-4 site of podophyllotoxin in this research. A series of seventeen podophyllotoxin-derived esters have been achieved and then evaluated their antitumor activities against four different cancer cell lines: A549, MCF-7, HepG2, and HeLa. Among all the compounds, compound 7c showed the best antiproliferating properties with IC50  = 2.54 ± 0.82 µm against MCF-7 cancer cell line. It was obvious that the content of ROS grew significantly in MCF-7 in a way depending on the dosage. The time- and dose-dependent cell cycle assays revealed that compound 7c could apparently block cell cycle in the phase of G2/M along with the upregulation of cyclin A2 and CDK2 protein. According to further studies, confocal microscopy experiment has certified that compound 7c could restrain cancer from growing by blocking the polymerization of microtubule. Meanwhile, compound 7c could be ideally integrated with the colchicine site of tubulin. In future, it would be feasible to selectively design tubulin inhibitors with the help of 3D-QSAR. This means that it is hopeful to develop compound 7c as a potential agent against cancer due to its biological characteristics.

[Bedside diode laser photocoagulation for 103 cases with serious retinopathy of prematurity in NICU].

OBJECTIVE: To evaluate the efficacy and safety of the bedside diode laser photocoagulation for severe retinopathy of prematurity in neonatal intensive care unit (NICU). METHOD: Data of 103 patients with prethreshold or threshold retinopathy of prematurity (ROP), treated with diode laser photoablation after vecuronium-induced anesthesia and mechanical ventilation from March 2009 to July 2011 in NICU of Bayi Children's Hospital. RESULT: Totally 199 eyes in 103 patients received laser therapy with at least 5 months follow up. Among these eyes, zone I disease was found in 76 eyes (38.2%) of 39 infants, zone II disease was found in 123 eyes (61.8%)of 64 infants and additional disease was found in 180 eyes of 91 infants. After treatment 191 (96.0%) of 199 eyes had favorable outcomes and 8 developed to partial retinal detachment. The rate of favorable outcomes in zone I diseases and zone 2 diseases were 89.5% and 100% respectively. The laser therapy was undertaken in all patients safely and the use of ventilator was stopped quickly [after a mean of (6.7 ± 1.3) h]. CONCLUSION: Bedside laser photocoagulation in NICU is a safe and effective treatment mode for severe ROP and should be used widely.

[Retinopathy of prematurity screening in 2185 premature infants].

OBJECTIVE: To determine the incidence and risk factors of retinopathy of prematurity (ROP) among premature infants. METHODS: The fundus examination data of 2185 cases of premature infants [birth body weight ≤ 2000 g or gestational age (GA) ≤ 34 weeks] in neonatal intensive care unit of Bayi Children's Hospitals in Beijing between January 2009 and December 2010 were collected and retrospectively analyzed. RESULTS: Of 2185 cases of premature infants (1571 had used supplemental oxygen) received RetCam-II ophthalmoscopy screening, 287 cases developed ROP with the incidence of 13.1% according to the international classification of ROP (ICROP), including 34 cases (11.9%) suffering from zone I, 147 cases (51.2%) from zone II, and 106 cases (36.9%) from zone III. Stage 1, 2 and 3 lesions were 117 cases, 142 cases and 28 cases, accounting for 40.8%, 49.5% and 9.7%, respectively, while stage 4 and stage 5 lesions were not found. Thirty-six cases developed plus disease, accounting for 12.5%. Between ROP and Non-ROP groups, there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7 ± 359.3) g vs (1633.9 ± 352.3) g, gestational age (30.6 ± 2.0) g vs (32.4 ± 1.8) W and time of supplemental oxygen [Median 10 d (0 to 71 d) vs 2 d (0 to 36 d)]. Among zone I, II and III groups, there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7 ± 359.3) g vs (1633.9 ± 352.3) g, gestational age (29.3 ± 2.2) W vs (30.5 ± 1.9) W vs (31.2 ± 1.8) W and time of supplemental oxygen[Median 14 d (0 to 52 d)vs 10 d (0 to 71 d) vs 8 d (0 to 52 d)] (χ(2) = 257.5, 371.7, 6.695; P < 0.05), while among stage 1, 2 and 3 groups, there were also significant differences in birth weight (1593.3 ± 413.7) g vs (1481.3 ± 336.7) g vs (1325.3 ± 313.7) g, gestational age (30.9 ± 2.0) W vs (30.6 ± 1.9) W vs (29.5 ± 1.7) W and time of supplemental oxygen [Median 8 d (0 to 52 d) vs 11 d (0 to 65 d) vs 12 d (0 to 71 d)] (χ(2) = 230.8, 273.5, 6.695; P < 0.05). In 1004 cases admitted in 2009, 150 developed ROP with the incidence of 14.9%; while in 1181 cases admitted in 2010, 137 developed ROP with the incidence of 11.6%. There was significant differences in the incidence of ROP between these two years (χ(2) = 5.305, P < 0.05). Thirty-eight infants (1.7%) received laser therapy and only 3 infants progressed to stage 4 after laser therapy. Three infants with laser failed stopped progress after vasectomy. Finally, all patients were cured without blindness. CONCLUSIONS: Less birth weight, shorter GA and time of supplemental oxygen are close related to the development of ROP. It is necessary to pay high attention to the screen on premature infants with smaller gestation age, lower birth weight or using oxygen for the reduction or even avoid of blindness.

[Bedside treatment of retinopathy of prematurity by laser photocoagulation].

OBJECTIVE: To study the efficacy of bedside treatment by laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU). METHODS: The clinical data of 30 cases of ROP who underwent peripheral laser ablation on bedside in the NICU from March to August 2009 were studied retrospectively. RESULTS: A total of 59 eyes from 30 patients received the laser therapy, with a total cure rate of 95%. According to the International Classification of ROP, 26 eyes of 13 infants had zone 1 disease, and 33 eyes of 17 infants had zone 2 disease. The birth gestational age and birth weight as well as corrected gestational age and corrected weight at operation in the zone 1 disease group were significantly lower than those in the zone 2 disease group. The number of laser spots in the zone 1 disease group was significantly higher than that in the zone 2 disease group. The cure rate in the zone 2 disease group (100%) was significantly higher than that in the zone 1 disease group (88%). CONCLUSIONS: Laser retinal photocoagulation on bedside in the NICU is effective for both zone 1 and zone 2 ROP. As compared with the infants with zone 2 disease, the infants with zone 1 disease may have a poor outcome.

[Establishment of regional active neonatal transport network].

OBJECTIVE: To evaluate the clinical function and significance of establishing a regional active neonatal transport network (ANTN) in Beijing. METHOD: The authors retrospectively studied intensive care and the role of ANTN system in management of critically ill neonates and compared the outcome of newborn infants transported to our NICU before and after we established standardized NICU and ANTN system (phase 1: July 2004 to June 2006 vs phase 2: July 2006 to May 2008). RESULT: The number of neonatal transport significantly increased from 587 during phase 1 to 2797 during phase 2. Success rate of transport and the total cure rate in phase 2 were 97.85% and 91.99% respectively, which were significantly higher than those in phase 1 (94.36% and 88.69%, respectively, P < 0.01). The neonatal mortality significantly decreased in phase 2 compared with that in phase 1 (2.29% vs 4.31%, P < 0.01). The capacity of our NICU was enlarged following the development of ANTN. There are 200 beds for level 3 infants in phase 2, but there were only 20 beds in phase 1. Significantly less patients in the phase 2 had hypothermia, acidosis and the blood glucose instability than those in phase 1 (P < 0.01, 0.05, 0.01 and 0.05, respectively). The proportion of preterm infants transported to our NICU were higher in phase 2 compared with that in phase 1, especially infants whose gestational age was below 32 weeks. The proportions of asphyxia and respiratory distress syndrome were lower in phase 2 than that in phase 1, but the total cure rates of these two diseases had no significant changes between the two phases. The most important finding was that the improvement of outcome of premature infants and those with asphyxia and aspiration syndrome was noted following the development of ANTN. CONCLUSION: Establishing regional ANTN for a tertiary hospital is very important to elevate the total level in management of critically ill newborn infants. It plays a very important role in reducing mortality and improving total outcomes of newborn infants. There are still some problems remained to solve after four years practice in order to optimize the ANTN to meet needs of the development of neonatology.

[Endovascular embolization and microsurgical operation treatment of intracranial anterior circulation aneurysms].

OBJECTIVE: To explore the surgical treatment and effect of intracranial anterior circulation aneurysms. METHODS: Thirty-eight patients with intracranial anterior circulation aneurysms were enrolled, 9 were treated with endovascular embolization,and 29 with pterion approach micro-euthyphoria operation. RESULTS: One patient was postoperative death. Thirty-four patients were followed up. Among them, 26 were recovery, 1 was botan animation, 2 were meta-palsy, 3 oculomotor palsy, and 2 epilepsy. CONCLUSION: Surgical treatment of intracranial anterior circulation aneurysms is the first choice to help blood tumor cleaning-up and intracranial pressure degrading. Embolotherapy can be applied for patients unfit for operation, but we do not recommend wide use of it due to preoperative cranial nerve injury.