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1.
Bioorg Chem ; 124: 105829, 2022 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-35490582

RESUMO

Androgen signaling pathway plays an important role in the occurrence and development of prostate cancer (PCa), and anti-androgen drugs are one of the most effective therapies for PCa. Darolutamide 4 (ODM-201) is a promising second- generation antiandrogen because of its unique chemical structure and good activity against androgen receptor (AR). Herein, the structure-activity relationship of ODM-201 was studied, and 37 analogues were synthesized. Half of them exhibited similar or better anti-AR transcriptional activity compared to ODM-201. In addition, the inhibitory activity of compound 28t against the two resistant mutants (AR-F876L and AR-T877A) was superior to that of ODM-201. This study provides a new clue for the further optimization of ODM-201 and the development of anti-CRPC drugs.

2.
Org Biomol Chem ; 20(11): 2261-2270, 2022 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-35229848

RESUMO

An efficient approach to access functionalized indole derivatives has been developed through Cu(OTf)2-catalyzed C3 aza-Friedel-Crafts alkylation of substituted indoles 5a-5m, N-methyl-pyrrole with linear N,O-acetals 4a-4l. As a result, a series of C3 amide aza-alkylated indole derivatives 6a-6ag and 7 were synthesized in moderate to excellent yields.


Assuntos
Acetais , Indóis , Alquilação , Catálise , Estrutura Molecular , Estereoisomerismo
3.
Clin Transl Allergy ; 12(2): e12116, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35136540

RESUMO

BACKGROUND: Little is known about the changes in allergen sensitization in China secondary to the environmental variations over the past decade. We aimed at investigating the variations in sensitization among asthma and/or rhinitis patients in China between 2008 and 2018. METHODS: This study analyzed cross-sectional data from national surveys conducted in China in 2008 and 2018. After finishing the questionnaire, participants underwent serum specific IgE measurements. A total of 2322 and 2798 patients were enrolled in 2008 and 2018, respectively. The significance of differences in sensitization rates among four regions of China were assessed. Correlation analysis was used to identify the associations of sensitization with climate change and planting of Artemisia desertorum between the two surveys. RESULTS: Compared with 2008, the general sensitization rate to mites significantly increased in 2018, which ranked highest among all tested allergens. Sensitization to pollens, especially Artemisia vulgaris, showed the greatest increase in the north. The annual mean temperature, rainfall and relative humidity in all four regions, and the Artemisia desertorum coverage in the northeastern area, increased significantly in 2018 as compared with 2008. From 2008 to 2018, an increase in Dermatophagoides pteronyssinus sensitization was significantly associated with an increase in relative humidity (r = 0.54, p = 0.037). The increase in A. vulgaris sensitization was significantly associated with the increase in the A. desertorum planting area (r = 0.67, p = 0.006) and with a decrease in rainfall (r = -0.59, p = 0.021). CONCLUSIONS: House dust mites remain the most important allergen in Chinese individuals with asthma and/or rhinitis. Pollen sensitization dramatically increased in northern China. Increases in sensitization to dust mites and Artemisia were related to the increases in humidity and planting area of A. desertorum.

4.
Geohealth ; 6(2): e2021GH000529, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35128294

RESUMO

Acute exacerbation of chronic obstruction pulmonary disease (AECOPD) as a respiratory disease, is considered to be related to air pollution by more and more studies. However, the evidence on how air pollution affect the incidence of AECOPD and whether there are population differences is still insufficient. Therefore, we select PM10, PM2.5, SO2, NO2, CO, and O3 as representatives combined with daily AECOPD admission data from 1 January 2015 to 26 June 2016 in the rural areas of Qingyang, northwestern China to explore the associations of air pollution with AECOPD. Based on a time-stratified case-crossover design, we constructed a distributed lag nonlinear model to qualify the single and cumulative lagged effects of air pollution on AECOPD. Stratified related risks by sex and age were also reported. The cumulative exposure-response curves were approximately linear for PM2.5, "V"-shaped for PM10, "U"-shaped for NO2 and inverted-"V" for SO2, CO and O3. Exposure to high-PM2.5 (42 µg/m3), high-PM10 (91 µg/m3), high-SO2 (58 µg/m3), low-NO2 (12 µg/m3), and high-CO (1.55 mg/m3) increased the risk of AECOPD. Females aged 15-64 were more susceptible under extreme concentrations of PM2.5, SO2, CO, and low-PM10 than other subgroups. In addition, adults aged 15-64 were more sensitive to extreme concentrations of NO2 compared with the elderly ≥65 years old, while the latter were more sensitive to high-PM10. High-SO2, high-NO2, and extreme concentrations of PM2.5 had the greatest effects on the day of exposure, while low-SO2 and low-CO had lagged effects on AECOPD. Precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for AECOPD associated with air pollutants.

5.
Gut ; 71(5): 961-973, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33849943

RESUMO

OBJECTIVE: Recent studies have found aristaless-related homeobox gene (ARX)/pancreatic and duodenal homeobox 1 (PDX1), alpha-thalassemia/mental retardation X-linked (ATRX)/death domain-associated protein (DAXX) and alternative lengthening of telomeres (ALT) to be promising prognostic biomarkers for non-functional pancreatic neuroendocrine tumours (NF-PanNETs). However, they have not been comprehensively evaluated, especially among small NF-PanNETs (≤2.0 cm). Moreover, their status in neuroendocrine tumours (NETs) from other sites remains unknown. DESIGN: An international cohort of 1322 NETs was evaluated by immunolabelling for ARX/PDX1 and ATRX/DAXX, and telomere-specific fluorescence in situ hybridisation for ALT. This cohort included 561 primary NF-PanNETs, 107 NF-PanNET metastases and 654 primary, non-pancreatic non-functional NETs and NET metastases. The results were correlated with numerous clinicopathological features including relapse-free survival (RFS). RESULTS: ATRX/DAXX loss and ALT were associated with several adverse prognostic findings and distant metastasis/recurrence (p<0.001). The 5-year RFS rates for patients with ATRX/DAXX-negative and ALT-positive NF-PanNETs were 40% and 42% as compared with 85% and 86% for wild-type NF-PanNETs (p<0.001 and p<0.001). Shorter 5-year RFS rates for ≤2.0 cm NF-PanNETs patients were also seen with ATRX/DAXX loss (65% vs 92%, p=0.003) and ALT (60% vs 93%, p<0.001). By multivariate analysis, ATRX/DAXX and ALT status were independent prognostic factors for RFS. Conversely, classifying NF-PanNETs by ARX/PDX1 expression did not independently correlate with RFS. Except for 4% of pulmonary carcinoids, ATRX/DAXX loss and ALT were only identified in primary (25% and 29%) and NF-PanNET metastases (62% and 71%). CONCLUSIONS: ATRX/DAXX and ALT should be considered in the prognostic evaluation of NF-PanNETs including ≤2.0 cm tumours, and are highly specific for pancreatic origin among NET metastases of unknown primary.


Assuntos
Deficiência Intelectual , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Talassemia alfa , Proteínas Correpressoras/genética , Genes Homeobox , Proteínas de Homeodomínio , Humanos , Deficiência Intelectual/genética , Chaperonas Moleculares/genética , Recidiva Local de Neoplasia/genética , Tumores Neuroendócrinos/genética , Proteínas Nucleares/genética , Neoplasias Pancreáticas/patologia , Telômero/genética , Telômero/patologia , Fatores de Transcrição/genética , Proteína Nuclear Ligada ao X/genética , Talassemia alfa/genética
6.
Ann Am Thorac Soc ; 19(2): 255-263, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34288830

RESUMO

Rationale: The etiology of acute respiratory distress syndrome (ARDS) may play an important role in the failure of noninvasive ventilation (NIV). Objectives: To explore the association between ARDS etiology and risk of NIV failure. Methods: A multicenter prospective observational study was performed in 17 intensive care units in China from September 2017 to December 2019. Patients with ARDS who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). From initiation to 24 hours of NIV, the respiratory rate, heart rate, arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2), and arterial carbon dioxide pressure improved slower in patients with ARDSp than those with ARDSexp. Patients with ARDSp experienced more NIV failure (55% vs. 28%; P < 0.01) and higher 28-day mortality (47% vs. 14%; P < 0.01). The adjusted odds ratios of NIV failure and 28-day mortality were 5.47 (95% confidence interval [CI], 3.04-9.86) and 10.13 (95% CI, 5.01-20.46), respectively. In addition, we combined the presence of ARDSp, presence of septic shock, age, nonpulmonary sequential organ failure assessment score, respiratory rate at 1-2 hours of NIV, and PaO2/FiO2 at 1-2 h of NIV to develop a risk score of NIV failure. With the increase of the risk score, the rate of NIV failure increased. The area under the curve of the receiver operating characteristic was 0.84 (95% CI, 0.79-0.89) and 0.81 (0.69-0.92) in the training and validation cohorts, respectively. Using 5.5 as cutoff value to predict NIV failure, the sensitivity and specificity was good. Conclusions: Among patients with ARDS who used NIV as a first-line therapy, ARDSp was associated with slower improvement, more NIV failure, and higher 28-day mortality than ARDSexp. The risk score combined presence of ARDSp, presence of septic shock, age, nonpulmonary sequential organ failure assessment score, respiratory rate at 1-2 hours of NIV, and PaO2/FiO2 at 1-2 hours of NIV has high accuracy to predict NIV failure among ARDS population.


Assuntos
Ventilação não Invasiva , Síndrome do Desconforto Respiratório , Humanos , Unidades de Terapia Intensiva , Escores de Disfunção Orgânica , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia
7.
Comput Intell Neurosci ; 2021: 4471044, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34754302

RESUMO

From a macro perspective, futures index of agricultural products can reflect the trend of macroeconomy and can also have an early warning effect on the possible crisis and provide a reference for the government's economic forecast and macro control. Therefore, it is necessary to strengthen the research on early warning and prediction of agricultural futures price. For the prediction of futures price, there are two kinds of common models: one is the traditional classic time series model, and the other is the neural network model under the wave of artificial intelligence. This paper selects the 1976 closing data of agricultural futures index from January 10, 2012, to February 27, 2020, and uses the time series differential autoregressive integrated moving average model (ARIMA model) and long short-term memory model (LSTM model) to study this work, respectively, and compares the predicted effects of the two models in some metrics. Based on the predicted results of the two models, a simple trading strategy is established, and the trading effects of the two models are compared. The results show that the LSTM model has obvious advantage over ARIMA time series model in the price index prediction of agricultural futures market.


Assuntos
Inteligência Artificial , Redes Neurais de Computação , Algoritmos , Previsões , Memória de Longo Prazo
8.
Chempluschem ; 86(11): 1530-1536, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34791820

RESUMO

Mixed halide perovskites are promising memristive materials because of their excellent electronic-ionic properties. In this work, lead-free Cs2 AgBiBr6-x Clx (x=0, 0.2, 0.4, 0.6, 0.8, 1.0) double perovskite films were fabricated using a one-step solution spin-coating method in air. Moreover, the ITO/Cs2 AgBiBr6-x Clx /Al sandwich-like devices are fabricated to investigate the memristive behaviors. The present memristors exhibit nonvolatile and bipolar resistive switching behaviors without electroforming process. Interestingly, as the chloride content increases, the ON/OFF ratio of the device increases from 103 to 104 , the average SET voltage and the RESET voltage decrease from -0.40 V to -0.21 V and from 1.55 V to 1.34 V, respectively. In addition, resistance states of devices can be maintained after 100 switching cycles and 104  s of reading. This study provides new possibility for the development of low-power and environmentally friendly memristors.

9.
Pancreas ; 50(8): 1180-1186, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34714282

RESUMO

OBJECTIVE: The aim of the study was to identify risk factors associated with the failure of noninvasive ventilation (NIV) in patients with severe acute pancreatitis (SAP). METHODS: Patients who received NIV as a first-line therapy because of acute respiratory failure caused by SAP were enrolled. RESULTS: A total of 133 patients were enrolled. Of the patients, 32 (24%) experienced NIV failure. Male sex (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.48-12.22), older age (OR, 1.04; 95% CI, 1.01-1.08), a higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.18; 95% CI, 1.03-1.36), and a procalcitonin level greater than 3.8 ng/mL (OR, 6.28; 95% CI, 2.04-19.31) were independently associated with NIV failure. The receiver operating characteristic curves for predicting NIV failure were 0.67, 0.72, and 0.76 tested by age, procalcitonin, and Acute Physiology and Chronic Health Evaluation II score, respectively. From initiation to 24 hours, the patients in the NIV failure group had a higher proportion of Glasgow Coma Scale scores of 14 or less, a higher proportion of pH ≤7.35, and higher respiratory rates than ones in the successful NIV group. CONCLUSIONS: One of 4 SAP patients experience NIV failure. Age, sex, disease severity, level of inflammation, and vital signs can be used to predict NIV failure.


Assuntos
Ventilação não Invasiva , Pancreatite/complicações , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , APACHE , China , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Falha de Tratamento
10.
Front Med (Lausanne) ; 8: 730441, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604267

RESUMO

Objective: A considerable part of COVID-19 patients were found to be re-positive in the SARS-CoV-2 RT-PCR test after discharge. Early prediction of re-positive COVID-19 cases is of critical importance in determining the isolation period and developing clinical protocols. Materials and Methods: Ninety-one patients discharged from Wanzhou Three Gorges Central Hospital, Chongqing, China, from February 10, 2020 to March 3, 2020 were administered nasopharyngeal swab SARS-CoV-2 tests within 12-14 days, and 50 eligible patients (32 male and 18 female) with completed data were enrolled. Average age was 48 ± 11.5 years. All patients underwent non-enhanced chest CT on admission. A total of 568 radiomics features were extracted from the CT images, and 17 clinical factors were collected based on the medical record. Student's t-test and support vector machine-based recursive feature elimination (SVM-RFE) method were used to determine an optimal subset of features for the discriminative model development. Results: After Student's t-test, 62 radiomics features showed significant inter-group differences (p < 0.05) between the re-positive and negative cases, and none of the clinical features showed significant differences. These significant features were further selected by SVM-RFE algorithm, and a more compact feature subset containing only two radiomics features was finally determined, achieving the best predictive performance with the accuracy and area under the curve of 72.6% and 0.773 for the identification of the re-positive case. Conclusion: The proposed radiomics method has preliminarily shown potential in identifying the re-positive cases among the recovered COVID-19 patients after discharge. More strategies are to be integrated into the current pipeline to improve its precision, and a larger database with multi-clinical enrollment is required to extensively verify its performance.

11.
Ann Palliat Med ; 10(9): 9480-9487, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628873

RESUMO

BACKGROUND: This study investigated the epidemiological characteristics, predisposing factors, clinical features, microbiological findings, and treatment outcomes of patients with fungal keratitis in southeastern China. METHODS: A retrospective review was carried out on 718 patients diagnosed with fungal keratitis at the the First Affiliated Hospital of Fujian Medical University between January 2004 and December 2017. The sociodemographic data, predisposing factors, clinical details, microbiological findings, and treatment strategies were analyzed. RESULTS: Fungal keratitis was diagnosed in 718 patients (442 male and 276 female; mean age, 41.4±13.1 years). Most patients came from rural areas (79.7%) and farm work was the main occupational activity (51.7%). Cases were more common during the harvest season between October and December (41.6%). Corneal trauma (73.7%), particularly injury with vegetative matter (51.5%), was the predominant predisposing factor. Corneal scrapings obtained from 621 patients were diagnosed as positive on direct microscopy using a 10% potassium hydroxide (KOH) wet mount preparation. The positive culture rate of corneal scrapings was 89.6%. Fungal isolates were Fusarium species in 444 eyes and Aspergillus species in 98 eyes. Antifungal medications were used to treat 529 patients and 189 patients received surgery. CONCLUSIONS: Fungal keratitis is a leading cause of infective corneal ulcers in southeastern China. Corneal trauma was the major predisposing factor and direct microscopic examination was a rapid and sensitive method for diagnosis. The species Fusarium was the most common fungal isolate. Antifungal medication was an effective method for treating early and mild cases.


Assuntos
Infecções Oculares Fúngicas , Ceratite , Adulto , Antifúngicos/uso terapêutico , China/epidemiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/epidemiologia , Feminino , Humanos , Ceratite/tratamento farmacológico , Ceratite/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Can Respir J ; 2021: 9960667, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34336048

RESUMO

Background: A rating scale that takes into account heart rate, acidosis, consciousness, oxygenation, and respiratory rate (the HACOR score) has been used to predict noninvasive ventilation (NIV) failure in patients with chronic obstructive pulmonary disease (COPD). However, the HACOR score has not been used to predict NIV failure in non-COPD patients with acute-on-chronic respiratory failure. Methods: This study was performed in the respiratory intensive care unit of a teaching hospital. Data had been collected prospectively between June 2011 and January 2019. We enrolled non-COPD patients who received NIV due to acute-on-chronic respiratory failure, pH < 7.35, and PaCO2 >45 mmHg. NIV failure was defined as requiring intubation or dying during NIV. The HACOR score was determined at initiation and after 1-2, 12, and 24 h of NIV. Scores can range from 0 to 27, with higher scores indicating a higher risk of NIV failure. Results: A total of 148 patients were enrolled in the study, 52 with sleep apnea-hypopnea syndrome, 34 with chronic thoracic sequelae, 31 with bronchiectasis, 14 with chest wall deformity, 5 with obesity-hypoventilation syndrome, and 12 with other conditions. Of the patients, 19 (13%) experienced NIV failure. From initiation to 24 h of NIV, the HACOR scores of patients who experienced NIV failure were much higher than those of patients who received successful NIV. The area under the receiver operating characteristic curve was 0.69, 0.91, 0.91, and 0.94 when the HACOR score was tested at initiation and after 1-2, 12, and 24 h of NIV, respectively. To obtain the best sensitivity and specificity, the cutoff value at initiation was 7 with a sensitivity of 68% and a specificity of 61%. After 1-2 h of NIV, it was 5 with a sensitivity of 90% and a specificity of 85%. After 12 h of NIV, it was 4 with a sensitivity of 82% and a specificity of 91%. After 24 h of NIV, it was 2 with a sensitivity of 100% and a specificity of 76%. Conclusions: The HACOR score has high sensitivity and specificity for predicting NIV failure among non-COPD patients who receive NIV due to acute-on-chronic respiratory failure with respiratory acidosis.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Síndrome do Desconforto Respiratório , Insuficiência Respiratória , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Taxa Respiratória
13.
BMC Pulm Med ; 21(1): 157, 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33975566

RESUMO

BACKGROUND: Factors that may increase the risk for delirium and the firm knowledge around mechanism for delirium in noninvasive ventilation (NIV) patients is lacking. We investigated the incidence, characteristics, and outcomes of delirium in NIV patients. METHODS: A prospective observational study was performed in an intensive care unit (ICU) of a teaching hospital. Patients in whom NIV was used as a first-line intervention were enrolled. During NIV intervention, delirium was screened using the Confusion Assessment Method for the ICU each day. The association between delirium and poor outcomes (e.g., NIV failure, ICU and hospital mortality) was investigated using forward stepwise multivariate logistic regression analyses. RESULTS: We enrolled 1083 patients. Of these, 196 patients (18.1%) experienced delirium during NIV intervention. Patients with delirium had higher NIV failure rates (37.8% vs. 21.0%, p < 0.01), higher ICU mortality (33.2% vs. 14.3%, p < 0.01), and higher hospital mortality (37.2% vs. 17.0%, p < 0.01) than subjects without delirium. They also had a longer duration of NIV (median 6.3 vs. 3.7 days, p < 0.01), and stayed longer in the ICU (median 9.0 vs. 6.0 days, p < 0.01) and the hospital (median 14.5 vs. 11.0 days, p < 0.01). These results were confirmed in COPD and non-COPD cohorts. According to subtype, compared to hyperactive delirium patients, hypoactive and mixed delirium patients spent more days and many more days on NIV (median 3.4 vs. 6.5 vs. 10.1 days, p < 0.01). Similar outcomes were found for length of stay in the ICU and hospital. However, NIV failure, ICU mortality, and hospital mortality did not differ among the three subtypes. CONCLUSIONS: Delirium is associated with increases in poor outcomes (NIV failure, ICU mortality, and hospital mortality) and the use of medical resources (duration of NIV, and lengths of stay in the ICU and hospital). Regarding subtype, hypoactive and mixed delirium are associated with higher, and much higher, consumption of medical resources, respectively, compared to hyperactive delirium.


Assuntos
Delírio/epidemiologia , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Ventilação não Invasiva/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Hospitais de Ensino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Falha de Tratamento
14.
J Org Chem ; 86(4): 3433-3443, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33533615

RESUMO

The first Ni(OTf)2-catalyzed hydroamination of ynamides 2 was developed by reacting with secondary amines (1 and 4). This protocol features excellent regioselectivity, a broad substrate scope of secondary aryl amines, and good functional group tolerance for ynamides. Using this method, a variety of substituted ethene-1,1-diamine compounds were prepared in moderate to excellent yields with high regioselectivities.


Assuntos
Aminas , Níquel , Catálise
15.
Medicine (Baltimore) ; 100(5): e24296, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592874

RESUMO

RATIONALE: Due to its nonspecific manifestations, pneumonic-type adenocarcinoma can be easily misdiagnosed as pneumonia, tuberculosis, or other diseases, especially in developing countries where many patients in the early stage refuse invasive examinations. Early recognition of pneumonic-type adenocarcinoma is essential. PATIENT CONCERNS: We report a case of pneumonia lung adenocarcinoma diagnosed by frozen lung biopsy after death. DIAGNOSES: A 75-year-old male patient was admitted to the hospital on April 24, complaining of 5 months of recurrent coughing, expectoration, and panting, and his symptoms had been worsening over the past month. INTERVENTIONS: After obtaining informed consent from the patient's family, transbronchial cryobiopsy was performed at the bedside. OUTCOMES: After a positive rescue, the patient died. Pathological examination indicated adenocarcinoma. LESSONS: At present, surgery is still the first choice for the treatment of pneumonic lung cancer, and early diagnosis can remove the tumor as much as possible. Transbronchial cryobiopsy can be used for the collection of pathological samples, especially for the early diagnosis of pneumonic lung cancer.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Biópsia/métodos , Criocirurgia/métodos , Neoplasias Pulmonares/diagnóstico , Idoso , Evolução Fatal , Humanos , Pulmão/patologia , Masculino
16.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(1): 142-148, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33474904

RESUMO

OBJECTIVE: To explore the clinical diagnostic application of invasive cardiopulmonary exercise test (iCPET) in patients with unexplained dyspnea. METHODS: A retrospective analysis was conducted, covering patients with a chief complaint of exertional dyspnea between May 5, 2017 and October 1, 2020. Right cardiac catheterization examination was performed on patients whose cause had not been identified through routine examination, and further iCPET was performed on patients if no clear etiology was identified through right cardiac catheterization. According to the results and the diagnostic criteria of iCPET, patients showing no obvious abnormalities in the right cardiac catheterization examination were divided into four subgroups: exercise-induced pulmonary arterial hypertension (eiPAH), exercise-induced heart failure with preserved ejection fraction (eiHFpEF), preload failure, and oxidative myopathy. By comparing the lab test, echocardiography, right heart catheter and iCPET peak exercise data of the subgroups, the disease distribution and exercise hemodynamic characteristics of patients with unexplained dyspnea examined by iCPET were described. RESULTS: Of the 1 046 patients with exertional dyspnea, 771 were diagnosed with routine examination, while among the remaining 275 patients, 131 (47.6%) were diagnosed with right cardiac catheterization and 144 (52.4%) showed no clear etiology after routine examination and right cardiac catheterization. Of these 144 patients, 49 (34.0%) received iCPET with a median exercise time of 375 s. A total of 47 patients completed the examination, with a male-to-female ratio of 0.27∶1 and an average age of (47.9±14.4) years old. Among the 47 patients, 76.6% (36/47) aged between 20 and 59 and 78.7% (36/47) lived in urban areas. The preload failure group ( n=27) showed low right atrium pressure at peak exercise intensity. The eiHFpEF group ( n=9) showed high wedge pressure of pulmonary capillaries at peak of exercise intensity. The eiPAH group ( n=8) showed high average pulmonary artery pressure at peak exercise intensity. The oxidative myopathy group ( n=3) was characterized by impairment of tissue uptake and/or utilization of oxygen during exercise. According to the comparison among the three subgroups of the preload failure, eiHFpEF and eiPAH, the eiPAH group had the highest blood K + level in routine examination, while the preload failure group had the lowest blood K + level ( P=0.014). The iCPET of the three subgroups showed statistically significant ( P=0.001) difference in right atrial pressure increase during exercise. Among the three, the eiHFpEF group had the highest increase and the preload failure group had the lowest increase. Conclusion  In unexplained dyspnea patients showing no abnormal results in right cardiac catheterization examination, the main cause was preload failure, which manifested as low right atrial pressure at peak exercise intensity. The study showed that iCPET was of important value for dyspnea cases when the cause of the condition was not revealed with right cardiac catheterization.


Assuntos
Teste de Esforço , Insuficiência Cardíaca , Adulto , Cateterismo Cardíaco , Dispneia/etiologia , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Propulsora Pulmonar , Estudos Retrospectivos
17.
Heart Lung ; 50(1): 37-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33138976

RESUMO

BACKGROUND: The clinical characteristics of the patients with COVID-19 complicated by pneumothorax have not been clarified. OBJECTIVES: To determine the epidemiology and risks of pneumothorax in the critically ill patients with COVID-19. METHODS: Retrospectively collecting and analysing medical records, laboratory findings, chest X-ray and CT images of 5 patients complicated by pneumothorax. RESULTS: The incidence of pneumothorax was 10% (5/49) in patients with ARDS, 24% (5/21) in patients receiving mechanical ventilation, and 56% (5/9) in patients requiring invasive mechanical ventilation, with 80% (4/5) patients died. All the 5 patients were male and aged ranging from 54 to 79 years old. Pneumothorax was most likely to occur 2 weeks after the beginning of dyspnea and associated with reduction of neuromuscular blockers, recruitment maneuver, severe cough, changes of lung structure and function. CONCLUSIONS: Pneumothorax is a frequent and fatal complication of critically ill patients with COVID-19.


Assuntos
COVID-19 , Pneumotórax , Idoso , Estado Terminal , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Estudos Retrospectivos , SARS-CoV-2
18.
Org Biomol Chem ; 19(2): 457-466, 2021 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-33336677

RESUMO

An efficient approach to access functionalized (2,3-dihydroisoxazol-4-yl) ketones has been developed by reacting nitrones 4 with ynones 7 or terminal ynones 10 in a one-pot fashion. The reaction went through a formal Sc(OTf)3-catalyzed [3 + 2]-cycloaddition process to generate a number of functionalized (2,3-dihydroisoxazol-4-yl) ketones 11aa-11aw, 11ba-11la and 12aa-12ae in moderate to good yields.

19.
J Org Chem ; 85(21): 13567-13578, 2020 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-33112605

RESUMO

An approach to access functionalized 3,4-dihydro-1,3-oxazin-2-ones has been developed by reacting semicyclic N,O-acetals 5 and 6 with ynamides 7 or terminal alkynes 8 in a one-pot fashion. The reaction went through a formal [4 + 2] cycloaddition process to generate a number of functionalized 3,4-dihydro-1,3-oxazin-2-ones 9a-9ak and 10a-10bc in yields of 34-97%. In addition, the utility of this transformation was demonstrated by the synthesis of (±)-sedamine 13.

20.
Can Respir J ; 2020: 8885464, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33123301

RESUMO

Background: Risk factors for noninvasive ventilation (NIV) failure after initial success are not fully clear in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: Patients who received NIV beyond 48 h due to acute exacerbation of COPD were enrolled. However, we excluded those whose pH was higher than 7.35 or PaCO2 was less than 45 mmHg which was measured before NIV. Late failure of NIV was defined as patients required intubation or died during NIV after initial success. Results: We enrolled 291 patients in this study. Of them, 48 (16%) patients experienced late NIV failure (45 received intubation and 3 died during NIV). The median time from initiation of NIV to intubation was 4.8 days (IQR: 3.4-8.1). Compared with the data collected at initiation of NIV, the heart rate, respiratory rate, pH, and PaCO2 significantly improved after 1-2 h of NIV both in the NIV success and late failure of NIV groups. Nosocomial pneumonia (odds ratio (OR) = 75, 95% confidence interval (CI): 11-537), heart rate at initiation of NIV (1.04, 1.01-1.06 beat per min), and pH at 1-2 h of NIV (2.06, 1.41-3.00 per decrease of 0.05 from 7.35) were independent risk factors for late failure of NIV. In addition, the Glasgow coma scale (OR = 0.50, 95% CI: 0.34-0.73 per one unit increase) and PaO2/FiO2 (0.992, 0.986-0.998 per one unit increase) were independent protective factors for late failure of NIV. In addition, patients with late failure of NIV had longer ICU stay (median 9.5 vs. 6.6 days) and higher hospital mortality (92% vs. 3%) compared with those with NIV success. Conclusions: Nosocomial pneumonia; heart rate at initiation of NIV; and consciousness, acidosis, and oxygenation at 1-2 h of NIV were associated with late failure of NIV in patients with COPD exacerbation. And, late failure of NIV was associated with increased hospital mortality.


Assuntos
Desequilíbrio Ácido-Base/epidemiologia , Pneumonia Associada a Assistência à Saúde/epidemiologia , Frequência Cardíaca , Intubação Intratraqueal/estatística & dados numéricos , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Gasometria , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Oxigênio/sangue , Pressão Parcial , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Taxa Respiratória , Fatores de Risco , Fatores de Tempo , Falha de Tratamento
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