Phosphine-catalyzed [3 + 2] annulation reaction: highly regio- and diastereoselective synthesis of 2-azaspiro[4.4]nonene-1,3-diones.

A novel phosphine-catalyzed [3 + 2] annulation of γ-substituted allenoates with succinimides was developed, which was successfully applied to the synthesis of 2-azaspiro[4.4]nonene-1,3-dione derivatives. The reaction afforded the desired products in moderate to high yields (up to 96%) with excellent regioselectivities and diastereoselectivities (up to >99 : 1 dr). A plausible reaction mechanism has also been proposed based on previous literature.

Chiral bifunctional ferrocenylphosphine catalyzed highly enantioselective [3 + 2] cycloaddition reaction.

A series of air-stable ferrocenylphosphines LB1-LB8 were designed and prepared in high yields. (R,SFc)-ferrocenylphosphine LB5 was found to efficiently promote the asymmetric [3 + 2] cycloaddition of Morita-Baylis-Hillman carbonates with maleimides to afford the corresponding bicyclic imides with 84-99% ee and 67-99% yield. Interestingly, the configuration of these products was contrary to those reported in the literature.

[Clinical analysis of acute invasive fungal sinusitis with orbital infection].

The clinical manifestation of acute invasive fungal sinusitis was associated with facial pain,altered sense of smell, blindness and headache. Physical examinations show that dark brown nasal secretions with bone resorption in paranasal sinus. Radiographi parameters showed uneven density in paranasal sinus and intraorbital extension. Fungus smears and pathological examination can make a definitive diagnosis.

[Analysis of food allergens in patients with allergic rhinitis in Guangzhou].

OBJECTIVE: To investigate the distribution of multiple food allergens in patients with allergic rhinitis in Guangzhou area. METHOD: Skin prick tests were performed in 1529 patients with allergic rhinitis. The result was discussed by the age of patients, the types of allergens and the response intensity. RESULT: Five hundred and eighty-seven cases were positive. The most important food allergens were crab (25.6%), prawn (19.4%). There were statistical differences of positive reactions among three age groups (P < 0. 05). The main food allergen was seafood. CONCLUSION: Crab and prawn are the main food allergens in patients with allergic rhinitis in Guangzhou. It is helpful for clinical diagnosis and treatment.

[Treating obstructive sleep apnea with nasal operation and revised uvulopalatopharyngoplasty].

OBJECTIVE: Nasal operation and/or H-uvulopalatopharyngoplasty (UPPP) was performed for obstructive sleep apnea hypopnea syndrome (OSAHS) patients with both oral pharynx and nasal obstruction, results analyzed. METHODS: Patients were divided into group A (46 cases) and group B (42 case) randomly. Nasal procedures were: septoplasty, radiofrequency reduction of inferior turbinate, adenoidectomy and functional endoscopic operation. Cases in group A had nasal operation first, while cases in group B first had UPPP. All patients had sleep study with polysomnography (PSG) 2 and 12 months after each operation. Those who failed to reach the criteria of being effective after first surgery (defined as a 25% reduction in baseline apnea hypopnea index (AHI) received second phase operation (nasal operation for group B and UPPP for group A). The response rates were compared between the two groups after each phase of operation. RESULTS: In group A, the phase one operation were effective in 44.0% (11/25) for the mild degree OSAHS patients (defined as AHI < 20/h), according to the sleep study performed 2 months after surgery, and no recurrence after one-year. All moderate ones (defined as 20/h < AHI < 40/h) responded poorly to nasal operation. The overall response rate was 23.9% (11/46). Non-responses (35 cases) in group A underwent UPPP and the response rate to it was 85.7% (30/35) in one year. In group B, UPPP operation was effective in 63.6% (14/22) mild cases and 30.0% (6/20) moderate cases in 2 months but 4 cases had recurrence in one year. Twenty-two cases underwent the second phase operation of nose and the response rate was 86.4% (19/22) in one year. There was no statistical significance on the overall response rate between group A and B (89.1% vs 83.3%, P > 0.05). While there was statistical significance of response rate between those patients who had only one operation and those who had both surgeries (P < 0.05). CONCLUSIONS: The combination of nasal procedures and UPPP is effective a for OSAHS patient with nasal diseases especially in mild and moderate cases.

[A clinical study on obstructive sleep apnea hypopnea syndrome treating by nasal operation].

OBJECTIVE: To study the treatment of OSAHS with nasal diseases by nasal operation. METHOD: Ninety four cases of OSAHS with nasal diseases were analyzed. The patients were operated on nasal cavity to improve ventilation included Septectomy, CPS for inferior turbinate and FESS. The patients were examined by PSG at 2 months and 1 year after operation. All patients were followed up one year. RESULT: Among 94 cases, 19 cases had efficient result after nasal operation and had no recurrence one year after operation. The efficient rate was 20. 21% (19/94). These patients were mild degree and I type. The other 75 cases had invalid result. CONCLUSION: The patients of OSAHS with nasal diseases, especially mild degree and I type one should be undertaken nasal operation.

Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: a controlled study.

BACKGROUND: Portal hypertensive gastropathy is an important complication of liver cirrhosis and it contributes to acute gastric bleeding. Effective management of this condition remains a clinical challenge. We assessed and compared the efficacy of octreotide, vasopressin, and omeprazole in the treatment of acute bleeding in patients with portal hypertensive gastropathy. METHODS: Sixty-eight patients with portal hypertensive gastropathy were randomized into Octreotide, Vasopressin, and Omeprazole groups. Bleeding was monitored by observing the contents of the nasogastric tube. Blood transfusion requirements and side-effects of drugs were recorded. Repeat endoscopies were scheduled 2 weeks after treatment. RESULTS: Complete bleeding control after 48 h of drug infusion was achieved in all patients receiving octreotide (100%), 14/22 patients receiving vasopressin (64%), and 13/22 patients receiving Omeprazole (59%). Octreotide required much less time and significantly fewer blood transfusions to control bleeding. Patients receiving vasopressin experienced more side-effects than those receiving octreotide and omeprazole. In the 17 patients whose bleeding was not controlled within 48 h by either vasopressin or omeprazole, complete bleeding control was achieved by combined use of these two agents. Follow-up endoscopy showed dramatic improvement in gastric mucosal erosions, superficial ulceration and erythema. CONCLUSIONS: Octreotide appeared to be more effective in controlling acute bleeding in patients with hypertensive gastropathy, with significantly rapid action, smaller transfusion requirements, and minor side-effects. Simultaneous administration of vasopressin and omeprazole appeared to have additive effects.