Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.

BACKGROUND: Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system, comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate. It severely affects the patients' quality of life. AIM: To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage. METHODS: From March 2018 to May 2020, 118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan. The control group used a hard-channel minimally invasive puncture and drainage procedure. The observation group underwent minimally invasive neuroendoscopic surgery. The changes in the levels of serum P substances (SP), inflammatory factors [tumor necrosis factor-α, interleukin-6 (IL-6), IL-10], and the National Hospital Stroke Scale (NIHSS) and Barthel index scores were recorded. Surgery related indicators and prognosis were compared between the two groups. RESULTS: The operation time (105.26 ± 28.35) of the observation group was min longer than that of the control group, and the volume of intraoperative bleeding was 45.36 ± 10.17 mL more than that of the control group. The hematoma clearance rates were 88.58% ± 4.69% and 94.47% ± 4.02% higher than those of the control group at 48 h and 72 h, respectively. Good prognosis rate (86.44%) was higher in the observation group than in the control group, and complication rate (5.08%) was not significantly different from that of the control group (P > 0.05).The SP level and Barthel index score of the two groups increased (P < 0.05) and the inflammatory factors and NIHSS score decreased (P < 0.05). The cytokine levels, NIHSS score, and Barthel index score were better in the observation group than in the control group (P < 0.05). CONCLUSION: Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage; however, hematoma clearance is more thorough, and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

Organocatalyst-controlled site-selective arene C-H functionalization.

Over the past three decades, organocatalysis has emerged as a powerful catalysis platform and has gradually been incorporated into the routine synthetic toolbox to obtain chiral molecules. However, its application in the site- and enantioselective functionalization of inactive aryl C-H bonds remains in its infancy. Here, we present an organocatalyst-controlled para-selective arene C-H functionalization strategy that addresses this issue, which remains an enduring challenge in arene functionalization chemistry. By emulating enzyme catalysis, the chiral phosphoric acid catalyst offers an ideal chiral environment for stereoinduction, and the projecting substituents give control of chemo- and site-selectivity. Various types of nucleophile are compatible with this method, affording more than 100 para-selective adducts with stereodefined carbon centres or axes in viable molecular contexts. This protocol is expected to provide a general strategy for para-selective functionalization of arene C-H bonds in a controlled manner.

Organocatalytic asymmetric arylation of indoles enabled by azo groups.

Arylation is a fundamental reaction that can be mostly fulfilled by electrophilic aromatic substitution and transition-metal-catalysed aryl functionalization. Although the azo group has been used as a directing group for many transformations via transition-metal-catalysed aryl carbon-hydrogen (C-H) bond activation, there remain significant unmet challenges in organocatalytic arylation. Here, we show that the azo group can effectively act as both a directing and activating group for organocatalytic asymmetric arylation of indoles via formal nucleophilic aromatic substitution of azobenzene derivatives. Thus, a wide range of axially chiral arylindoles have been achieved in good yields with excellent enantioselectivities by utilizing chiral phosphoric acid as catalyst. Furthermore, highly enantioenriched pyrroloindoles bearing two contiguous quaternary chiral centres have also been obtained via a cascade enantioselective formal nucleophilic aromatic substitution-cyclization process. This strategy should be useful in other related research fields and will open new avenues for organocatalytic asymmetric aryl functionalization.

Comparison of neuroendoscopic and microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels / 中国内镜杂志

Objective To compare the efficacy of neuroendoscopic vs microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels and clinical symptoms. Methods A retrospective analysis was conducted on 211 cases with pituitary tumor resection patients from January 2012 to June 2016, of which 112 cases with endoscopic endonasal transsphenoidal pituitary tumor resection (group A), 99 cases with microscopic transsphenoidal pituitary tumor resection (group B), and operation related indexes, hormone variations before discharge and symptoms remission 24 weeks after operation were extracted and compared. Results Two groups of patients with different tumor resection extent (Z = 2.14, P = 0.032), group A achieved total resection rate was significantly higher than the group B (79.5% vs 67.7%) (P = 0.037); the operation time of group A was significantly longer than group B [(93.6 ± 26.7) vs (79.8 ± 20.2) min, t = 4.26, P = 0.000], group A with the mean hospitalization stay was significantly less than group B [(7.9 ± 2.5) vs (10.2 ± 4.3) d, t = 4.67, P = 0.000], postoperative complications of group A were significantly lower than those of group B (5.4% vs 14.1%, χ2 = 4.73, P = 0.030). Two groups of postoperative hormone levels decreased in different degree (Z = 2.42, P = 0.016), group A with hormone recovery rate before discharge was significantly higher than group B (82.2% vs 66.7%, χ2 = 6.09, P = 0.014), and decline on prolactinomas, ACTH adenoma, ghrelin hormone were significantly higher than group B [(43.2 ± 10.5) vs (33.5 ± 9.1) ng/ml, (26.0 ± 8.8) vs (20.2 ± 7.0) pmol/L, (11.0 ± 3.9) vs (8.7 ± 3.2) μg/L, t = 3.60, t = 2.65, t = 2.12, all P < 0.05]. There was no significant differences between the two groups in remission of clinical symptoms 24 weeks after operation (P > 0.05). Conclusion Neuroendoscopic endonasal transsphenoidal pituitary adenoma resection is more efficient and less operative complications compared with microscopic surgery, which is more conducive to the recovery of postoperative hormone levels.

N-Heterocyclic Carbene-Catalyzed Oxidative Annulations of α,ß-Unsaturated Aldehydes with Hydrazones: Selective Synthesis of Optically Active 4,5-Dihydropyridazin-3-ones and Pyridazin-3-ones.

A novel and efficient method for the highly enantioselective synthesis of chiral 4,5-dihydropyridazin-3-one derivatives has been developed based on the chiral N-heterocyclic carbene-catalyzed oxidative annulation between α,ß-unsaturated aldehydes and hydrazones. Meanwhile, the selective synthesis of either 4,5-dihydropyridazin-3-ones or pyridazin-3-one derivatives from the same reactants has been achieved by simply varying catalytic and reaction conditions.

A novel NKX2.6 mutation associated with congenital ventricular septal defect.

Congenital heart disease (CHD) is the most common birth defect and is the most prevalent non-infectious cause of infant death. Aggregating evidence demonstrates that genetic defects are involved in the pathogenesis of CHD. However, CHD is genetically heterogeneous and the genetic determinants for CHD in an overwhelming majority of patients remain unknown. In this study, the coding regions and splice junctions of the NKX2.6 gene, which encodes a homeodomain transcription factor crucial for cardiovascular development, were sequenced in 210 unrelated CHD patients. As a result, a novel heterozygous NKX2.6 mutation, p.K152Q, was identified in an index patient with ventricular septal defect (VSD). Genetic analysis of the proband's available family members showed that the mutation cosegregated with VSD transmitted as an autosomal dominant trait with complete penetrance. The missense mutation was absent in 400 control chromosomes and the altered amino acid was completely conserved evolutionarily across species. Due to unknown transcriptional targets of NKX2.6, the functional characteristics of the identified mutation at transcriptional activity were analyzed by using NKX2.5 as a surrogate. Alignment between human NKX2.6 and NKX2.5 proteins displayed that K152Q-mutant NKX2.6 was equivalent to K158Q-mutant NKX2.5, and introduction of K158Q into NKX2.5 significantly reduced its transcriptional activating function when compared with its wild-type counterpart. This study firstly links NKX2.6 loss-of-function mutation with increased susceptibility to isolated VSD, providing novel insight into the molecular mechanism underpinning VSD and contributing to the development of new preventive and therapeutic strategies for this common form of CHD.

Changing the reaction pathway by NHC/Brønsted base cooperative catalysis: highly stereoselective synthesis of multifunctional benzo[a]fluoren-11-ones from the dimerization of 2-(aroylvinyl)arylaldehydes.

The unprecedented NHC/Brønsted base-cocatalyzed dimerization reaction of 2-(aroylvinyl)arylaldehydes was reported. In the presence of a triazole carbene catalyst alone, no reaction of 2-(aroylvinyl)arylaldehydes was observed. However, the combination of triazole carbene and 4-methoxyphenolate efficiently catalyzed the dimerization of 2-(aroylvinyl)arylaldehydes to proceed through a benzoin-Michael-Michael reaction cascade, producing 6-aroyl-5-(aroylmethyl)-11a-hydroxybenzo[a]fluoren-11-ones as the sole diastereomers in good yields.