[Annual review of interventional pulmonology in 2022]

Interventional pulmonology is an essential part of the treatment of respiratory diseases and an important component of modern respiratory medicine. In recent years, interventional respiratory medicine has kept up with the trend of the times, constantly developing and integrating various techniques, expanding the scope of application of interventional respiratory medicine, and developing in the direction of personalized and precision medicine as well. Here, we reviewed the new progress and up-to-date research achievements of interventional pulmonology from December 2021 to September 2022.

[Analysis of clinical phenotype and genotype of Chinese children with disorders of sex development]

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

Circular RNA expression alteration and bioinformatics analysis in patients with acute cerebral infarction injury

In recent years, a steady increase has been detected in the incidence of acute cerebral infarction (ACI). ACI is caused by blood flow disruption, leading to high disability and mortality rates. Understanding the underlying molecular mechanisms is critical toward developing effective therapeutic approaches. Circular RNAs (circRNAs) are an important class of non-coding RNAs, which have been implicated in several molecular pathways, and their dysregulation has been described in several disease conditions. Here, we set out to explore the possible regulatory role of circRNAs in ischemic stroke and study their molecular function in disease. First, we applied high-throughput sequencing techniques to identify the differential changes of plasma circRNAs expression in patients with acute cerebral infarction. Next, we used GO and KEGG pathway analysis to predict the function of differentially expressed circRNAs. Moreover, we have assessed the possible interaction between the identified differentially expressed circRNAs and miRNAs. Finally, we have selected and validated five downregulated circRNAs by RT-qPCR. Together, the results of this study provide evidence that circRNAs are potential biomarkers for early diagnosis of cerebral infarction and have to be considered as targets for drug treatment.

[A randomized controlled study of peramivir, oseltamivir and placebo in patients with mild influenza]

Objectives: To evaluate the effectiveness and safety of peramivir trihydrate in patients with influenza. Methods: This was a randomized, double-blind, double-dummy, placebo and positive control, multicenter clinical trial, comparing peramivir trihydrate with oseltamivir and placebo. The inclusive criteria were 15-70 years old, onset within 48 h, positive rapid influenza antigen test, and febrile (>38℃) accompanied with at least two associated symptoms. The severe cases complicated with chronic pulmonary and cardiac diseases, malignancies, organ transplantation, hemodialysis, uncontrolled diabetes, immunocompromised status, pregnancy and coexistence of bacterium infections were excluded. All patients were randomized 2∶2∶1 to receive peramivir, oseltamivir and placebo respectively. The primary endpoint was the disease duration, the secondary endpoints included time to normal axillary temperature and normal living activities, viral response, and adverse effects. Results: Following informed consent, 133 patients were included in this study. Four patients were exclude due to missing medical records, not fitting inclusion or exclusion criteria and poor compliance. A total of 129 patients were finally analyzed, including 49 cases, 54 cases and 26 cases in peramivir group, oseltamivir group and placebo group. The median disease duration were 96 (76, 120) hours, 105 (90,124) hours, and 124 (104, 172) hours in three groups respectively (P>0.05) . The time to normal axillary temperature, normal living activities and viral response were not significantly different in three groups (P>0.05) . Conclusion: The value of antiviral therapy in patients with mild influenza needs to be further determined.

[The efficacy and safety of transbronchial lung cryobiopsy in interstitial lung disease: a prospective study]

Objective: To evaluate the efficacy and safety of transbronchial lung cryobiopsy (TBCB) and conventional transbronchial lung biopsy (TBLB) in the diagnosis of interstitial lung diseases(ILD). Methods: A prospective, self-control study was conducted during January 2017 and April 2017 in First Affiliated Hospital of Guangzhou Medical University. A total of 25 patients [male 16, female 9; mean age (51±13) years, range 24 to 70 years] with inconclusive diagnosis of interstitial lung diseases were sequentially enrolled. In the study, TBCB (TBCB group) and TBLB (TBLB group) were performed successively under general anesthesia in all patients. The size of biopsy specimens, the duration of procedures, complications and pathological results were recorded. Gaussian distribution data were compared between 2 groups by using Student's t test, while abnormal distribution data were compared by using Wilcoxon rank sum test. The incidences of bleeding and pathologic diagnostic yield between the 2 groups were compared by using Pearson chi-square test. A P-value< 0.05 was assumed to be statistically significant. Results: The specimen sizes of TBCB group and TBLB group were (12.3+ 4.9) and (3.1+ 1.9) mm(2) respectively (t=-18.268, P=0.000). The duration of procedures was (7.8±3.2) and (5.4±2.1)min respectively (Z=-3.001, P=0.003). In TBCB group, the diagnostic yield was 72% (18/25), with valuable pathological results in 2 cases (8%), but in 5 cases (20%) it failed to provide valuable pathological results. In TBLB group, the diagnostic yield was 12% (3/25). There were no useful pathological results in other 22 cases. The difference in the rate of useful pathological results between TBCB group and TBLB group was significant (χ(2)=20.779, P=0.000). There was no pneumothorax or severe bleeding. The rate of mild to moderate bleeding in TBCB group and TBLB group was 47.2%(50/106) and 18.9%(20/106) (χ(2)=19.195, P=0.000) respectively. Conclusion: TBCB is superior to TBLB for lung biopsy as indicated by larger sample size, higher diagnostic yield and less complication. TBCB is valuable for the diagnosis of ILD.

[Measurement and analysis of tracheal inner diameter in Chinese adults using multi-slice spiral CT, multi-planar reconstruction and special window technique]

Objective: To measure the inner diameter of tracheal(TD) in Chinese adults by multi-slice spiral CT(MSCT), multi-planar reconstruction(MPR) with special window technique and analyze its influencing factors. Methods: A total of 824 normal adults(male 435, female 389) and 16 patients with small peripheral pulmonary nodules(SPN) receiving chest multi-slice spiral CT (MSCT) in the physical examination at the First Affiliated Hospital of Guangzhou Medical University between January, 2014 and December, 2015 were included and their records were retrospectively analyzed. The 16 patients with SPN received bronchoscopy and the images were recorded followed by measurement of tracheal diameter using software. MSCT and MPR images were obtained by the 3Dview software, and the inner diameter of the trachea at 4 horizontal positions were measured by special window technique (window width 500 Hu, window level 100 Hu): thoracic entrance (TD(1)), aortic arch (TD(2)), 2 cm higher than the carina of trachea (TD(3)) and the narrowest trachea (TD(4)). Results: The results of bronchoscopy and software measurement in 16 patients were consistent with those of MSCT and MPR combined with special window technique (P>0.05). The TD at 4 positions in adult males were larger than those of adult females (P<0.01). The TD values at each position for males and females were as follows: (18.9±1.7) and (15.6±1.3) mm (t=30.9, P<0.01) for TD(1), (18.8±1.6) and (16.1±1.2) mm (t=28.0, P<0.01) for TD(2), (19.0±1.6) and (16.3±1.3) mm (t=26.5, P<0.01) for TD(3), (18.4±1.5) and (15.5±1.1) mm (t=31.3, P<0.01) for TD(4), respectively. The age, weight and BMI were not significantly correlated with the tracheal diameter (P>0.05). The height was linearly correlated with the tracheal diameter: for males, TD(1)=0.071× height (cm) + 6.964 (r=0.249, P<0.05), TD(2)=0.064 × height (cm) + 7.898 (r=0.246, P<0.05), TD(3)=0.074 × height (cm) + 6.533 (r=0.279, P<0.05), TD(4)=0.056 × height(cm) + 8.811(r=0.226, P<0.05); while for females, TD(1)= 0.046× height (cm) + 8.331 (r=0.183, P<0.05), TD(2) = 0.058 × height (cm)+ 6.950(r=0.248, P<0.05), TD(3)=0.059 × height (cm)+ 7.052 (r=0.235, P<0.05), TD(4) =0.044× height (cm) + 8.520 (r=0.208, P<0.05). Conclusion: MSCT and MPR combined with special window technique are accurate and feasible for the measurement of adult tracheal diameter. The diameter of the trachea in males is larger than that in females, and it is positively correlated with height, but not with age, body weight and BMI. The tracheal diameter can be evaluated by linear regression equation.

Myelinated Ah-type trigeminal ganglion neurons in female rats: neuroexcitability, chemosensitivity to histamine, and potential clinical impact

Migraine is a chronic neurological disorder characterized by recurrent moderate-to-severe headaches often associated with numerous autonomic nervous system symptoms, and it is more prevalent in women. To fully understand the underlying mechanism, standard electrophysiology was performed with trigeminal ganglion neurons (TGNs) isolated from adult rats of both genders using the whole-cell patch clamp technique to test the distribution, neuroexcitability, and chemosensitivity to histamine. In addition to traditionally classified A- and C-type TGNs, myelinated Ah-type TGNs were also observed in females. The electrophysiological features showed low firing threshold and the capability to fire repetitively upon stimulation. Ah-type neurons also functionally expressed persistent TTX-R Na(+) channels with more hyperpolarized activating voltage. Iberiotoxin and NS11021 significantly altered the discharge profiles of Ah-type TGNs. Finally, Ah-type TGNs showed a more potent reaction to histamine, with relatively larger inward currents and membrane depolarization compared with C-types. These data provide evidence of the gender-specific distribution of myelinated Ah-type TGNs in adult female rats, characterized by a low threshold and high frequency of firing that are at least partially attributable to persistent TTX-R Na(+) and BK-KCa channel expression and potent chemosensitivity to histamine, suggesting that Ah-type TGNs may play a key role in gender differences in migraine.

Development and validation of an improved Bradford method for determination of insulin from chitosan nanoparticulate systems

CONTEXT

Blank chitosan nanoparticles are currently used as reference for the calibration curve, which fails to resolve the supernatant of the nanoparticles in the interference of Coomassie Brilliant Blue G-250 reagent; supernatants are generated at different chitosan nanoparticulate prescriptions, which have different interferences. There are notable errors in the experimental results, and the method is not feasible.

OBJECTIVE

In this study, an improved, rapid, and economic Bradford method was developed and validated.

MATERIALS AND METHODS

The pH of the supernatant of blank chitosan nanoparticles was adjusted to 7-9 through adding saturated NaOH. The precipitation (free chitosan) in the solution was separated by centrifuging for about 10 min (4000 r/min).

RESULTS

The method eliminated the interference of free chitosan of different prescriptions. The results showed that the method presented a linearity in the range of 50-300 microg/mL (R(2) = 0.9992), and possessed a good inter-day and intra-day precision based on relative standard deviation values (less than 3.10%). Recovery of the supernatant of blank chitosan nanoparticles was between 98.30 and 99.93%, and the recovery of blank chitosan nanoparticles was between 95.57 and 100.27%.

DISCUSSION AND CONCLUSION

The method was further tested for determination of the association efficiency of insulin to nanoparticulate carriers composed of chitosan. Encapsulant release under simulated gastrointestinal fluids was evaluated.

Immunosuppressive constituents from Urtica dentata Hand

A novel biscoumarin, 6,6',7,7'-tetramethoxyl-8,8'-biscoumarin (1), was isolated from the ethyl acetate extract of Urtica dentata Hand, together with five known compounds named as 7,7'-dihydroxy-6,6'-dimethoxy-8,8'-biscoumarin (2), 7,7'-dimethoxy-6,6'-biscoumarin (3), scoparone (4), vanillic acid (5), and daucosterol (6). Structures of the isolated compounds were elucidated on the basis of spectroscopic analysis including 2D NMR experiments. Compounds 1 and 2 were confirmed to be a rare carbon-carbon linked symmetrical biscoumarin. Compounds 1-4, especially 1 (IC(50) = 8.18 x 10(- 5) mol/l), showed potent immunosuppressive activities as determined by the Cell Counting Kit-8 assay for lymphocyte proliferation. Also, in the FACS analysis, 1 (IC(50) = 5.19 x 10(- 4) mol/l) promoted the differentiation of CD4(+)CD25(+)Foxp3(+) T regulatory cells distinctly compared to the normal control. Thus, 1 possessed specific immunosuppressive property by eliciting T regulatory cells, which may provide a potential treatment strategy for autoimmune diseases.