Traditional Chinese medicine of Polygonum cuspidatum has been utilized in China for thousands of years. Its primary active compound, polydatin, exhibits a variety of pharmacological effects including the regulation of glucose and lipid metabolism, suppression of cough and asthma, as well as antibacterial and anti-inflammatory properties. However, conventional methods for polydatin production are inadequate to satisfy the market demand. This study aims to explore the green and efficient preparation of polydatin. With resveratrol as the substrate, we efficiently synthesized polydatin by using the triple mutant IGW (Y14I/I62G/M315W) of the glycosyltransferase UGT_BS based on a strategy of two-enzyme coupled with one-pot and realized the recycling of uridine diphosphate-glucose (UDPG). The conditions of the two-enzyme reaction were optimized. Under the conditions of 35 ℃, pH 8.0, IGW: AtSuSy1 activity ratio of 3:4, dimethyl sulfoxide (DMSO) volume fraction of 5%, uridine diphosphate (UDP) concentration of 0.10 mmol/L, and sucrose concentration of 0.6 mol/L, the conversion of 2 mmol/L resveratrol reached 80.6% within 1 h, and the proportion of polydatin was over 90%. This study achieved the recycling of UDPG via a two-enzyme coupling system and shortened the reaction time. At the same time, the fed-batch strategy was adopted, and the yield of polydatin reached 6.28 g/L after 24 h in the one-pot coupling reaction, which provided a new strategy for green and efficient preparation of polydatin.
Stilbenes/chemistry* ; Glucosides/biosynthesis* ; Resveratrol ; Fallopia japonica/chemistry* ; Glycosyltransferases/genetics*

Objective To evaluate the relationship between diabetic nephropathy(DN)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM)based on imaging and clinical testing data.Methods Totally 600 T2DM patients who visited the First People's Hospital of Ziyang from March 2021 to December 2022 were included.The fundus photography and fundus fluorescein angiography were performed on all these patients and their age,gender,T2DM duration,cardiovascular diseases,cerebrovascular disease,hypertension,smoking history,drinking history,body mass in-dex,systolic blood pressure,diastolic blood pressure and other clinical data were collected.The levels of fasting blood glu-cose(FPG),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipo-protein cholesterol(LDL-C),glycosylated hemoglobin(HbA1c),24 h urinary albumin(UAlb),urinary albumin to creati-nine ratio(ACR),serum creatinine(Scr)and blood urea nitrogen(BUN)were measured.Logistic regression was used to analyze the risk factors associated with DR.DR staging was performed according to fundus images,and the convolutional neural network(CNN)algorithm was used as an image analysis method to explore the correlation between DR and DN based on emission computed tomography(ECT)and clinical testing data.Results The average lesion area rates of DR and DN detected by the CNN in the non-DR,mild-non-proliferative DR(NPDR),moderate-NPDR,severe-NPDR and pro-liferative DR(PDR)groups were higher than those obtained by the traditional algorithm(TCM).As DR worsened,the Scr,BUN,24 h UAlb and ACR gradually increased.Besides,the incidence of DN in the non-DR,mild-NPDR,moderate-NPDR,severe-NPDR and PDR groups was 1.67％,8.83％,16.16％,22.16％and 30.83％,respectively.Logistic regression analysis showed that the duration of T2DM,smoking history,HbA1c,TC,TG,HDL-C,LDL-C,24 h UAlb,Scr,BUN,ACR and glomerular filtration rate(GFR)were independent risk factors for DR.Renal dynamic ECT analysis demonstrated that with the aggravation of DR,renal blood flow perfusion gradually decreased,resulting in diminished renal filtration.Conclusion The application of CCN in the early stage DR and DN image analysis of T2DM patients will improve the diag-nosis accuracy of DR and DN lesion area.The DN is worsening as the aggravation of DR.

Objective Visual electrophysiology and optical correlation tomography angiography(OCTA)were used to investigate differences in preoperative retinal function in patients with type 2 diabetic cataract(DC)without obvious retinopathy(NDR)and to determine the clinical application of whole-process blood glucose man-agement(WBGM)for improving postoperative vision in DC patients.Methods This study investigated the preop-erative and postoperative visual electrophysiology(N75,P100,photopic FERG,and scotopic FERG),peripapil-lary retinal nerve fiber layer(pRNFL)and peripapillary capillary vessel density(ppVD)data,as well as trends in these data changes during blood glucose management intervention.Results As the course of T2DM progressed,FBG and HbA1c increased,the N75 and P100 lategraduancy periods of patients gradually lengthened,and the photopic FERG,scotopic FERG,pRNFL,and ppVD values decreased at each postoperative time point.At the same time,the best corrected visual acuity(BCVA)of patients after surgery gradually decreased(P<0.05).Compared with that at 1 week after surgery,the BCVA of Group A(without whole-process blood glucose manage-ment)gradually increased at 1 month and 3 months after surgery but showed a downward trend at 1 year after sur-gery.The BCVA of Group B(with whole-process blood glucose management)gradually stabilized at 1 month after surgery,and at all time points after surgery,the BCVA of Group B was better than that of Group A.The results showed that N75 and P100 in Group A were greater than those in Group B,while the photopic and scotopic FERG,pRNFL,and ppVD(%)in Group A were lower than those in Group B.In addition,N75 and P100 in Group A showed a gradual prolongation trend at various time points after surgery,while photopic FERG,scotopic FERG,pRNFL,and ppVD(%)showed a gradually decreasing trend.However,the above data in Group B gradu-ally stabilized at 3 months after DC surgery,approaching the preoperative level of the group(P<0.05).In the state of whole blood glucose management,although N75 and P100 both reached their longest durations at 1 week af-ter surgery,N75,P100,photopic FERG,scotopic FERG,and pRNFL showed a gradually decreasing trend at 1 month and 3 months after surgery,while ppVD(%)gradually increased(P<0.05).At various time points from 3 months to 1 year after surgery,the overall trend of the above indicators remained stable and close to the preoperative values(P>0.05).Conclusion According to the results of the quantitative analysis of visual electrophysiology and OCTA,in DC patients without obvious retinopathy and with the worsening of diabetes,retinal function decreased,but whole-process blood glucose management effectively restored retinal function and improved visual quality after surgery.

Objective This research was to evaluate the integrity of visual pathways in patients with Parkinson disease(PD)by visual evoked potential(VEP),especially those with visual hallucinations.Methods A total of 76 PD patients were enrolled in this study.According to the presence or absence of visual hallucinations,they were divided into two groups:24 patients with visual hallucinations and 52 patients without visual hallucinations.At the same time,22 sex-and age-matched healthy controls were selected.All subjects underwent VEP test,and Unified Parkinson's Disease Rating Scale(UPDRS),Hoehn&Yahr stage(H-Y stage)and Mini-mental State Examination(MMSE)were performed for PD patients.Results The latencies of N75,P100 and N135(88.26±10.47)ms,(118.48±8.53)ms,(144.71±9.48)ms were significantly longer in PD patients with visual hallucinations than in those without visual hallucinations[(79.00±6.96)ms,(108.60±7.01)ms,(135.95±8.21)ms](P<0.001).However,the amplitudes of N75-P100 and N135-P100[4.35(2.73,7.30)μV]、[6.40(4.15,9.90)μV]were significantly lower in PD patients with visual hallucinations than in those without visual hallucinations[7.10(5.28,9.98)μV]、[9.05(6.30,12.60)μV](P<0.001,P=0.037).Correlation analysis showed that P100 latency was positively correlated with H-Y stage,UPDRS-I,UPDRS-II,and UPDRS-III scores(r=0.537,P=0.007),(r=0.635,P=0.001),(r=0.594,P=0.004)and(r=0.558,P=0.005)in PD visual hallucinations group.Conclusion The integrity of the visual pathway is impaired in PD patients with visual hallucinations.As the progression of the disease,the impairment of visual pathway may be further deteriorated,which may extend beyond the upper pathways of visual pathway to the brain.

OBJECTIVE: To compare effectiveness of injecting platelet-rich plasma (PRP) with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury. METHODS: A clinical data of 30 patients with supraspinatus tendon injury, who met the selection criteria and were admitted between December 2022 and December 2023, was retrospectively analyzed. Thirty patients were treated with 4 injections of leukocyte-poor PRP (LP-PRP, n=10), leukocyte-rich PRP (LR-PRP, n=11), and triamcinolone ( n=9), with an interval of 7-10 days between each injection. There was no significant difference between groups ( P>0.05) in the age, gender, disease duration, affected shoulder side, Ellman classification, preoperative visual analogue scale (VAS) score, Constant score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score. At 1, 3, and 6 months after injection, the shoulder pain and function were evaluated by using the VAS score, Constant score, DASH score, and ASES score. MRI was conducted to observe supraspinatus tendon healing. RESULTS: No severe adverse reactions was observed in all groups. All patients were followed up 6-7 months, with an average of 6.5 months. After injection, the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group, while the VAS score and DASH score decreased, with significant differences compared to before injection ( P<0.05). Except for no significant difference between 3 and 6 months after injection in LR-PRP group ( P>0.05), the above scores showed significant differences between different time points ( P<0.05). At 1 month after injection, the Constant score in triamcinolone group significantly increased compared to before injection, while the VAS score significantly decreased ( P<0.05). There was no significant difference in all scores between other time points in the triamcinolone group ( P>0.05). Except for 1 month after injection, there was no significant difference in Constant score and VAS score between groups ( P>0.05). At all other time points, the LR-PRP group and LP-PRP group had better scores than the triamcinolone group ( P<0.05). There was no significant difference between the LR-PRP group and the LP-PRP group ( P>0.05). MRI showed that only 4 patients in the LP-PRP group had signs of repair at the supraspinatus tendon injury site at 6 months after injection, while no significant tendon repair sign was observed in the other patients. CONCLUSION Compared with triamcinolone treatment, multiple injections of LP-PRP and LR-PRP under ultrasound can promote the recovery of shoulder joint function and significantly relieve pain in patients with supraspinatus tendon injury, and imaging improvement can be seen after LP-PRP treatment.
Humans ; Platelet-Rich Plasma ; Rotator Cuff Injuries/therapy* ; Female ; Male ; Treatment Outcome ; Pain Measurement ; Leukocytes ; Tendon Injuries/therapy* ; Middle Aged ; Ultrasonography ; Ultrasonography, Interventional ; Range of Motion, Articular ; Adult

This paper introduced the development of medical specialists alliance in Zhejiang University. With Jinhua Central Hospital as an example,merits and setbacks of the 3-level trusteeship model in practice were discussed,with improvement recommendations raised for progress of the hierarchical medical system.

Thanks to the policies of resources to strengthen grassroots ,and innovative resource placement in Zhejiang province and the help of Zhejiang University School of Medicine ,Shaoxing regional medical center has achieved significant improvement in its medical capabilities .The cooperation features the following :active promotion of new medical ideas and key technologies ;overall enhancement of scientific and technological innovation ;talent training to advance disciplinary development ;and joint efforts to train postgraduates .The momentum ,however ,can only be maintained ,unless such problems as the means of resources placement ,disciplines alignment ,and medical workers development can be well addressed .

Objective To study the role of call stimulate in arousal of coma patients after severe craniocerebral injury.Methods Twenty patients with severe craniocerebral trauma coma,admitted to our hospital from June 2014 to June 2015,were randomly divided into stimulation group (n=13) and control group (n=7).In addition to the regular relatives call stimulation,other treatments in stimulation group were the same as the control group.One,2,and 4 weeks after call stimulation,Glasgow Coma Scale (GCS) scores,blood flow velocity changes of internal carotid artery (ICA) and middle cerebral artery (MCA),and neurotransmitter contents of5-hydroxytryptamine (5-HT),dopamine (DA),norepinephrine (NE) and acetylcholine (Ach) in the cerebrospinal fluid (CSF) were detected.Results The consciousness was significantly improved in the stimulation group since the second week;at the 4th week,the GCS scores (11.85±2.58) were significantly higher than those in the control group (9.14±2.85,P＜0.05).ICA and MCA blood flow velocity of both groups reached peak level in the first week,and then,gradually decreased till the end of the observation;ICA velocity value in the stimulation group (72.85± 7.45) was lower than that in the control group (82.14±11.61).The DA,Ach and NE content in the stimulation group were significantly increased at the 4th week as compared with those in the control group (P＜0.05);but no significant difference was noted between the two groups in the content of 5-TH (P＞0.05).Conclusion The call stimulus has certain awaking effect on coma patients,whose mechanism may be related to call induced changes of cerebral blood flow velocity and related neurotransmitter release.

Objective To assess the clinical efficacy and safety of topiramate in adult and children patients with epilepsy. Methods Open-label experience with topiramate as adjunctive, added-on to monotherapy and monotherapy were analyzed.The efficacy was assessed by comparing the average frequency per month for 3 months after topiramate added to the maintenance period of the baseline therapy. Results Topiramate was proven to be a valuable new antiepileptic drug either in monotherapy (86%) or in added-on therapy (70%) on partial onset epilepsy, West syndrome and Lennox-Gastaut syndrome, and showed no tolerance.The topiramate dosage in patients with monotherapy [(85.87?29.19)mg/d in adult] is lower than in those using added-on therapy [(161.11?58.18)mg/d] significantly, and the most common adverse events were CNS-related, but few patients had discontinued the therapy.Conclusions The topiramate used for monotherapy or added-on therapy should be regarded as an effective and widespread antiepileptic drug, without tolerance and severe adverse actions.