An ultra high performance liquid chromatography-photodiode array detection-tandem quadrupole mass spectrometry ( UPLC-PAD-MS/MS) method was developed for the determination of total 13 flavonols and flavonol glycosides in red onion which including 6 quercetin and its glycosides, 4 isorhamnetin and its glycosides, 3 Kaempferol and its glycosides. The chromatographic separation was carried out by used a UPLC HSS T3 column and eluted under gradient with mobile phases of acetonitrile and water both contained 0 . 1%formic acid at a flow rate of 0. 3 mL/min. The results showed that the major flavonols and flavonol glycosides in red onion were quercetin-4’-glucoside, quercetin-3, 4’-diglucoside, quercetin and Isorhamnetin-4’-glucoside. The amounts and distributions of flavonols and flavonol glycosides among different parts of red onion were different. For the same amount of dry materials, the content ratio of total flavonols and flavonol glycosides in the outer two layers, the third layer and the inner layer was 60. 3:33. 0:6. 7, the amount of quercitin and its glycosides accounts above 92. 1% of total flavonols and flavonol glycosides for each part. In the outer two layers, the amount of flavonol monoglycosides are the highest, in the third layer, the amount of flavonol aglycones were the highest, but in the inner layer, the amount of flavonol diglycosides were the highest. Small amounts of Kaempferol and its glycosides were found in red onion, and mostly were found in outer layers. This method is simple, fast, accurate and convenient, and can be used to analyze flavonols and flavonol glycosides in onion product.

Objective To explore clinical significance of constriction of fetal ductus arteriosus diagnosed by echocardiography.Methods Seventy-one cases with constriction of fetal ductus arteriosus (DA) and one fetus with premature closure of DA were detected by fetal echocardiography among 2380 singleton fetuses.The echocardiographic characteristics and clinical outcomes were reviewed and analyzed.Results Of 71 cases with constriction of fetal DA,58 cases were found with right heart enlargement,12 cases with tricuspid regurgitation,8 cases with arrhythmia and 1 case with pericardial effusion.The echocardiographic characteristics showed narrowed diameter of DA,dilatation of pulmonary artery and descending aorta was also noted,DA was markedly curved.The peak systolic velocity(PSV) and enddiastolic velocity(EDV) in the ductus arteriosus measured by pulsed Doppler echocardiography increased (PSV≥ 180 cm/s,EDV≥35 cm/s).All cases were confirmed normal by neonate echocardiography.Conclusions Prenatal echocardiography plays important role in diagnosis of constriction of fetal DA.Early diagnosis and intimate follow-up can direct clinician to offer suitable consultation for parents and management for fetuses.

ObjectiveTo evaluate the therapeutical effect and toxicity of home-made paclitaxel and cisplatin combination in metastatic breast cancer.Methods Home-made paclitaxel 175 mg/m2,d1 intravenous drip,cisplatin 80 mg/m2,d1-3 intravenous drip,21-28 d was one cycle,all patients continuous course treatment for 2-6 cycles,then the effect was evaluated.ResultsAll the patients received meso-cycle were 4 (2-6) cycles chemotherapy.The total effective rate was 56.60％ (30/53),disease control rate was 81.13％(43/53 ).The rates of internal organ metastasis and non-internal organ metastasis,before menopause and after menopause had no significant difference [56.76％ (21/37) vs.56.25％ (9/16),59.09％ (13/22) vs.54.84％ ( 17/31 ),P ＞ 0.05 ].The median existence time for all the patients was 18.8 ( 12-27 ) months.The survival rate was 56.60％ (30/53) and 30.19％ (16/53) for 1 and 2 years respectively.The major toxieities were gastrointestinal reaction,alopeoia and myelosuppression,the rates of nerve and heart toxicities were less,15.09％ (8/53) and 7.55％ (4/53) respectively.ConclusionThe therapeutic effect of home-made paclitaxel and cisplatin combination in metastatic breast cancer is good,it is to be worth to spread in clinic.

AIM: To study the inhibitory effects of nm23-H1 gene on proliferation and invasion of human lung adenocarcinoma A549 cell line. METHODS: Recombinant eukaryotic expression vector pcDNA3.1-nm23-H1 containing full length of human nm23-H1 cDNA was constructed and transfected into a human lung adenocarcinoma A549 cell line by lipofectamine. Cell strain that expressed nm23-H1 stably was screened out by G418 and named pcDNA-nm23-A549. Expression of nm23-H1 was identified by RT-PCR and immunohistochemistry. Growth curves were drawn to detect the inhibitory effects on cell proliferation. Cell cycle of pcDNA-nm23-A549 was examined by flow cytometry. Atomic force microscopy was used to observe the filopodia on the surface of the cells. RESULTS: Introduction of nm23-H1 obviously inhibited the proliferation of A549. Expression of nm23-H1 did not induce apotosis in A549 cells but increased the percentage of phase G_1 cells and decreased phase S cells. Meanwhile, phase G_1 to phase S transition was restrained. Filopodia in the cell surface was much fewer and its structure changed in cells transformed. CONCLUSION: nm23-H1 is capable of inhibiting A549 proliferation and decreasing its metastatic ability, probably by interfering with cell cycle and cell surface structure.

Objective:To investigate the learning curve of laparoscopic transanal total mesorectal excision (taTME) for rectal cancer operated by one or two surgery teams.Methods:The retrospective cross-sectional study was conducted. Based on the concept of real-world research, the clinical data of 1 458 patients undergoing laparoscopic rectal cancer taTME from 44 medical centers who were registered in the Chinese taTME registry collaborative (CTRC) database from May 2010 to May 2020 were collected. The 1 458 patients were divided into cohorts with one surgery team or two surgery teams according to the operation method. Patients with one surgery team underwent taTME by transabdominal operation and then by transanal operation. Patients with two surgery teams underwent taTME by transabdominal and transanal operation simultaneously with duration of the simutaneous operation time ≥30 minutes. The entire surgical process of patients with two surgery teams is not required to be performed by two surgery teams simutaneously. The clinical data were collected from the medical centers with similar operation amount according to the operation time sequence to analyze the difference between different operation stages and explore the learning curve. The operation time was taken as the parameter to carry out cumulative sum analysis and draw the learning curve of laparoscopic rectal cancer taTME in each medical center. The clinicopathological characteristics of patients from two medical centers with the largest difference in learning curves were analyzed. Observation indicators: (1) screening results of clinical data; (2) clinical data collection of patients with one surgery team; (3) surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages; (4) learning curve of the one surgery team; (5) clinical data collection of patients with two surgery teams; (6) surgical situations of laparoscopic rectal cancer taTME from the two surgery teams; (7) learning curve of the two surgery teams. The cumulative sum was calculated by the CUSUM=∑i=1nXi-U, where Xi represented the operation time of each taTME, U represented the average operation time of all cases, and n represented the operation number. Fitting process was conducted on scatter plot of learning curves. Taking the apex of learning curve as the boundary, the learning curve was divided into two stages. The abscissa corresponding to the apex of learning curve was the number of operations that needed to be performed to cross the learning curve. Measurement data with normal distribution were represented as Mean±SD. Comparison between two groups was conducted using the t test and comparison between multiple groups was conducted using the ANOVA. Measurement data with skewed distribution were represented as M( P25,P75), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the rank sum test. Count data were analyzed using the chi-square test or Fisher exact probability. Results:(1) Screening results of clinical data:the clinical data of 661 patients from 7 medical centers with one surgery team and two surgery teams were collected. (2) Clinical data collection of patients with one surgery team: the clinical data of 312 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected including 42 cases in the number 2 medical center, 97 cases in the number 20 medical center, 82 cases in the number 33 medical center, 35 cases in the number 37 medical center and 56 cases in the number 39 medical center, respectively. (3) Surgical situations of laparoscopic rectal cancer taTME from the one surgery team in different operation stages: three medical centers including the number 2, number 37 and number 39 medical center with close operation volume provided the clinical data of cases distributed in five operation stages. Among the five operation stages, the proportion of high-quality operation of total mesorectal excision (TME) was ≥17/18, the incidence of postoperative complications was ≤13.3%(4/30) and the incidence of anastomotic leakage was ≤10.0%(3/30). There was no significant difference in the TME quality, postoperative complications or anastomotic leakage among the five operation stages ( P>0.05). There was no significant difference in the operation time among the five operation stages ( χ2=6.950, P>0.05). (4) Learning curve of the one surgery team: the number of operations corresponding to the turning point of learning curve in number 2 and number 20 medical center was 22 and 39, respectively. The number of operations corresponding to the turning points of learning curve in number 33 and number 37 medical center was 15, 66 and 10, 28, respectively. The number of operations corresponding to the turning point of learning curve in number 39 medical center was 20. The overall curve of number 20 medical center was in line with the trend of learning curve and 39 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 20 and number 33 medical center. Cases with the gender of male or female, age, body mass index, cases classified as stage 1, stage 2, stage 3 or stage 4 of the American Society of Anesthesiologists (ASA) Classification, cases with neoadjuvant therapy, duration of postoperative hospital stay of the number 20 medical center were 77, 20, (60±10)years, 24 kg/m 2(22 kg/m 2, 26 kg/m 2), 1, 88, 8, 0, 8, 8, 11 days (9 days, 13 days), respectively, versus 51, 31, (64±11)years, 23 kg/m 2(21 kg/m 2, 26 kg/m 2), 0, 35, 43, 1, 31, 16 days (13 day, 21 day) of number 33 medical center, showing significant differences in the above indicators between the two medical centers ( χ2 =6.442, t=-2.265, Z=-2.032, -6.870, χ2 =22.120, Z=-8.408, P<0.05). (5) Clinical data collection of the two surgery teams: the clinical data of 259 patients undergoing laparoscopic rectal cancer taTME from 5 medical centers were collected, including 46 cases in the number 2 medical center, 47 cases in the number 8 medical center, 78 cases in the number 18 medical center, 43 cases in the number 33 medical center and 45 cases in the number 44 medical center, respectively. (6) Surgical situations of laparoscopic rectal cancer taTME from the two surgery teams: four medical centers including the number 2, number 8, number 33 and number 44 medical center with close operation volume provided the clinical data of cases distributed in four operation stages. Among the four operation stages, the proportion of high-quality operation of TME was ≥50.0%(13/26), the incidence of postoperative complications was ≤35.0%(14/40) and the incidence of anastomotic leakage was ≤22.5%(9/40). There was no significant difference in the TME quality, postoperative complications or operation time among the four operation stages ( χ2 =3.252, 4.733, 8.848, P>0.05). There was a significant difference in the incidence of anastomotic leakage among the four operation stages ( P<0.05). (7) Learning curve of the two surgery teams: the number of operations corresponding to the turning point of learning curve in number 2 and number 8 medical center was 28 and 16, respectively. The number of operations corresponding to the turning points of learning curve in number 18, number 33 and number 44 medical center was 12 and 58, 10 and 36, 14 and 36, respectively. The overall curve of number 2 medical center was in line with the trend of learning curve and 28 cases of operations was the minimum number needed to cross the learning curve. The biggest difference in learning curve was shown between the number 2 and number 33 medical center. The age and cases with tumor in stage T0 and (or) Tis, stage T1, stage T2, stage T3 or stage T4 of the T staging of the number 2 and number 33 medical center were (60±12)years, 3, 1, 9, 11, 20 and (65±10)years, 2, 3, 22, 15, 0, respectively, showing significant differences in the above indicators between the two medical centers ( t=-2.280, Z=-4.033, P<0.05). Conclusion:Thirty-nine cases of operations was the minimum number for the one surgery team to cross the learning curve of laparoscopic rectal cancer taTME and 28 cases of operations was the minimum number for the two surgery teams to cross the learning curve of laparoscopic rectal cancer taTME.

OBJECTIVETo study the chemical constituents from aerial parts of Fallopia dumetosum.

METHODThe 80% ethanol extract was separated by means of silica gel and Sephadex LH-20 column chromatography. The compounds isolated from the plant were identified by physicochemical properties and spectroscopic evidence.

RESULTTen compounds were obtained and identified as emodin (1), physcion (2), quercetin (3), luteolin (4), 5"- methoxy-hydnocarpin (5), ethylparaben (6), protocatechuic acid (7), (2S,3S, 4R) -sphinganine-(2'R) -delta5'6' (E) -2'-hydroxyl tetracosanoylamino (8), beta-sitosterol (9), and daucosterol (10).

CONCLUSIONAnthraquinones and flavones were the major constituents of this plant. All compounds were isolated firstly from this plant, and compounds 5, 7, and 8 were isolated from the genus Fallopia for the first time.

Anthraquinones ; chemistry ; isolation & purification ; Flavones ; chemistry ; isolation & purification ; Plant Components, Aerial ; chemistry ; Plant Extracts ; chemistry ; Plants, Medicinal ; chemistry ; Polygonaceae ; chemistry

As a general anesthetic,esketamine has the advantages of sedation,analgesia,and slight respiratory depression within the clinical dose range,which is suitable for preoperative sedation in children.Intravenous injection is mostly used in clinical practice,but nasal dropping is not affected by the venous access and has a rapid onset time with no first pass effect.The recommended nasal dose of esket-amine is 1 mg/kg,with reliable sedation effect and few adverse reactions.When combined with dexmedeto-midine or midazolam,sedation onset time of esketamine can be significantly shortened,the respective drug dosage can be reduced,and postoperative pain can be alleviated.Nasal dropping alone or combined with dexmedetomidine can be safely used in children with congenital heart disease complicated by pulmonary hy-pertension,which helps to maintain the stability of hemodynamic.This article summarizes the current situa-tion of clinical application of nasal dropping of esketamine to provide reference for its rational application.

Objective To evaluate the efficacy,safety,and economy of 4 intravenous iron formulations in the treatment of iron deficiency anemia(IDA)by rapid health technology assessment,and to provide evidence for clinical decision-making.Methods PubMed,Embase,the Cochrane Library,CNKI,WanFang,SinoMed,and official websites of international health technology assessment agencies were electronically searched to collect health technology assessment reports,systematic reviews/Meta-analysis,and pharmacoeconomic studies concerning the treatment of IDA with iron sucrose(IS),iron dextran(ID),ferric carboxymaltose(FCM),and iron isomaltoside(IIM)from the inception to August 15,2024.Two researchers independently screened the studies,extracted data and assessed the quality of included studies.The results were then qualitatively described and analyzed.Results A total of 32 studies were included,including one health technology assessment report,16 systematic reviews/Meta-analysis,and 15 pharmacoeconomic evaluations.In terms of effectiveness,FCM had a higher response rate than that of IS(P＜0.05),FCM and IIM had no statistical difference(P＞0.05).Regarding hemoglobin level change,patients treated with FCM had higher hemoglobin levels than those treated with IS(P＜0.05);the improvement in hemoglobin levels between IIM and FCM was inconclusive.In terms of ferritin level change,FCM might be superior to the other three intravenous iron formulations.In terms of safety,the adverse event rates for FCM,IS,ID and IIM were 12.0％,15.3％,12.0％and 17.0％,respectively;IIM was significantly associated with a lower rate of cardiovascular adverse events compared to FCM and IS(P＜0.05);FCM had the highest rate of hypophosphatemia among the four formulations(P＜0.05),and there was no significant difference among IIM,IS and ID(P＞0.05);IIM had a lower risk of severe or serious hypersensitivity reactions compared to FCM and IS.In terms of economy,FCM and IIM had an economic advantage compared to IS.The economic efficiency ranking among IS,ID,and FCM was in the order of FCM,ID,and IS,the economic comparison between FCM and IIM remains inconclusive and needs to be further demonstrated.Conclusion FCM and IIM have good efficacy,safety and economy in the treatment of IDA,but most of the included economy studies based on foreign populations,and domestic economic studies need to be further demonstrated.

Objective To examine the incidence ,clinical characteristics ,and risk factors for falls within two years after stroke in elderly patients. Methods A total of 365 elderly stroke patients from the Department of Neurology at the 8th Nanning People's Hospital were recruited from June 1 , 2013 to December 31 ,2014. They were divided into a fall group and a non-fall group and were followed up for two years. The incidence and clinic characteristics of falls were analyzed. The risk factors for falls were analyzed by multiple Logistic regression analysis. Results Of the 365 stroke patients included in this study ,falls were observed in 146(40.2％ )patients. The interval between the stroke and the first fall :72(49.3％ )patients had the first fall within 3 months;22(15.1％ )occurred between 4 and 6 months;20 (13.7％ )between 7 and 12 months ;17 (11.6％ )between 13 and 18 months ;and 15 (10.3％ )between 19 and 24 months.A hundred and five(71.9％ )patients fell during daytime and 41 (28.1％ )patients during night.Eighteen(12.3％ )patients had one fall ;65(44.5％ )patients fell 2 to 4 times ;60(41.1％ )patients fell 5 to 10 times ;and 3(2.1％ )patients fell over 10 times.A total of 709 falls were observed.Places of falls :102(69.9％ )falls happened indoors and 44(30.1％ )falls occurred outdoors.Circumstances of falls :27 (18.5％ )patients fell when turning over ;23 (15.8％ )fell when rising from a seating position ;4(2.7％ )patients fell when showering ;15(10.3％ )patients fell while standing ;9(6.8％ )fell when turning around ;56(38.3％ )fell while walking ;and 12(8.2％ )fell while climbing the stairs or running.The severity of falls :52(35.6％ )patients had no injury ;78(53.2％ ) suffered soft tissue injury ;16 (11.0％ )had fractures ;and 78 (53.2％ )had fear of falling.Multiple Logistic regression analysis showed that age(OR=2.41 ;95％ CI :1.69-3.05) ,history of falls(OR =2.85 ;95％ CI :1.46-3.81) ,history of stroke(OR=1.87 ;95％ CI :1.12-2.79) ,right hemiplegia(OR=2.37 ;95％ CI :1.62-4.59) ,left hemiplegia(OR= 2.47 ;95％ CI :1.46-4.78) ,paraplegia(OR= 2.55 ;95％ CI :1.57-4.98) ,visual impairment(OR=2.35 ;95％ CI :1.35-6.62) ,apraxia(OR=2.53 ;95％ CI :1.42-5.63) ,unilateral spatial neglect (OR=3.34 ;95％ CI :2.82-6.34) ,use of psychotropic medications (OR= 1.76 ;95％ CI :1.11-1.98) ,impaired physical mobility (OR = 1.58 ;95％ CI :1.82-2.91) ,low MMSE scale(OR = 3.42 ;95％ CI :1.38-7.41) ,low Barthel Index score(OR = 2.83 ;95％ CI :0.97-4.68) ,BBS scale<45(OR=2.48 ;95％ CI :1.27-4.18) ,TUG>15seconds(OR=3.56 ;95％ CI :1.91-5.23) ,and lack of rehabilitation therapy (OR=3.42 ;95％ CI :1.38-7.41)were independent predictors for falls(all P<0.05). Conclusions Falls are common among elderly patients within two years after stroke.Most falls happen indoors ,during daytime and while moving.Age ,history of falls ,history of stroke ,hemiplegia ,visual impairment ,apraxia ,unilateral spatial neglect ,use of psychotropic medications ,walk with a walker ,low MMSE scale ,low Barthel Index score ,BBS scale<45 ,TUG>15 seconds ,and lack of rehabilitation therapy are independent risk factors for falls after stroke.

Objective:To investigate the incidence, clinical characteristics and risk factors for hip fractures in patients within two years after stroke onset.Methods:A total of 332 persons with first-onset stroke from the neurology department of our hospital between 1 June 2013 and 31 December 2014 were recruited and were divided into the hip fracture group and the non-hip fracture group.Clinical characteristics were recorded.Vision was tested as normal or impaired.Patients were accessed by the National Institutes of Health Stroke Scale(NIHSS), Behavioral Inattention Test, Baking Tray Task, Mini-Mental State Examination(MMSE), Birgitta Lindmark(BL)motor assessment scale, Berg Balance Scale(BBS), Timed Up & Go(TUG)Scale, and Stops Walking When Talking(SWWT)Scale.The clinic characteristics and risk factors for hip fractures were compared between the two groups after a 2-year follow-up.The accuracy of risk factors for fracture prediction was assessed by the sensitivity, specificity, and positive and negative predictive values.Results:Of 332 patients with stroke, 16 cases fractured their hips within two years after stroke onset, which corresponded to an incidence of 33‰/year(95% CI: 15‰/year-50‰/year). The 2-year mortality rate was 44%(95% CI: 25%-60%)and 48%(95% CI: 42%-54%)in patients with and without hip fractures respectively( χ2=0.036, P=0.724). The mean survival time for patients with and without hip fracture was 2.72 years(95% CI: 1.45-2.79)and 2.21 years(95% CI: 1.48-2.34)respectively.The proportions of patients with previous fractures history( χ2=16.780, P=0.041)and impaired vision( χ2=11.210, P=0.027), MMSE scale score( U=14.220, P=0.031), TUG ≥ 15 s( χ2=18.560, P=0.000)were higher, and SWWT( χ2=20.340, P=0.000)was lower in the hip fracture group than in the non-hip fracture group.The negative predictive values of previous fractures history, impaired vision, TUG and SWWT were higher than their positive predictive value.The specificities of previous fractures history, impaired vision, and SWWT were higher than their sensitivities.And the sensitivity of TUG was higher than its specificity. Conclusions:Hip fractures after stroke are common in elderly patients.Fractures often occur during daytime at home in daily activities.The previous fractures history, visual and cognitive dysfunction and impaired functional mobility are risk factors for hip fractures.We should take measures to prevent falls according to the relevant factors.Among the test scales, the timed up & go(TUG)scale could much more accurately identify patients at high risk for hip fractures.