ObjectiveBased on traditional quality evaluation of Gardeniae Fructus（GF） recorded in historical materia medica， this study systematically compared the quality differences between wild and cultivated GF from morphological characteristics， microscopic features， and contents of primary and secondary metabolites. MethodsVernier calipers and analytical balances were used to measure the length， diameter and individual fruit weight of wild and cultivated GF， and the aspect ratio was calculated. A colorimeter was used to determine the chromaticity value of wild and cultivated GF， and the paraffin sections of them were prepared by safranin-fast green staining and examined under an optical microscope to observe their microstructure. Subsequently， the contents of water-soluble and alcohol-soluble extracts of wild and cultivated GF were detected by hot immersion method under the general rule 2201 in volume Ⅳ of the 2020 edition of the Pharmacopoeia of the People's Republic of China， the starch content was measured by anthrone colorimetric method， the content of total polysaccharides was determined by phenol-sulfuric acid colorimetric method， the sucrose content was determined by high performance liquid chromatography coupled with evaporative light scattering detection（HPLC-ELSD）， and the contents of representative components in them were measured by ultra-performance liquid chromatography（UPLC）. Finally， correlation analysis was conducted between quality traits and phenotypic traits， combined with multivariate statistical analysis methods such as principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， key differential components between wild and cultivated GF were screened. ResultsIn terms of traits， the wild GF fruits were smaller， exhibiting reddish yellow or brownish red hues with significant variation between batches. While the cultivated GF fruits are larger， displaying deeper orange-red or brownish red. The diameter and individual fruit weight of cultivated GF were significantly greater than those of wild GF， while the blue-yellow value（b^*） of wild GF was significantly higher than that of cultivated GF. In the microstructure， the mesocarp of wild GF contained numerous scattered calcium oxalate cluster crystals， while the endocarp contained stone cell class round， polygonal or tangential prolongation， undeveloped seeds were visible within the fruit. In contrast， the mesocarp of cultivated GF contained few calcium oxalate cluster crystals， or some batches exhibited extremely numerous cluster crystals. The stone cells in the endocarp were predominantly round-like， with the innermost layer arranged in a grid pattern. Seeds were basically mature， and only a few immature seeds existed in some batches. Regarding primary metabolite content， wild GF exhibited significantly higher total polysaccharide level than cultivated GF（P<0.01）. In category-specific component content， wild GF exhibited significantly higher levels of total flavonoids and total polyphenols compared to cultivated GF（P<0.01）. Analysis of 12 secondary metabolites revealed that wild GF exhibited significantly higher levels of Shanzhiside， deacetyl asperulosidic acid methyl ester， gardenoside and chlorogenic acid compared to cultivated GF（P<0.01）. Conversely， the contents of genipin 1-gentiobioside， geniposide and genipin were significantly lower in wild GF（P<0.01）. ConclusionThere are significant differences between wild and cultivated GF in terms of traits， microstructure， and contents of primary and secondary metabolites. At present， the quality evaluation system of cultivated GF remains incomplete， and this study provides a reference for guiding the production of high-quality GF medicinal materials.

ObjectiveTo investigate the protective effects and mechanisms of Bushen Zhuyun prescription （BSZY） on abortion rats with kidney deficiency-corpus luteum inhibition syndrome. MethodsAn abortion rat model with kidney deficiency-corpus luteum inhibition syndrome was constructed. Pregnant mice aged 8-10 weeks were randomly divided into a control group （Control）， a model group （Model）， low-dose BSZY （BSZY-L）， medium-dose BSZY （BSZY-M）， and high-dose BSZY （BSZY-H） groups （2.57， 5.14， 10.28 g·kg^-¹）， and a Zishen Yutai Pill （ZSYT） group （1.575 g·kg^-¹）. Hematoxylin-eosin （HE） staining was used to evaluate histopathological changes in ovarian and decidual tissue of rats in each group. Enzyme-linked immunosorbent assay （ELISA） was employed to measure levels of estrogen （E₂）， progesterone （P）， luteinizing hormone （LH）， prolactin （PRL）， and follicle-stimulating hormone （FSH） in serum. The candidate targets of BSZY were obtained from the Traditional Chinese Medicine System Pharmacology Platform （TCMSP） and Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP） v2.0 databases， while disease targets for recurrent spontaneous abortion （RSA） were retrieved from GeneCards， DrugBank， Online Mendelian Inheritance in Man （OMIM）， and Therapeutic Target Database （TTD）. The intersection targets were identified by the Venny 2.1.0 platform. Pathway enrichment analysis was conducted based on the Metascape database to predict the potential mechanisms of BSZY. Additionally. Western blot was used to verify the effects of BSZY on the expression of estrogen receptor （ERα）， phosphatidylinositol 3-kinase （PI3K）， and protein kinase B （Akt） and explore its protective mechanism on RSA rats. ResultsCompared with the control group， the model group exhibited significantly decreased uterine， ovarian， and embryonic wet weights （P<0.05， P<0.01）， with an abortion rate of 57.18%. The ovarian tissue showed varying degrees of reduction in primordial follicles， primary follicles， mature follicles， and corpora lutea， along with a large number of atretic follicles. The endometrium was thinner， and decidual tissue exhibited cellular edema and disorganized arrangement. In contrast， compared with the model group， the BSZY groups at all doses and the ZSYT group demonstrated increased uterine， ovarian， and embryonic wet weights， along with a reduced abortion rate. The number of primordial follicles， primary follicles， mature follicles， and corpora lutea increased， while atretic follicles decreased. The endometrium thickened， and decidual tissue displayed normal cellular structure with tight arrangement. Additionally， the model group showed significantly decreased levels of E₂， P， PRL， and FSH in serum （P<0.05， P<0.01）， along with a decreasing trend in LH level. In contrast， the BSZY groups at all doses exhibited significantly elevated levels of E₂， P， LH， PRL， and FSH in serum （P<0.05， P<0.01）. Network pharmacology predictions suggested that BSZY may exert protective effects against abortion in rats by activating the ERα/PI3K/Akt signaling pathway. Western blot results confirmed that BSZY significantly upregulated the expression of ERα， PI3K， and p-Akt proteins （P<0.05， P<0.01）. ConclusionBSZY has a protective effect on the abortion rats with kidney deficiency-corpus luteum inhibition syndrome， possibly by activating the ERα/PI3K/Akt signaling pathway to reduce ovarian apoptosis and regulate endocrine function， thereby lowering the abortion rate.

BACKGROUND:Hydroxyapatite is the main inorganic component of bone tissue.The polymer has the structure and function of a biomimetic extracellular matrix.The composites of hydroxyapatite and polymer have been widely studied. OBJECTIVE:To summarize the research status of hydroxyapatite composite polymer materials for bone tissue repair. METHODS:The articles collected in PubMed,Web of Science,CNKI and WanFang databases were searched from January 2010 to April 2023.The Chinese and English search terms were"hydroxyapatite,polymer,composites,degradability,bone defect,bone repair".Finally,75 articles were included for review. RESULTS AND CONCLUSION:Polymers often used in composite with hydroxyapatite for bone tissue repair include natural polymers(collagen,chitosan,alginate,serine protein,cellulose,hyaluronic acid,and polyhydroxybutyrate)and synthetic polymers[polylactic acid,polylactic acid-hydroxyacetic acid copolymer,poly(has-lactide),poly(amino acid)and poly(vinyl alcohol)].The mechanical properties and osteoinductivity of hydroxyapatite/polymer composites were improved compared with pure hydroxyapatite.Hydroxyapatite composite with polymers can be made into porous scaffolds,hydrogels,and coatings for bone repair.Hydroxyapatite/polymer composites can accelerate bone reconstruction with a slow release of loaded drugs and cytokines due to their bionic extracellular matrix structure and function.Based on the diversity of causes of bone defects and the fact that bone repair is a complex continuous process involving multiple biological factors and proteins,repair materials with mechanical properties matching bone tissue,degradation processes synchronized with bone repair,and efficient osteogenesis and vascularization need to be further investigated.

Objective:To investigate the effect of five-element music therapy combined with meridian-based acupoint massage timed according to qi circulationon on negative emotions and sleep quality in older adults with chronic heart failure. Methods:A total of 112 older adult patients with chronic heart failure who received treatment at The Affiliated Hospital of Hangzhou Normal University between January 2022 and June 2023 were included in this study. They were randomly divided into a control group ( n = 56) and a study group ( n = 56) using the random number table method. Based on conventional treatment, the control group received five-element music therapy, while the intervention group underwent a combination of five-element music therapy and meridian-based acupoint massage timed according to qi circulation. Before and after the intervention, a comparison was made between the two groups in terms of the scores of the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), and various dimensions of the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Additionally, the sleep outcome and patient satisfaction were also compared between the two groups. Results:After intervention, the scores of the HAMA and HAMD in the study group were (11.29 ± 2.48) points and (12.48 ± 3.36) points, respectively. In contrast, the control group had scores of (15.93 ± 3.35) points and (16.50 ± 4.32) points, respectively. After intervention, the scores of the HAMA and HAMD scales in both the study and control groups demonstrated a significant reduction in comparison with their respective pre-intervention scores [study group: (20.13 ± 5.18) points, (23.95 ± 8.97) points, control group: (19.36 ± 5.45) points, (23.79 ± 7.61) points, t = 15.35, 10.24, 5.65, 8.93, all P < 0.001). After intervention, the scores of the HAMA and HAMD scales in the study group were significantly lower than those in the control group ( t = -8.34, -5.49, both P < 0.001). After intervention, the scores of the PSQI in the study and control groups were (7.05 ± 0.96) points and (9.91 ± 1.28) points, respectively. After intervention, the scores of PSQI in both the study and control groups demonstrated a significant reduction compared with their respective pre-intervention scores [study group: (12.98 ± 2.21) points, control group: (12.50 ± 2.48) points, t = 24.68, 9.79, both P < 0.05]. After intervention, the score of the PSQI in the study group was significantly lower than that in the control group ( t = 13.34, P < 0.05). Based on the scores across various dimensions of the MLHFQ, it was observed that after intervention, the scores of emotional, physical, and other domains in both the study and control groups [study group: (9.36 ± 2.29) points, (16.95 ± 3.80) points, (18.50 ± 2.33) points; control group: (12.93 ± 2.00) points, (19.98 ± 3.98) points, (20.04 ± 2.24) points] decreased significantly compared with their pre-intervention scores [study group: (15.57 ± 1.55) points, (26.23 ± 4.63) points, (21.18 ± 2.50) points, control group: (16.09 ± 1.87) points, (25.32 ± 4.40) points, (21.57 ± 2.69) points, t = 21.66, 18.55, 8.44, 11.29, 11.73, 4.61, all P < 0.001]. After intervention, the scores of emotional, physical, and other domains in the study group were significantly lower than those in the control group ( t = -8.79, -4.13, -3.56, all P < 0.05). Patient satisfaction in the study group was superior to that that in the control group [98.21% (55/56) vs. 87.50% (49/56), χ2 = -3.09, P < 0.05]. Total effective rate of intervention on sleep in the study group was significantly higher than that in the control group [92.86% (52/56) vs. 78.57% (44/56), χ2 = -2.09, P < 0.05]. Conclusion:Five-element music therapy combined with meridian-based acupoint massage timed according to qi circulationon in the treatment of chronic heart failure in older adults can effectively alleviate negative emotions, improve the quality of life and sleep, and increase patient satisfaction with nursing care.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective To establish a fluoroscopic percutaneous vertebral augmentation model in dogs by measuring and analyzing canine spinal anatomy.We also assessed the effectiveness and safety of this modeling method by postoperative radiological analysis.Methods Morphological measurements were taken in six dogs,aged approximately 12～24 months,and the following parameters of the lumbar vertebrae were determined:height of the L1～L7 vertebrae,width of the vertebral base,distance from the upper edge of the intervertebral disc to the narrowest part of the vertebra,distance from the vertical line of the spinous process to the upper edge of the intervertebral disc,and vertical distance from the midpoint of the transverse process to the lower edge of the intervertebral disc.These measurements were obtained to clarify the anatomical characteristics of the canine vertebrae and determine the optimal location,direction,and depth for bone-cement injection.A percutaneous vertebral augmentation model was subsequently established in the L4,L5,and L6 vertebrae of six healthy Beagle dogs,weighing 20～25 kg.The dogs were euthanized 4 weeks post-surgery and examined radiologically.Primary observations included the surgical duration,postoperative distribution of the implanted bone cement,and integrity of the vertebral canal and anterior edge of the vertebrae.Results Anatomical observation of the canine vertebrae revealed that the vertebral height increased gradually from L1～L5 and then decreased from L5～L7.The width of the vertebral base increased consistently from L1～L7.The distance from the vertical line of the spinous process to the upper edge of the intervertebral disc showed an increasing trend from L1～L7(1.9～4.0 mm).The distance between the midpoint of the base of the transverse process and the lower edge of the intervertebral disc increased gradually from L1～L5(4.7～6.9 mm).There was no significant difference in the distance between the midpoint of the base of the transverse process and the lower edge of the intervertebral disc in the L4,L5,and L6 segments among the dogs(P=0.925).The midpoint of the root of the transverse process of the spine was taken as the puncture point,and the insertion direction and horizontal plane were at an angle of 20°～30°,with a head tilt of 5°～15° and a puncture depth of 1.2～1.5 cm.If the puncture was directed towards the caudal side of the vertebra,the angle of the needle tail was 30°～35°,with a penetration depth of 1.5～1.8 cm.This technique allowed the successful construction of a canine vertebral puncture surgical model.A total of 15 canine vertebral puncture surgical models were successfully created,with an average surgery time of 22.7±4.6 min(15～30 min)per vertebral segment.During surgery,one vertebral segment experienced spinal cord injury result ing in paralysis of the hind limbs and bowel and bladder incontinence.Two vertebral cortical bones fractured,but there were no deaths due to anesthesia or infection.Four weeks post-surgery,micro-computed tomography-based three-dimensional reconstructions consistently showed bone cement distributed within the trabecular bone of the canine vertebrae,with newly formed bone tissue enveloping the implanted material.There was no leakage,and no complications such as damage to the vertebral canal or the anterior wall of the vertebrae.Conclusions A safe and reliable canine vertebral augmentation puncture model can be successfully established based on the anatomy of the canine lumbar vertebrae(L4～L6)and using the midpoint of the base of the transverse process as a bony landmark.

Objective To analyze the relationships of carotid plaque characteristics and hemorheology with disease classification and severity in elderly patients with ischemic stroke. Methods A total of 240 elderly patients with ischemic stroke were selected as observation group, and were further divided into different groups based on disease classification [complete anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), lacunar infarction (LACI)] and severity of the disease (mild, moderate, and severe); another 60 elderly healthy individuals with physical examinations were selected as control group. The characteristics of carotid artery plaques [carotid intima-media thickness (IMT), number of plaques, maximum length of plaques, and nature of plaques]as well as hemorheology indexes[erythrocyte sedimentation rate (ESR), hematocrit (HCT), plasma fibrinogen (Fib), plasma viscosity, and whole blood viscosity]were measured in all the cases, and the relationships of carotid plaque characteristics and hemorheology with disease classification and severity were analyzed. Results The IMT, the number of plaques, maximum diameter of plaques, ESR, HCT, Fib, plasma viscosity, and whole blood viscosity in the observation group were significantly higher than those in the control group (P < 0.05); the IMT, the number of plaques, and maximum diameter of plaques in the LACI group were significantly lower than those in the TACI, PACI, and POCI groups, while the ratios of stable plaques were significantly higher (P < 0.05); the ESR, HCT, Fib, plasma viscosity, and whole blood viscosity in the LACI group were significantly lower than those in the TACI, PACI, and POCI groups (P < 0.05); the IMT, the number of plaques, and maximum diameter of plaques in the mild group were significantly lower than those in the moderate and severe groups, the ratio of stable plaques was significantly higher than that in the moderate and severe groups, the IMT, the number of plaques, and maximum diameter of plaques in the moderate group were significantly lower than those in the severe group (P < 0.05); the ESR, HCT, Fib, plasma viscosity, and whole blood viscosity in the mild group were significantly lower than those in the moderate and severe groups, and the above indicators in the moderate group were significantly lower than those in the severe group (P < 0.05). Conclusion The characteristics of carotid artery plaques and hemorheology in elderly patients with ischemic stroke are related to the classification and severity of the disease, and the status of carotid artery plaques and hemorheological abnormalities in elderly patients with TACI, PACI, and POCI types of ischemic stroke are more severe than those of patients with LACI type.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To compare the hemostatic effects and patient comfort of different compression methods for hemostasis after transradial coronary intervention.Methods:A total of 160 patients who received transradial coronary intervention in The Affiliated Hospital of Hangzhou Normal University from October 2018 to February 2020 were included in this study. In group A ( n = 80), patients underwent spiral compression at the puncture point (release for 1 turn at 2 hours after surgery, rotation for 1 circle after 1 hour, and full decompression). In group B ( n = 80), patients underwent spiral compression at the puncture point (release for 1 turn at 2 hours after surgery, rotation for 1 circle after 2 hours, and full decompression). Percutaneous arterial oxygen saturation value in the affected limb, heart rate, and Visual Analog Scale score at different times after surgery, pain and comfort score at 2 and 12 hours post-surgery were compared between the two groups. Results:Percutaneous arterial oxygen saturation value at 4 and 12 hours post-surgery in group A was (96.6 ± 0.7)% and (97.8 ± 0.5)%, respectively, which was significantly higher than that in group B [(96.2 ± 0.6)%, (97.6 ± 0.7)%, t = 3.88, 2.08, both P < 0.05]. There were no significant differences in total score and subscale score of the General Comfort Questionnaire at 2 hours post-surgery between groups A and B (both P < 0.05). At 12 hours post-surgery, scores of psychological and physical subscales and total score of the General Comfort Questionnaire in group A were (23.64 ± 3.02) points, (12.64 ± 2.05) points, (68.25 ± 6.04) points, which were significantly higher than those in group B [(22.20 ± 2.96) points, (11.38 ± 2.47) points, (64.42 ± 6.71) points, t = 3.05, 3.51, 3.79, all P < 0.05]. At 2 hours post-surgery, there was no significant difference in Numerical Rating Scale score between groups A and B ( P > 0.05). At 4 and 12 hours post-surgery, Numerical Rating Scale score in group A was (2.51 ± 0.58) points and (1.75 ± 0.76) points, respectively, which was significantly lower than that in group B [(2.95 ± 0.63) points, (2.31 ± 0.71) points, t = -4.59, -4.82, both P < 0.05). The incidence of complications was significantly lower in group A than in group B (8.75% vs. 20.00%, χ2 = 4.11, P < 0.05). Conclusion:Compression for hemostasis is highly effective by releasing for 1 turn at 2 hours after transradial coronary intervention, rotating for 1 circle after 1 hour, and full compression because it can greatly mitigate pain, ensure the oxygen supply to the affected limbs, and improve patient comfort.