Objective To study antitumor and hemolytic activities of nobiliside B from the sea cucumber Holothuria nobilis Selenka and its acetylic ramification.Methods Triterpene glycoside nobiliside B was acetylated with pyridine and Ac2O in icy bath,the acetylic products were separated by multi-chromatography to afford acetoxy-nobiliside B(2).The cytotoxic activity of the glycosides against ten human tumor cell lines was evaluated with the sulforhodamione B(SRB) protein assay.Results On the basis of chemical method,spectroscopic analysis and comparison with the data of nobiliside B,the structure of compound 2 was elucidated as: 3-O-[6″-acetoxy-?-D-glucopyranosyl(1→2)-4′-O-sulfate-?-D-xylopyranosyl]-holosta-9-ene-22,25-epoxy-3?,17?-diol-sodium salt.The bioassay results showed that the hemolytic activity of compound 2 was significantly decreased,while the antitumor activity was kept.Conclusion One novel acetoxy compound with high antitumor activitiy and less side effect was obtained by structure modification of nobiliside B,and should be study as a new potential antitumor drug.

Objective To explore the clinicopathological features,diagnosis and differential diagnosis of colonic muco-submucosal elongated polyp (CMSEP).Methods The clinical manifestations,endoscopic and histological features of three cases of CMSEP were analyzed.The literature was reviewed with regard to the diagnostic criteria and differential diagnosis.Results Three patients were male,and aged 25,45 and 75 years old.Two polyps were at transverse colon and one at rectum.Under colonoscope,all three cases showed the long pedunculated polyps.The surfaces of two polyps were smooth and the colors were similar to colonic mucosa while one polyp appeared mucosal erosion and congestion on the top.Under optical microscope,three cases had similar lesions.The axis of the lesions was expanded submucosa and the surface was the layer of colonic mucosa.The expanded and thick walled blood vessels were seen paralleled to the long axis in the submucosa of the axis of lesions.One polyp with mucosal erosion on the top presented with adenocarcinomal changes.Conclusions CMSEP is a kind of specific polypoid lesion,with characteristic colonoscopic and pathological features.Most are benign changes,however malignant changes occur in a few cases.In histology,CMSEP should be identified with mucosal prolapse syndrome associated inflammatory polyp.

Background: Fecal microbiota transplantation (FMT) has become a new method for treating some complicated intestinal diseases, and has achieved remarkable effects in the treatment of Clostridium difficile infection (CDI). Aims: To systematically evaluate the efficacy and possible influencing factors of FMT on the treatment of ulcerative colitis (UC). Methods: Clinical trials of FMT for the treatment of UC were retrieved from PubMed, Medline, Embase, CNKI, Chinese Science and Technology Journal Database. Meta-analysis of randomized controlled trials (RCTs) was conducted by RevMan 5.3 software. And influences of different factors on efficacy of FMT were analyzed by meta-analysis of single rate. Results: Eleven clinical trials including 4 RCTs and 7 non-RCTs were included. Meta-analysis for 4 RCTs showed that clinical remission rate and efficacy rate were significantly increased in FMT group than in control group (OR=2.89, 95% CI: 1.70-4.92, P<0.000 01; OR=2.70, 95% CI: 1.31-5.57, P=0.007). Meta-analysis of single rate showed that clinical remission rate was significantly increased in lower digestive tract transplantation group than in upper digestive tract transplantation group (39% vs. 19%, P=0.037), however, no significant difference in clinical remission rate was found among different donor selection groups (P=0.967). Conclusions: The efficacy of FMT for treatment of UC is affirmative, the effect of transplantation through lower digestive tract is better, and the effect is not related with specific donor.

Chemoradiotherapy is an important part in the adjuvant regimen for locally advanced gastric cancer after radical resection. Adjuvant chemoradiotherapy has demonstrated a clear local control and survival advantage for locally advanced patients with less than D2 lymph node dissection. Thus, chemoradiotherapy is recommended as standard of care in the postoperative setting. However, the role of radiotherapy for patients with more extensive D2 lymph node dissections remains controversial. Three phase III random-ized clinical trials in Asia show that adjuvant chemoradiotherapy after D2 dissection is safe and feasible and may benefit certain groups of patients. The benefit of radiotherapy in the case of more extensive surgery still warrants well-designed, fully powered randomized controlled clinical trials for verification. More studies are needed to focus on the identification of patient subgroups that are at high risk for locoregional failure and may benefit from adjuvant chemoradiotherapy. Further optimization of target volume in the radiother-apy and exploration of new modalities of radiation techniques are also necessary.

Objective To investigate the clinical efficacies of the conservative and surgical treatment of grade m and Ⅳ traumatic hepatic rapture.Methods The clinical data of 77 patients with traumatic hepatic rapture were analyzed.All the patients were admitted to the Fuzhou General Hospital of Nanjing Military Command from January 2004 to June 2014.According to the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS) and the Becker classification,there were 44 patients and 33 patients had grade Ⅲ and grade Ⅳ traumatic hepatic rapture,respectively.The vital signs,condition of the wound and the resuhs of imaging examination were comprehensively analyzed,and the conservative and surgical treatment methods were selected accordingly.Patients were followed up via outpatient examination or telephone interview till September 2014.Results There were 19 patients received conservative treatment and 25 received surgical treatment among the 44 patients with grade m traumatic hepatic rapture,and 5 received conservative treatment and 28 received surgical treatment among the 33 patients with type Ⅳ traumatic hepatic rapture.Thirty-one patients received suture of the liver,18 received partial hepatectomy and 4 received damage control surgery.All the 77 patients were cured without perioperative death.For patients with grade m traumatic hepatic rapture,the duration of hospital stay were (12 ± 9)days and (20 ± 15)days for patients received conservative and surgical treatment,respectively; and for patients with grade Ⅳ traumatic hepatic rapture,the duration of hospital stay were (17 ± 3) days and (34 ± 25) days for patients received conservative and surgical treatment,respectively.Nineteen patients had complications,including 10 with hepatic abscess,5 with bile leakage (cured by puncture and drainage),2 with pseudoaneurysm (cured by interventional therapy with digital subtraction angiography),1 with adhesive intestinal obstruction and delayed hemorrhage (cured by operation for 2 times).Seventy-one patients were followed up,with the rate of 92.2％ (71/77).The median time of follow-up was 7 months (range,3-15 months).Only 1 patient was complicated with hepatic abscess at postoperative month 13,and was cured by puncture and drainage,and the other patients were live and well.Conclusions The success rate of operation for patients with grade m traumatic hepatic rapture is relatively high with short hospital stay and quick recovery of patients.The indication of conservative treatment for patients with grade Ⅳ traumatic hepatic rapture should be strictly controlled,and the surgical treatment is the main means of therapy.Hepatic abscess,bile leakage and pseudoaneurysm are the common complications for patients with traumatic hepatic rapture.

Objective To investigate the effects of intracavity double pipe suction in the duodenal rupture repair.Methods The clinical data of 56 patients with duodenal rupture repair who were admitted to Fuzhou General Hospital from January 2003 to January 2014 were retrospectively analyzed.Thirty-one patients and 25 patients received the simple drainage (simple drainage group) and intracavity double pipe suction (intracavity double pipe suction group) for duodenal rupture repair.Quantitative data were presented by $ ± s,repeated measures analysis of variance and the t-test were used to evaluate quantitative data,respectively.Count data were analyzed using Chi-square test or Fisher's exact test.Results Volume of drainage of patients in the intracavity double pipe suction group at day 1,2,3,4,5,6,7 were (220 ± 54) mL,(284 ± 65) mL,(368 ± 35) mL,(413 ± 41) mL,(454 ± 62) mL,(714 ± 96) mL and (852 ± 121) mL,compared with (102 ± 30) mL,(124 ± 29)mL,(186 ±26)mL,(110 ±21)mL,(167 ±31)mL,(193 ±35)mL and (182 ±44)mL in the simple drainage group,with a significant difference between the 2 groups (F =65.214,P ＜ 0.05).The volumes of drainage of the 2 patterns were compared at postoperative day 1 to 7,with a significant difference (t =9.532,11.624,13.421,15.257,14.147,18.311,20.135,P ＜0.05).The incidence of duodenal fistula,intraperitoneal infection and wound infection in the simple drainage group were 29.0％ (9/31),41.9％ (13/31) and 51.6％ (16/31),compared with 4.0％ (1/25),12.0％ (3/25) and 16.0％ (4/25) in the intracavity double pipe suction group,showing a significant difference between the 2 groups (x2 =4.460,6.077,7.645,P ＜ 0.05).The incidence of pancreatic fistula and pulmonary infection in the sample drainage group and intracavity double pipe suction group were 16.1％ (5/31) and 29.0％ (9/31),8.0％ (2/25) and 12.0％ (3/25),with no significant difference between the 2 groups (x2 =0.836,2.385,P ＞ 0.05).The duration of hospital stay and hospital expenses in the simple drainage group and the intracavity double pipe suction group were (30 ± 14) days and(12 ± 6) x 104 yuan,(21 ± 7) days and (7 ± 5) x 104 yuan,respectively,with significant difference between the 2 groups (t =3.161,2.913,P ＜ 0.05).Conclusion The intracavity double pipe suction for duodenal rupture repair is simple and effective for significantly improving the prognosis of patients and reducing the duration of hospital stay and hospital expenses.

Objective To investigate the underlying causes, clinical characteristics, treatment and prognosis of non-traumatic pneumomediastinum (PM) in children. Methods A retrospective analysis of the clinical data of 64 children diagnosed with non-traumatic PM in Yuying Children’s Hospital Affiliated to Medical University from Jan 2003 to Dec 2013 was performed. Nineteen children with SPM and the other 45 with clear causes of non-traumatic PM were divided into two groups for comparison. According to age, 64 cases were divided into 0-6y group and 6-18y group for further comparison. Results A total of 64 patients with non-traumatic PM were collected. Nineteen of them aged 14.90±2.00 y had SPM with unknown etiology, and 84.2%were male. The other group of 45 patients aged 4.26±4.45y, and 55.6%of this group were male. The common causes were pneumonia or other lower respiratory tract infection, asthma and foreign body inspiration. The patients with SPM were always with chest pain. While the patients with clear causes of non-traumatic PM were more complained of dyspnea, coughing, subcutaneous emphysema. The treatment of patients with SPM was bed rest, oxygen uptaking, antitussive, anti-infection and other conservative therapy. All the patients with clear causes of non-traumatic PM had favorable prognosis with the treatment of actively curing primary disease and timely mediastinal air drainage, subcutaneous air drainage and thoracic close drainage. In 35 cases younger than 6 years old, the most common causes were pneumonia or other lower respiratory tract infection, none had SPM. In 29 cases older than 6 years, 19 of them had SPM. Conclusions Etiologies of pneumomediastinum varied with age in children,which should be vigilantly examined, especially for those younger than 6 years old. The key of the treatment to non-traumatic PM with clear etiologies was to treat its primary disease.

Objective To observe the effect of Chinese medicine of Gukang(GK) on bone mineral density(BMD) in osteoporosis rats.Methods Seventy-two female SD rats were randomized into 6 groups: pseudo-operation group,model group,nilestriol group(in the dose of 1mg/kg),and high-,middle-and low-dose GK groups(9.6,4.8 and 2.4 g?kg-1?d-1 respectively).Rat models of osteoporosis were induced by removal of bilateral ovaries.Three months after operation,the rats were given the corresponding medicine according the experimental design.After treatment for 3 months,in-vivo BMD as well as the in-vitro BMD in the isolated left femur and tibia was detected with dual energy X-ray bone densitometer.Results The in-vivo general BMD and lumbar BMD of the model group were decreased(P

Objective: To systematically evaluate the incidence of falls among empty nesters in China, so as to provide the evidence for preventing falls among empty nesters. Methods: Publications pertaining to cross-sectional studies of falls among empty nesters in China were retrieved from international and national databases, including CNKI, Wanfang Data, VIP, Cochrane Library, Web of Science and PubMed from inception to August, 2022. Meta-analysis was performed using the software Stata 15.1, and the combined incidence and 95%CI of falls among empty nesters in China was analyzed. Sensitivity analysis was performed using the leave-one-out method to evaluate the stability of outcome indicators. In addition, the publication bias was evaluated using Funnel plot. Results: Initially, 795 articles were screened in the literature, and 17 articles were finally included, covering 5 468 participants. Meta-analysis revealed that the incidence of falls among empty nesters in China was 23.0% (95%CI: 16.6%-29.5%). Subgroup analysis showed that the incidence of falls among empty nesters published from 2016 to 2022 was higher than that from 2008 to 2015 (20.4% vs. 17.3%; P<0.05). The incidence of falls among empty nesters in western regions was higher than that in eastern and central regions (27.4% vs. 15.9% and 15.0%; P<0.05). The incidence of falls among empty nesters in urban areas was higher than that in rural areas (20.8% vs. 9.9%; P<0.05). Sensitivity analysis showed that the study results were stable, and the funnel plot identified some publication bias. Conclusion The incidence of falls among empty nesters in China was 16.6% to 29.5%, and it is recommended to strengthen the assessment and prevention of risk factors of falls among empty nesters.

Objective To explore the influence of erythropoietin (EPO) on infection induced neonatal rat brain injury at different starting time and its related mechanism.Methods Postnatal day 2 (P2) newborn SD rats were randomly divided into 4 groups:control group (group A),lipopolysaccharide (LPS) group (group B),the early EPO group(group C)and the later EPO group(group D).Pups in group A,B and C were injected different drugs intraperitoneally(group A for saline,group B for 0.6 mg/kg of LPS,and group C for 0.6 mg/kg of LPS and 5 000 U/kg of EPO) once a day for consecutive 5 days(P2-P6).LPS in group D were injected 0.6 mg/kg of LPS intraperitoneally once a day for consecutive 5 days(P2 P6),and with 5 000 U/kg of EPO once a day for consecutive 5 days(P7-P1 1).Rats in each group were given different drugs starting at corresponding time by intraperitoneal injection for 5 consecutive days.Every 10 newborn rats in group A and B were selected randomly on P2(6 h after intraperitoneal injection of drugs for the first time),P7 and P12,the brains were divided into the left and the right hemispheres marked by sagittal suture,using enzyme-linked immunosorbent assay method to evaluate the erythropoietin receptor(EPOR) protein level with the right cerebral hemisphere and reverse transcription-polymerase chain reaction (RT-PCR) method was used to investigate EPOR mRNA level of the left cerebral hemisphere.Immunohistochemical method was adopted to evaluate the expression of myelin basic protein(MBP),glial fibrillary acidic protein(GFAP) and EPOR at specified time point,and HE dyeing for the pathological changes of brain damage in different groups.Results HE staining of the group A presented the normal structure in the neonatal rat brain.Reduced numbers of hippocampal pyramidal cells,expansion of the lateral ventricles and periventricular leukomalacia were found in group B.No leukomalacia or lateral ventricles's expansion in EPO administrated groups and it was more obvious in group C.The EPOR protein and mRNA of group B was increased compared with the group A.The EPOR protein and mRNA levels had a tendency to decline with the increase of age.The MBP expression of group B(107.46 ±3.65)was significantly reduced compared with the group A(146.78 ± 3.13) (P ＜ 0.05),and the expression of EPO groups increased in contrast to the group B,moreover,the group C (126.25 ± 4.42) increased more obviously than that of group D(117.35 ± 3.42) (P ＜ 0.05).The GFAP expression of group B(141.46 ± 11.92 at P7 and 149.48 ± 13.59 at P12) increased significantly than group A(120.63 ± 13.32 at P7 and 119.74 ± 12.48 at P12) (P ＜0.05),the EPO group expressed lower than group B at the P12,and the group C (134.59 ± 12.19) decreased than the group D(137.27 ± 13.87) (P ＞ 0.05).Conclusions EPO shows a protective effect on the cerebral white matter injury caused by postpartum infection,it is superior to administer EPO at early time than later time.The mechanism of the protective effect may be connected with the fact that the infection can induce the expression of brain EPOR and the EPOR expression level has a tendency to decline with the increase of age.