Objective: To compare the volatile compounds extracted from Rhodiola renulata respectively by HS-SPME and SD. Methods:The volatile constituents from Rhodiola crenulata were extracted respectively by HS-SPME and SD, and then the contents and the names were confirmed by GC-MS. Results:Totally 39 compounds were identified from Rhodiola crenulata by HS-SPME while 16 ones were identified by SD. Among them, 4 common compounds were detected. Conclusion: There are some differences between the two methods. Compared with SD, HS-SPME is obviously better because more volatile constituents can be extracted from the herb, furthermore, HS-SPME has notable advantages of higher retrieval matching and sensitivity.

Objective: To analyze the therapeutic effect of repeated hepatectomy on recurrent hepatocellu-lar carcinoma and prognostic factors. Methods: We retrospectively analyzed the clinicopathologic data of 48 patients who underwent repeated hepatectomy for recurrent hepatocellular carcinoma between July 1995 and July 2003. Overall survival rate and disease-free survival (DFS) rate were calculated by Kaplan-Meier meth-od. Prognostic factors were analyzed by univariate and multivariate analysis. Results: The median survival of 48 patients was 36.4 months. The overall 1-, 3-, and 5-year survival rates were 81.3%, 45.8%, and 27.1%, re-spectively. The disease-free 1-, 3-, and 5-year survival rates were 70.8%, 25.0%, and 16.7%, respectively. Univariate analysis showed that TNM stage of primary tumor, TNM stage of the recurrent tumor, vascular in-vasion, recurrent tumor size (>5cm) and recurrence-free interval were prognostic risk factors for overall surviv-al. While TNM stage of primary tumor, recurrent tumor size (>5cm), TNM stage of recurrent tumor, vascular in-vasion, pathological grading of recurrent tumor, preoperative AFP and recurrence-free interval were prognos-tic risk factors for DFS. Multivariate analysis showed that recurrence-free interval and TNM stage of recurrent tumor were independent prognostic risk factors for overall survival. While recurrence-frae interval and recur-rent tumor size (>5cm) were independent prognostic risk factors for DFS. Conclusion: Short recurrence-free in-terval (≤24 months), recurrent tumor size (>5cm) and TNM stage of recurrent tumor indicate poor prognosis of patients who received repeated hepatectomy for recurrent hepatocellular carcinoma.

Objective To compare the efficacy of percutaneous radiofrequency ablation (PRFA) and repeat hepatectomy for solitary recurrent hepatocellular carcinoma (HCC) with the diameter≤3 cm. Methods The clinical data of 151 patients with recurrent HCC (diameter≤3 cm) who were admitted to the Cancer Center of Sun Yat-Sen University from January 1999 to December 2009 were retrospectively analyzed. Of all the patients, 79received PRFA (PRFA group) and 72 received repeat hepatectomy (repeat hepatectomy group). The survival rate, morbidity and recurrence of the tumor between the two groups were compared. All data were analyzed using t test, chi-square test or Log-rank test, and the survival of the patients were analyzed using the Kaplan-Meier method. Results The mobidities of the PRFA group and repeat hepatectomy group were 13% (10/79) and 36%(26/72), respectively, with a significant difference between the two groups (x2=11.411, P＜0.05). The cumulative 1-, 2-, 3-, 4-, 5-year survival rates were 89.7%, 75.2%, 67.1%, 61.5%, 56.6% in the PRFA group, and 86.0%, 67.6%, 53.6%, 44.1%, 40.2% in the repeat hepatectomy group, with no significant difference between the two groups (x2=1.610, P＞0.05). The cumulative 4-, 5-year survival rates of the PRFA group were significant higher than those in the repeat hepatectomy group (x2=4.682, 4. 196, P ＜ 0.05). The local tumor recurrence rate of the PRFA group was 5% (4/79), and the incisal margin recurrence rate was 3% (2/72) in the repeat hepatectomy group, with no significant difference between the two groups (x2=0.565, P＞0.05). Conclusion As a less invasive treatment method, PRFA is superior to repeat hepatectomy for solitary recurrent HCC with the diameter≤3 cm.

To determine the content of dendrobine in Dendrobium nobile from different harvest times and plant parts, to research the inherent rule about it. GC with internal standard was used to determine. The content of dendrobine had significant differences in different periods and parts. The dendrobine content is higher in four-year root than in three-year root. The dendrobine content in the upper segment of stem is the highest, secondly is in the middle seg-ment, and in the low segment is the lowest. This offered evidence to determine the most appropriate harvest time and fair use of different parts for D.nobil.

Objective To analyze the status quo of joint surgeons' research level,explore possible influence factors for their research capacity.Methods A total of 140 joint surgeons from third grade hospital andsecondary hospital in Beijing were selected.The self-rating scale of scientific research was used for evaluation.Subjects were divided into two groups according to the high and low level of scientific research ability.In the middle and low level group,factors including age,working years,job title,education level,training opportunities,team situation,research activity time,hospital level,and job satisfaction were analyzed.Results The total scores of the research subject were distributed from 12 to 115,with a median of 69.5 (40～90).The four dimensions,accounted from low to high were statistical knowledge,software operation,scientific research basis and thesis writing.According to the single factor analysis,age,education level,chance of training,presence or absence of team,time of scientific research activities,hospital level,satisfaction with work were related to the level of scientific research capacity of joint surgeons (P＜0.05);multiple regression results shows that the impact level of scientific research,from large to small,is whether there are scientific research teams,job satisfaction,and time for scientific research activities.These three factors can explain the change of scientific research ability by 60.5％ (R2 =0.605).Conclusions The joint surgeon's research capacity is at a relatively high level,while the statistical knowledge and software operation scores are low,which calls for more study and mastery.Increasing the construction of scientific research teams,improving job satisfaction,and increasing the time for scientific research activities can improve the scientific research capacity.

Objective:To analyze and summarize the clinical features of pyogenic liver abscess (PLA) patients treated in 10 years, so as to provide evidence to improve current diagnosis and corresponding treatment strategies of PLA.Methods:The clinical symptoms, signs, laboratory and imaging findings, etiology and different treatments as well as corresponding efficacy and prognosis of PLA patients treated in Xiangya Hospital of Central South University during January 2010 to December 2019 were retrospectively analyzed.The chi-square was used to evaluate the differences of the categorical variables.Results:A total of 528 PLA cases were included in this study.Diabetes mellitus (46.8%, 247/528), biliary tract diseases (34.7%, 183/528) and previous hepatobiliary surgery history (19.7%, 104/528) were three most common risk factors leading to PLA. Fever (80.9%, 427/528), loss of appetite (53.6%, 283/528) and abdominal pain (51.9%, 274/528) were most common clinical manifestations. The accuracies of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were 95.5%(472/494), 97.0%(384/396), and 96.8%(92/95), respectively. The positive rate of pus culture (70.9%, 168/237) was higher than that of blood culture (20.0%, 42/210), and the difference was statistically significant ( χ2=115.746, P<0.01). The top three most common bacteria were Klebsiella pneumoniae (122 strains), Escherichia coli (29 strains) and Enterococcus faecium (10 strains). The drug resistance rate of Klebsiella pneumoniae to ampicillin was as high as 97.4%(112/115). The treatment programs included 200 cases of sole antibiotic treatments. Based on the antibiotic treatment, imaging guided percutaneous puncture therapy was the most commonly used treatment (45.6%, 241/528), included imaging guided percutaneous puncture and drainage (29.0%, 153/528) and imaging guided percutaneous catheterization (16.7%, 88/528). The surgical treatments included surgical catheter drainage (5.5%, 29/528) and surgical hepatectomy(11.0%, 58/528). The total number of cured cases was 495, and the cure rate was 93.8%. Conclusions:The common clinical manifestations of PLA are fever, loss of appetite, abdominal pain. Ultrasound is a routine and effective method to detect liver abscess. Klebsiella pneumoniae is the most common pathogen. Imaging guided percutaneous puncture is the most common treatment.

Objective To study the effect of active cycle of breathing techniques ( ACBT ) on the respiratory function and quality of life in patieats undergoing mechanical ventilation .Methods A total of 65 patients with respiratory failure treated by mechanical ventilation were randomly divided into control group ( n=30) and ACBT group ( n=35) .The patients in ACBT group were treated by ACBT , and the patients in the control group were treated by conventional nursing care .Patients'vital signs , respiratory function and quality of life were compared.The level of physical recovery and quality of life were measured by the scale of the Barthel index and the activities of daily living (ADL), respectively.Results In the ACBT group, the mean time of mechanical ventilation was (24.0 ±8.9) h and the success rate of ventilator weaning was 77.1%, which were better than those of (75.0 ±6.7) h and 53.3%in the control group.There were significant differences between the groups (t=2.73,6.92, respectively;P<0.05).At the first day after ventilation, there was no significant difference in the score of ADL between the groups (P>0.05).But the score of ADL was significantly different at the third day (t=2.85,P<0.05).30.0% patients in the control group and 57.1% patients in the ACBT group had a good viability, the difference was significant (χ2 =6.47,P <0.05).Conclusions The active cycle of breathing techniques was useful in shortening the time of mechanical ventilation and can improve patients 'quality of life.

Objective:To investigate the application value of reactive oxygen species (ROS) and adiponectin (ADPN) in the judgment of liver inflammation in chronic hepatitis B virus infection combined with nonalcoholic fatty liver disease (NAFLD).Methods:A total of 159 cases with NAFLD (21 cases), chronic hepatitis B virus infection (57 cases), and chronic hepatitis B virus infection combined with NAFLD (81 cases) were collected between June 2016 to December 2018, and the visited patients diagnosis were confirmed by histopathological examination of the liver. ROS and ADPN level retained in serum was determined by enzyme-linked immunosorbent assay. Histopathological examination of liver tissue was used as the gold standard to discuss the diagnostic value of the serum in patients with chronic hepatitis B virus infection combined with NAFLD for the occurrence of nonalcoholic steatohepatitis. One-way analysis of variance was used for the comparison among multiple groups, and LSD-t test was used for pairwise comparison between groups. Measurement data for non-normal distributions were expressed as M (P25, P75). Comparisons between groups were performed using the Mann-Whitney U or Kruskal-Wallis H test. Chi-square test was used to compare the count data between groups. Correlation analysis was performed using Spearman correlation analysis. Histopathological grouping of liver tissue was used as the gold standard, and the area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the regression formula.Results:(1) In patients with chronic hepatitis B virus infection combined with NAFLD, the levels of ROS in the non-hepatic steatosis group and the mild hepatic steatosis group were significantly lower than those in the moderate and severe hepatic steatosis group, while the ADPN level in the non-hepatic steatosis group was significantly higher than liver steatosis group, P < 0.05. (2) The results of correlation analysis showed that ROS was significantly correlated with NAS score, change in the degree of fatty liver and lobular inflammation (all P < 0.05).There was a significant negative correlation between ADPN and the change in the degree of fatty liver ( P < 0.05). (3) Logistic regression analysis results showed that the diagnostic formula for chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis was 0.02 × controlled attenuation index + 0.584 × white blood cells/10 9 + 0.587 × ROS-10.982. The area under receiver operating characteristic curve of the subject was = 0.896. The sensitivity, specificity, positive and negative predictive value were 97.1%, 71.2%, 64.2%, and 97.9%. Conclusion:ADPN and ROS have certain reference value in differentiating the change in the degree of fatty liver and inflammation in chronic hepatitis B virus infection combined with NAFLD and the diagnostic formula has higher application value in the diagnosis and exclusion of chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis.

Objective:To analyze the clinical features, genetic characteristics, treatment and follow-up results of patients with hydrocephalus caused by methylmalonic acidemia combined with homocysteinuria, and to discuss the optimal strategies for assessing and treating such patients.Methods:From January 1998 to December 2020, 76 patients with hydrocephalus due to methylmalonic acidemia combined with homocysteinuria in the Department of Pediatrics in 11 hospitals including Peking University First Hospital were diagnosed by biochemical, genetic analysis and brain imaging examination. The patients were divided into operation-group and non-operation-group according to whether they underwent ventriculoperitoneal shunt. The clinical features, laboratory examinations, genotype, and follow-up data were retrospectively analyzed. Data were compared between the two groups using rank sum test, and categorical data were compared using χ 2 test. Results:Among the 76 patients (51 male, 25 female), 5 were detected by newborn screening, while 71 were diagnosed after clinical onset, 68 cases (96%) had early-onset, 3 cases (4%) had late-onset. The most common clinical manifestations of 74 cases with complete data were psychomotor retardation in 74 cases (100%), visual impairment in 74 cases (100%), epilepsy in 44 cases (59%), anemia in 31 cases (42%), hypotonia or hypertonia in 21 cases (28%), feeding difficulties in 19 cases (26%) and disturbance of consciousness in 17 cases (23%). Genetic analysis was performed in 76 cases, all of whom had MMACHC gene variations, including 30 homozygous variations of MMACHC c.609G>A. The most common variations were c.609G>A (94, 62.7%), followed by c.658_660del (18, 12.0%), c.567dupT (9, 6.0%) and c.217C>T (8, 5.3%). Therapy including cobalamin intramuscular injection, L-carnitine and betaine were initiated immediately after diagnosis. A ventriculoperitoneal shunt operation was performed in 41 cases (operation group), and 31 patients improved after metabolic intervention (non-operation group). There was no significant difference in the age of onset, the age of diagnosis, the blood total homocysteine, methionine, and urinary methylmalonic acid concentration between the two groups (all P>0.05). The symptoms of psychomotor development, epilepsy, and visual impairments improved gradually after a long-term follow-up in the operation group. Conclusions:Hydrocephalus is a severe complication of methylmalonic acidemia combined with homocysteinuria. The most common clinical manifestations are psychomotor retardation, visual impairment, and epilepsy. It usually occurs in early-onset patients. Early diagnosis and etiological treatment are very important. Hydrocephalus may improve after metabolic intervention in some patients. For patients with severe ventricular dilatation, prompt surgical intervention can improve the prognosis.

Objectives:To summarize the clinical and genetic characteristics of the patients with isolated methylmalonic acidemia and investigate the strategies for the diagnosis, treatment and prevention.Methods:Three hundred and fourteen patients (180 males, 134 females) with isolated methylmalonic acidemia were ascertained from 26 provinces or cities across the mainland of China during January 1998 to March 2020. Genetic analysis was performed by Sanger sequencing, gene panel sequencing, whole exome sequencing, multiplex ligation-dependent probe amplification or quantitative PCR. According to the age of onset, the patients were divided to early-onset group (≤12 months of age) and the late-onset group (>12 months of age). They were treated by cobalamin, L-carnitine and (or) special diet and symptomatic treatment. Statistical analysis was done using Chi-square test.Results:Fifty-eight of 314 (18.5%) patients were detected by Newborn screening using liquid chromatography tandem mass spectrometry. Five cases (1.6%) had a postmortem diagnosis. Two hundred and fifty-one patients (79.9%) were clinically diagnosed with an age of onset ranged from 3 hours after birth to 18 years. One hundred and fifty-nine patients (71.0%) belonged to early-onset groups, 65 patients (29.0%) belonged to the late-onset group. The most common symptoms were metabolic crises, psychomotor retardation, epilepsy, anemia and multiple organ damage. Metabolic acidosis and anemia were more common in early-onset patients than that in late-onset patients (20.8%(33/159) vs. 9.2% (6/65), 34.6% (55/159) vs. 16.9% (11/165), χ 2=4.261, 6.930, P=0.039, 0.008). Genetic tests were performed for 236 patients (75.2%), 96.2%(227/236) had molecular confirmation. One hundred and twenty-seven variants were identified in seven genes (MMUT, MMAA, MMAB, MMADHC, SUCLG1, SUCLA2, and MCEE), of which 49 were novel. The mut type, caused by the deficiency of methylmalonyl-CoA mutase, was the most common ( n=211, 93%) cause of this condition. c.729_730insTT, c.1106G>A and c.914T>C were the three most frequent mutations in MMUT gene. The frequency of c.914T>C in early-onset patients was significantly higher than that in late-onset patients (8.3% (18/216) vs. 1.6% (1/64), χ 2=3.859, P=0.037). Metabolic crisis was more frequent in mut type than the other types (72.6% (114/157) vs. 3/13, χ 2=13.729, P=0.001),developmental delay and hypotonia were less frequent in mut type (38.2% (60/157) vs. 9/13, 25.5% (40/157) vs. 8/13, χ 2=4.789, 7.705, P=0.030, 0.006). Of the 58 patients identified by newborn screening, 44 patients (75.9%) who were treated from asymptomatic phase developed normally whereas 14 patients (24.1%) who received treatment after developing symptoms exhibited varying degrees of psychomotor retardation. Conclusions:The characteristics of phenotypes and genotypes among Chinese patients with isolated methylmalonic acidemia were analyzed. Expanded the mutation spectrum of the associated genes. Because of the complex clinical manifestations and severe early onset of isolated methylmalonic acidemia, Newborn screening is crucial for early diagnosis and improvement of prognosis. MMUT gene is recommended for carrier screening as an effort to move the test earlier as a part of the primary prevention of birth defects.