In order to clarify the chemical constituents in Qiliqiangxin capsule, a rapid ultra-performance liquid chromatography/orthogonal acceleration time-of-flight mass spectrometry (UPLC-Q-TOF/MS(E)) method was established. Forty peaks were identified on line using this method. The herbal sources of these peaks were assigned. The results implied that triterpenoid saponins, flavonoid glycosides, C21-steroids and phenolic acids were included in the main components of Qiliqiangxin capsule. The method is simple and rapid for elucidation of the constituents of Qiliqiangxin capsule and the results are useful for the quality control of Qiliqiangxin capsule.

Objective To explore the postoperative psychological status of donors during pediatric living donor liver transplantation (LDLT) to elucidate the correlation between resilience,anxiety and depression.Methods Random sampling was employed for selecting 60 pediatric LDLT donors undergoing LDLT from September 2014 to February 2019.They were requested to answer a questionnaire.The questionnaire concluded general information,self-rating anxiety scale (SAS),selfrating depression scale (SDS) and Chinese version of Resilience Scale.Results The score of anxiety was (46.06 ± 10.06) and depression was (50.32 ± 11.49).Both values were higher than those of Chinese norm.The score of resilience was (59.55 ± 14.62).And the total score of resilience and the score of each dimension were negatively correlated with anxiety and depression (P＜0.01).Conclusions The postoperative anxiety and depression level of donors during LDLT are higher than the ordinary.Resilience is negatively correlated with the level of anxiety and depression.The lower level of resilience,the higher anxiety and depression of donors during LDLT.For clinicians,appropriate intervention measures should be taken for improving the resilience,reducing negative emotions and boosting the quality-of-life of donors during LDLT.

Objective:To explore the methods and clinical effects of the surgery for treating maxillary medication-related osteonecrosis of the jaw (MRONJ).Methods:The clinical data including gender, age, stage of lesion, treatment method and prognosis of 28 patients with maxillary MRONJ who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery of Medical School of Nanjing University from January 2013 to October 2020 were retrospectively analyzed. There were 20 males and 8 females. The mean age at onset was (65.6±11.1) years old. According to the guidelines of American Association of Oral and Maxillofacial Surgeons, the patients′ lesions were divided into 2 or 3 stages. Ten cases of stage 2 lesions were tightly sutured after partial jaw resection. Among them, 4 lesions were sutured directly with mucoperiosteal flaps, 4 lesions were covered by adjacent flaps and 2 lesions was covered by buccal fat pad flaps and adjacent flaps. Eighteen cases of stage 3 lesions were treated with sequestrectomy and drainage channels were formed. Patients were followed up regularly after the surgery, and the effect of surgical treatment was judged according to the clinical criteria such as clinical manifestations, local oral examination, imaging examination etc.Results:After follow-up for 12 to 52 months, the postoperative pain score (1.20±2.53) was significantly lower than preoperative pain score (6.70±0.95) ( P<0.05) in stage 2 patients. Eight patients′ mucosa healed completely without new dead bone formed. Two patients had recurrence and developed to stage 3 at the time of revisit. There were 18 cases of stage 3 lesions, which formed drainage channels after removal of the dead bone. The postoperative follow-up time was 2 to 67 months, and the symptoms of inflammation and infection disappeared. Postoperative pain score (3.40±0.51) was significantly lower than preoperative pain score (7.06±1.00) ( P<0.05). Conclusions:Soft tissue flap closure of wound after partial maxillectomy is an effective approach for the treatment of maxillary MRONJ stage 2 lesions, while maxillary stage 3 lesions could be treated for eliminating clinical symptoms and improving the quality of life when establishing unobstructed drainage after dead bone extraction.

Objective To screen the differentially expressed proteins in glomeruli during the treatment of lupus nephritis(LN)with hydroxychloroquine sulfate(HCQ).Methods Sixty female NZB/WF1 mice were used.At the age of 28 weeks,40 mice with proteinuria of 3+to 4+were divided into HCQ and control groups.After feeding for 36 weeks,the glomerular proteins were extracted by magnetic beads and analyzed by two-dimensional fluorescence difference gel electrophoresis(2D-DIGE)and matrix-assisted laser desorption/ioniza-tion time-of-flight mass spectrometry(MALDI-TOF-MS).The expression of the candidate proteins in the glomeruli of the LN mice was exa-mined by immunohistochemistry.Results A total of 31 differentially expressed proteins were identified between the two groups,including 24 upregulated and seven downregulated proteins.Conclusion The expression of proteins like RI and ENOA in the glomeruli of LN mice was significantly different during HCQ treatment.These proteins may be involved in the pathogenesis of LN and are therefore potential targets of HCQ in the treatment of LN.

Objective To study the optical imaging quality of multifocal intraocular lens (IOL) following Nd∶YAG laser damage.Methods Three hydrophobic acrylate discs used to make multifocal IOL were placed in line,and the Nd∶YAG laser was used to emit the posterior surface,mid-plane and anterior surface of the discs by gradually increasing the emitting energy to determine the damaged threshold energy of various planes.Eight multifocal IOLs were divided into 2 groups.IOL damage models were established by emitting 12 points along 12 clocks on circle of 3.0 mm in diameter in the group 1 (IOLs NO.1,2,3,4) and 6 points with 1-clock interval on circle of 1.0 mm in diameter in the group 2 (IOLs NO.5,6,7,8) with Nd∶YAG laser.The modulation transfer function (MTF),line spread function (LSF) and United States air force (USAF) test target images of the IOLs were tested under the optical aperture at 2.0,3.0 and 4.5 mm.Results The damage thresholds of laser power were not significantly different among three hydrophobic acrylate discs (Fgroup =1.100,P =0.337),and the thresholds were significantly different among different planes in the discs (Fposition =195.279,P=0.000),with the highest damage threshold in the anterior surface and the lowest damage threshold in the mid-plane of the discs(all at P＜0.01).The shifts of far focus and near focus MTF curves,LSF curves and USAF target images of the IOLs under the 2.0,3.0 and 4.5 mm optical aperture after laser damage were in coincidence with those before laser damage both in group 1 and group 2.The glare phenomenon of the USAF target image was observed at near focus under the 4.5 mm optical aperture both before and after laser damage.Conclusions Multifocal IOL is vulnerable to injury when the laser beam focuses on the midplane,and the anterior surface of IOL can tolerate certain degree of damage.In standard model eye,the MTF curves,LSF curves and USAF target images of multifocal IOL was not impacted by laser induced spots injuries under different pupil diameters.

Objective: To investigate the effect of long-term deep slow-wave sleep deprivation on the gonad axis, sperm abnormality rate, and structure of the testis in male rats and possible mechanisms. Methods: A total of 30 specific pathogen-free male Wistar rats aged 5 weeks were randomly divided into slow-wave sleep deprivation group 1 (SD1 group) , slow-wave sleep and sleep time deprivation group 2 (SD2 group) , and control group, with 10 rats in each group. The flower pot method was used to establish a model of sleep deprivation. In addition to 12-hour sleep deprivation at night, the rats in the SD1 group were given interference once every 24 minutes, and those in the SD2 group were deprived of sleep for 8 minutes every 24 minutes; the rats in the control group were given 12-hour light illumination and then placed in dark environment for 12 hours. All rats were sacrificed by exsanguination from the femoral artery, and the testis, the epididymis, and blood were collected for analysis. Sperm abnormality rate and sperm motility rate were measured, and cauda epididymal sperm counting was performed. ELISA was used to measure the serum levels of testosterone (T) , follicle-stimulating hormone (FSH) , and luteinizing hormone (LH) . Results: Compared with the control group, the SD2 group had a significant increase in organ coefficient of the epididymis (P<0.05) and a significant reduction in sperm motility rate (P<0.05) . There were significant differences between the SD1 group and the SD2 group in the increase in sperm abnormality rate (P<0.05) and the reduction in cauda epididymal sperm count (P<0.05) . The levels of FSH and T tended to increase, and the level of LH tended to decrease. Pathological examination showed degeneration and vacuolization of a small amount of spermatogenic cells in the SD1 group; in the SD2 group, there were significant degeneration, edema, and vacuolization of most spermatogenic cells, some spermatogenic cells were observed in the lumen, and there were no sperms in the lumen. Conclusion Long-term deep slow-wave sleep deprivation impairs the structure of the testis, affects sperm motility rate and sex hormones, and increases the risk of sperm abnormality.

Objective To compare the efficacy of ultrasound-guided microwave ablation versus thyroidectomy in the treatment of benign thyroid nodules(BTN)and to explore the influencing factors of prognosis.Methods A total of 282 BTN patients were enrolled and divided into ablation group(treated with ultrasound-guided microwave ablation,n=172)and resection group(treated with thy-roidectomy,n=110)based on treatment methods.Perioperative indicators and thyroid function indi-ces before and after surgery were compared between the two groups.Patients were followed up for 1 year and divided into good prognosis group[volume reduction rate(VRR)≥80％,n=210]and a poor prognosis group(VRR＜80％,n=72)based on the VRR.Factors influencing the prognosis of BTN patients were analyzed.Results The ablation group had shorter operative time and hospital stay,less intraoperative blood loss,and lower postoperative Visual Analogue Scale(VAS)scores compared to the resection group(P＜0.05).One month after surgery,serum thyrotropin(TSH)lev-els were higher,while free triiodothyronine(FT3)and free thyroxine(FT4)levels were lower than preoperative levels in both groups,however,TSH level was lower,and FT3 and FT4 levels were higher in the ablation group compared to the resection group(P＜0.05).Univariate analysis showed that preoperative TSH levels,the proportion of solid nodules,and the proportion of nodules in the risk zone were lower,while preoperative FT4 levels were higher in the good prognosis group compared to the poor prognosis group(P＜0.05).Binary Logistic regression analysis revealed that nodule type,nodule location,preoperative TSH,and preoperative FT4 were all influencing factors for the prognosis of BTN patients(P＜0.05).Conclusion Compared to thyroidectomy,ultra-sound-guided microwave ablation for BTN offers advantages such as less intraoperative blood loss,milder postoperative pain,shorter operative time and hospital stay,and less damage to thyroid func-tion.Preoperative TSH and FT4 levels,nodule type,and nodule location are closely related to the prognosis of BTN patients and should be given attention in clinical practice.

Objective To compare the efficacy of ultrasound-guided microwave ablation versus thyroidectomy in the treatment of benign thyroid nodules(BTN)and to explore the influencing factors of prognosis.Methods A total of 282 BTN patients were enrolled and divided into ablation group(treated with ultrasound-guided microwave ablation,n=172)and resection group(treated with thy-roidectomy,n=110)based on treatment methods.Perioperative indicators and thyroid function indi-ces before and after surgery were compared between the two groups.Patients were followed up for 1 year and divided into good prognosis group[volume reduction rate(VRR)≥80％,n=210]and a poor prognosis group(VRR＜80％,n=72)based on the VRR.Factors influencing the prognosis of BTN patients were analyzed.Results The ablation group had shorter operative time and hospital stay,less intraoperative blood loss,and lower postoperative Visual Analogue Scale(VAS)scores compared to the resection group(P＜0.05).One month after surgery,serum thyrotropin(TSH)lev-els were higher,while free triiodothyronine(FT3)and free thyroxine(FT4)levels were lower than preoperative levels in both groups,however,TSH level was lower,and FT3 and FT4 levels were higher in the ablation group compared to the resection group(P＜0.05).Univariate analysis showed that preoperative TSH levels,the proportion of solid nodules,and the proportion of nodules in the risk zone were lower,while preoperative FT4 levels were higher in the good prognosis group compared to the poor prognosis group(P＜0.05).Binary Logistic regression analysis revealed that nodule type,nodule location,preoperative TSH,and preoperative FT4 were all influencing factors for the prognosis of BTN patients(P＜0.05).Conclusion Compared to thyroidectomy,ultra-sound-guided microwave ablation for BTN offers advantages such as less intraoperative blood loss,milder postoperative pain,shorter operative time and hospital stay,and less damage to thyroid func-tion.Preoperative TSH and FT4 levels,nodule type,and nodule location are closely related to the prognosis of BTN patients and should be given attention in clinical practice.

BACKGROUND:Gradient artificial bone repair scaffolds can mimic unique anatomical features in musculoskeletal tissues,showing great potential for repairing injured musculoskeletal tissues. OBJECTIVE:To review the latest research advances in gradient artificial bone repair scaffolds for tissue engineering in the musculoskeletal system and describe their advantages and fabrication strategies. METHODS:The first author of the article searched the Web of Science and PubMed databases for articles published from 2000 to 2023 with search terms"gradient,bone regeneration,scaffold".Finally,76 papers were analyzed and summarized after the screening. RESULTS AND CONCLUSION:(1)As an important means of efficient and high-quality repair of skeletal system tissues,gradient artificial bone repair scaffolds are currently designed bionically for the natural gradient characteristics of bone tissue,bone-cartilage,and tendon-bone tissue.These scaffolds can mimic the extracellular matrix of native tissues to a certain extent in terms of structure and composition,thus promoting cell adhesion,migration,proliferation,differentiation,and regenerative recovery of damaged tissues to their native state.(2)Advanced manufacturing technology provides more possibilities for gradient artificial bone repair scaffold preparation:Gradient electrospun fiber scaffolds constructed by spatially differentiated fiber arrangement and loading of biologically active substances have been developed;gradient 3D printed scaffolds fabricated by layered stacking,graded porosity,and bio-3D printing technology;gradient hydrogel scaffolds fabricated by in-situ layered injections,simple layer-by-layer stacking,and freeze-drying method;and in addition,there are also scaffolds made by other modalities or multi-method coupling.These scaffolds have demonstrated good biocompatibility in vitro experiments,were able to accelerate tissue regeneration in small animal tests,and were observed to have significantly improved histological structure.(3)The currently developed gradient artificial bone repair scaffolds have problems such as mismatch of gradient scales,unclear material-tissue interactions,and side effects caused by degradation products,which need to be further optimized by combining the strengths of related disciplines and clinical needs in the future.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.