Pristimerin (Ⅰ), ?-sitosterol (Ⅱ),?-amyrin(Ⅲ),?-amyrin palmitate (Ⅳ)and 1-triacontanol acetate (Ⅴ)have been isolated from the root of Celastrus orbiculatus. I possesses strong cytotoxicity against P_(388) cell(IC_(50)=0. 267?g/ml )and LAX cell (IC_(50)= 0.018?g/ml)in vitro test. 13 CNMR assignments for I have been revised.

Based on their own characteristics and learning purposes of the child neurologic training doctors and to full use of the advantage of our hospital in faculties, facilities and patients, the plan was designed and focused on better understanding of clinical related basic theoretical knowledge, improving the ability of clinical research and thesis writing, strengthening communication skills between patients and doctors, and medical ethics training and health regulations learning. The training doctors achieved good results in the aspects of medical skills, research ability and comprehensive professional quality.

Objective To evaluate the clinical application of CT virtual cystoscopy (CTVC). Me-thods Thirteen patients who had clinical indication were studied. Iodine contrast was intravenously injected after the bladder was voided. Thin-slice spiral CT scanning of the bladder area was started when the bladder became filled with contrast media. By using 3D navigator smooth software, CTVC images were obtained. The findings in all cases were compared with the cystoscopy and surgical results. Results Nine patients with CTVC were proved vesical tumor,3 patients with CTVC were proved benign prostatic hyperplasia, and they were confirmed by cystoscopy,1 patient with cystitis glandularis could not be diagnosed with CTVC.By CTVC, the diagnostic accordance rate was 92.3%,the coincidence rate was 100.0% in vesical tumor. Conclusions CTVC is highly sensitive in displaying the vesical lesions.Being a new and non-invasive technique, CTVC is very helpful in the diagnosis of introvesical diseases. It has fine value in the clinical practice.

Objective:To investigate the clinicopathological characteristics and influencing factors of kidney prognosis in primary IgA nephropathy (IgAN) patients.Methods:The data of primary IgAN patients diagnosed with renal biopsy in the First Affiliated Hospital of Anhui Medical University from January 2015 to September 2019 were retrospective analyzed. According to the level of baseline estimated glomerular filtration rate (eGFR) when performing renal biopsy, the patients were divided into group A[eGFR≥90 ml·min -1·(1.73 m 2) -1], group B[eGFR 61-89 ml·min -1·(1.73 m 2) -1] and group C[eGFR≤60 ml·min -1·(1.73 m 2) -1]. The clinical and pathological data were collected and compared among the three groups. Kaplan-Meier method was conducted for renal results, whereas the Cox proportional-hazards regression model was exploited to analyze the influencing factors of kidney prognosis in IgAN patients. Results:A total of 742 patients were included in the study, including 394 cases (53.1%) in group A, 203 cases (27.4%) in group B, and 145 cases (19.5%) in group C. There were 325 males (43.8%) and 417 females (56.2%). The median duration of renal biopsy was 6 (1, 24) months, and the median age was 36 years old (18-68 years old). As the baseline level of renal function decreased, the proportion of patients with nephrotic syndrome, hypertension, anemia and hyperuricemia and the levels of 24 h urinary protein, serum triglyceride and total cholesterol increased significantly (all P<0.05), while the proportion of gross hematuria episodes and the ratio of serum albumin to globulin significantly decreased (all P<0.05). For the aspect of pathological manifestations, the proportions of cell proliferation in capillaries (E1), segmental sclerosis or adhesion (S1), renal tubular atrophy or interstitial fibrosis (T1/2), globular sclerosis, renal arteriole wall thickening and vitreous degeneration, Lee's grade Ⅳ and Ⅴ increased with the decrease of baseline renal function (all P<0.05). Kaplan-Meier analysis showed that the cumulative renal survival rate decreased with the decline of baseline renal function (Log-rank χ2=88.510, P<0.001). As a result of multivariate Cox regression analysis, nephrotic syndrome ( HR=2.399, 95% CI 1.054-5.459, P=0.037), hypertension ( HR=1.806, 95% CI 1.071-3.048, P=0.027), low baseline eGFR (taking group A as the reference, group B: HR=2.383, 95% CI 1.053-5.392, P=0.037; group C: HR=6.878, 95% CI 3.074-15.393, P<0.001), IgG deposition ( HR=2.224, 95% CI 1.384-3.574, P=0.001) and globular sclerosis ( HR=2.075, 95% CI 1.230-3.501, P=0.006) were the independent influencing factors for renal progression in primary IgAN patients. Conclusions:The level of baseline renal function in primary IgAN patients can be used to predict the extent of clinic-pathological damage. Nephrotic syndrome, hypertension, low baseline eGFR, IgG deposition and globular sclerosis are the independent influencing factors for renal progression in primary IgAN patients.

Objective To evaluate the significance of serum 8-hydroxy-deoxyguanosine acid ( 8-OHdG) in the diagnosis of nonalcoholic steatohepatitis ( NASH).Methods Patients or healthy subjects were enrolled at the Second Hospital of Tianjin Medical University and the Second People ′s Hospital of Tianjin from May 2013 to December 2015.A total of 41 patients with nonalcoholic fatty liver disease were enrolled in the study , including 20 nonalcoholic simple fatty liver ( NAFL) patients and 21 NASH patients whose diagnosis were proven by liver biopsy.The other 32 healthy subjects were studied as controls.Serum 8-OHdG, ALT, AST and GGT were tested.Nonalcoholic fatty liver disease activity score ( NAS ) and expression of 8-OHdG in liver was investigated between NAFL patients and NASH patients.The correlations between serum 8-OHdG and serum ALT , AST, GGT, and 8-OHdG in liver tissue in NASH group were investigated.In addition , the receiver operating characteristic ( ROC) curve analyses for ALT and 8-OHdG levels were performed in NAFL patients and NASH patients , and the cut-off value was determined.Results Serum 8-OHdG values in healthy controls , NAFL and NASH patients were (0.19 ±0.16) μg/L, (0.22 ±0.16) μg/L, (0.42 ±0.21) μg/L respectively.The serum 8-OHdG and serum ALT, GGT and 8-OHdG in liver tissue were all positively correlated in NASH group with respective correlation coefficient r values as 0.454 7, 0.382 9, and 0.497 6.AUC of 8-OHdG was 0.901 with cut-off value 0.39 μg/L.Its sensitivity was 88.3%and specificity was 81.5%, which were higher than those of ALT.Conclusion The value of serum 8-OHdG would be used as a marker for the diagnosis of NASH.

Objective To evaluate the accuracy of different anatomic landmark methods in determining the size of nasopharyngeal airway.Methods Fifty-two patients of both sexes,aged 16-60 yr,of American Society of Anesthesiologists physical status Ⅰ to Ⅲ,with body mass index of 18-30 kg/m2,scheduled for elective awake craniotomy for supratentorial tumors under sedation-awake-sedation anesthesia,were included.For each patient,the distance from the apex of nose to the right tragus (NT),distance from apex of nose to the right mandibular angle (NM),and thyro-mental distance (TM) were measured and marked on a transnasal tube correspondingly.The patients were placed in supine position without pillow,topical anesthesia (nasal mucosal surface) was performed with 2％ lidocaine,and patients were sedated with midazo1am,propofol and dexmedetomidine.When Observer's Assessment of Alertness/Sedation Scale score was 2 or 3 points,the tube was transnasally inserted to each marked depth.When the three marked depths mentioned above were reached,the positions of the tube's tip were checked using a fiberoptic bronchoscope and recorded as:above epiglottis (the tip of the tube was placed between the epiglottis and the free edge of soft palate) or below epiglottis (the tip of the tube placed at or beyond the epiglottis).Results When the depth reached the NT mark,the tube's tip was above epiglottis in 14 cases (27％),and the tube's tip was below epiglottis in 38 cases (73％).When the depth reached the NM mark,the tube's tip was above epiglottis in 31 cases (60％),and the tube's tip was below epiglottis in 21 cases (40％).When the depth reached the TM mark,the tube's tip was above epiglottis in 52 cases (100％).Compared with the NM and NT methods,the TM method had a higher probability with the tube's tip above epiglottis when used to determine the depth of insertion (P＜0.01).Conclusion TM anatomic landmark method provides higher accuracy in determining the size of nasopharyngeal airway.

Deciphering the metabolites of multiple components in herbal medicine has far-reaching significance for revealing pharmacodynamic ingredients.However,most chemical components of herbal medicine are secondary metabolites with low content whose in vivo metabolites are close to trace amounts,making it difficult to achieve comprehensive detection and identification.In this paper,an efficient strategy was proposed:herb-derived metabolites were predicted according to the structural characteristics and metabolic reactions of chemical constituents in Corydalis Rhizoma and chemical structure screening tables for metabolites were conducted.The fragmentation patterns were summarized from represen-tative standards combining with specific cleavage behaviors to deduce structures of metabolites.Ion abundance plays an important role in compound identification,and high ion abundance can improve identification accuracy.The types of metabolites in different biological samples were very similar,but their ion abundance might be different.Therefore,for trace metabolites in biological samples,we used the following two methods to process:metabolites of high dose herbal extract were analyzed to char-acterize those of clinical dose herbal extracts in the same biological samples;cross-mapping of different biological samples was applied to identify trace metabolites based on the fact that a metabolite has different ion abundance in different biological samples.Compared with not using this strategy,44 more metabolites of clinical dose herbal extract were detected.This study improved the depth,breadth,and accuracy of current methods for herb-derived metabolites characterization.

Objective:To systematically evaluate of the impact of non-specific soft tissue manipulation on pain severity in patients with chronic neck pain.Methods:Trials included in Meta-analysis were determined by searching PubMed, Embase, Cochrane Library, Web of Science and 5 English databases in the U.S. Clinical Trial Registry. The search terms include the subject terms of neck pain, soft tissue treatment, massage, and myofascial release. Two reviewers independently selected studies, extracted data and assessed the quality of the studies. The included trials were assessed by using the Cochrane risk-of-bias tool. STATA statistical software 16.0 was used for statistical analysis. Additionally, subgroup analysis and sensitivity analysis were performed to analyze the sources of heterogeneity and assess the stability of research results. Begg funnel plot and Egger′s publication bias plot were used to assess potential publication bias.Results:This systematic review included a total of 12 randomized controlled trials (566 patients in total). The participants were 18 to 85 years old. Most of the included studies were of medium quality. This Meta-analysis validated the effectiveness of soft tissue manual therapy on alleviating pain symptoms in patients with chronic neck pain ( ES =-0.83, 95% CI -1.15 to -0.51, P = 0.001). The Begg funnel plot indicated that there may be potential publication bias. Conclusions:This Meta-analysis found that soft tissue manual therapy has a significant effect on alleviating the pain of patients with chronic neck pain. However, different pain assessment tools could have a certain impact on the Meta-analysis results.

Objective:To analyze the MRI features of medulloblastoma (MB) in children, and screen out the key signs that can predict the risk of MB before surgery.Methods:Clinical and radiological data of 62 children with MB confirmed by pathology in Shenzhen Children′s Hospital from December 2012 to December 2021 were retrospectively analyzed. According to the diagnosis and treatment guidelines for children with MB (2021 edition), the patients were divided into standard risk group (43 cases) and high risk group (19 cases). MRI features of MB were observed and recorded, including tumor site, location of tumor center, tumor morphology, signal intensity of T 1WI, T 2WI and diffusion weighted imaging (DWI), enhancement pattern, cystic lesion size, location and number, peritumoral edema and hydrocephalus, and the maximum diameter of tumor was measured. The χ 2 test or Fisher exact probability method was used to compare the differences in age, gender and MRI signs between the two groups. The t test of two independent samples was used to compare the differences in the maximum diameter of tumors between the two groups. The indicators with statistically significant differences were included in binary logistic regression analysis to obtain independent influencing factors associated with the risk groups. The receiver operation characteristic curve was used to evaluate the diagnostic efficacy. Results:There were significant differences in age ( P=0.026), enhancement pattern ( P=0.018), cystic lesion size ( P=0.005), location ( P=0.011) and number ( P=0.003) between standard risk group and high risk group. There were no significant differences in gender, tumor site, location of tumor center, tumor morphology, signal intensity of T 1WI, T 2WI and DWI, peritumoral edema, hydrocephalus and maximum diameter of tumor between the two groups ( P>0.05). Binary logistic regression results showed the age (OR=0.207, 95%CI 0.040-0.983, P=0.042) and the number of cystic lesions (OR=0.215, 95%CI 0.073-0.630, P=0.005) were the protective factors for MB in high risk group, the enhancement pattern Ⅲ (OR=5.226, 95%CI 1.516-52.920, P=0.048) was the dangerous factor for MB in high risk group. The area under the curve of the combined diagnosis of high risk MB was 0.845 (95%CI 0.741-0.949). Conclusions:The age and MRI signs the pattern of tumor enhancement Ⅲ and the number of cystic lesion can be used to predict the risk grouping of MB preoperatively. When the child is younger and MB enhancement pattern is mainly peripheral enhancement without obvious cystic change, it may indicate high risk MB.

Objective To investigate the changes of peripheral blood expression levels of soluble fibrinogen-like protein 2 (sFGL2) in patients with chronic hepatitis B (CHB) before and after antiviral treatment.Methods From July 2013 to December 2014,initial CHB patients with entecavir antiviral therapy and healthy controls were enrolled.Clinical data at baseline and during follow-up were collected.Plasma levels of sFGL2 of all the included objects were measured by enzyme-linked immunosorbent assay (ELISA).All the patients received liver biopsy at baseline,and part of patients received a second liver biopsy at week 78 after treatment.The expression of sFGL2 in liver tissues were examined by immunohistochemistry.T test,Wilcoxon test and correlation analysis were performed for statistical analysis.Results A total of 71 CHB patients and 20 healthy controls were enrolled.At baseline,the level of plasma sFGL2 of CHB patients was significantly higher than healthy controls (105.6 μg/L (78.3 μg/L to 151.6 μg/L) vs 25.2 μg/L (18.8 μg/L to 34.3 μg/L),Z=-5.887,P＜ 0.01).The plasma sFGL2 level of patients with liver cirrhosis was 146.0 μg/L (111.3 μg/L to 166.8 μg/L),which was higher than that of patients without liver cirrhosis (79.0 μg/L (65.4 μg/L to 107.4 μg/L)),and the difference was statistically significant (Z=-4.912,P＜0.01).Plasma levels of sFGL2 were positively correlated with liver stiffness,liver inflammation and fibrosis stages (r=0.426,0.240 and 0.655;all P＜0.05).At 26 weeks and 52 weeks after treatment,the plasma levels of sFGL2 were 89.1 μg/L (69.8 μg/L to 125.5 μg/L) and 75.8 μg/L (53.4 μg/L to 98.9 μg/L),respectively,which gradually decreased compared with that at baseline (26 weeks vs baseline Z=-4.499,P＜0.01;52 weeks vs 26 weeks Z=-4.762,P＜0.01).Furthermore,at baseline the number of sFGL2 positive cells in the liver tissue of liver cirrhosis group was 33.0 ± 10.4,which was higher than that of non-liver cirrhosis group (17.6 ±6.7),and the difference was statistically significant (t=7.541,P＜0.01).Compared with that at baseline (24.5±2.0),the number of sFGL2 positive cells in liver tissue at week 78 after treatment decreased (11.3± 1.6),and the difference was statistically significant (t=11.980,P＜0.01).Conclusion Plasma level of sFGL2 is closely correlated with the degree of liver inflammation and fibrosis in CHB,and the plasma level of sFGL2 significantly decreases after long-term antiviral therapy.