ObjectiveTo investigate the effects of different fermentation methods and times on the fungal flora and chemical composition of Aurantii Fructus， in order to obtain the optimal fermentation conditions and flora structure， and to ensure the stability and controllability of the fermented varieties. MethodsScanning electron microscopy was used to observe and analyze the colony characteristics on the surface of Aurantii Fructus under different fermentation conditions. Internal transcribed spacer 2（ITS2） high-throughput sequencing， combined with fungal community diversity analysis and fungal community structure analysis， were used to obtain the fungal flora microbial categories of Aurantii Fructus under the conditions of traditional pressure-shelf fermentation and non-pressure-shelf natural fermentation for 7， 14， 21 d（numbered Y1-Y3 for the former， and numbered F1-F3 for the latter）， respectively. At the same time， the chemical components in the fermentation process were detected by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS）， combined with principal component analysis（PCA）， partial least squares-discriminant analysis（PLS-DA） and compound retention time， parent ions， characteristic fragment ions and other information， the differential compounds between the different fermentation samples were screened and identified. ResultsThe analysis of fungal community diversity showed that the dominant flora did not change at different fermentation time points in the traditional pressure-shelf fermentation method， while in the non-pressure-shelf natural fermentation method， there was a significant difference with the fermentation process， and at the genus level， the dominant genus of samples Y1， Y2， Y3 and F2 was Aspergillus， while the dominant genera of samples F1 and F3 were both Rhizopus. This indicated that the microbial growth environment provided by the traditional fermentation method was more stable， and the microbial community structure was more stable， which was more conducive to the stable and controllable fermentation process and fermented products. A total of 155 compounds were identified by compositional analysis， including 70 flavonoids， 38 coumarins， 10 alkaloids， 34 organic acids and 3 other compounds. After fermentation， two new components of ribalinine and pranferin were produced. Different fermentation conditions also brought about differences in chemical composition， multivariate statistical analysis obtained 26 differential compounds under two different fermentation methods， mainly including flavonoids， organic acids and coumarins. Comprehensively， the microbial community structure of samples fermented by the traditional pressure-shelf method of Aurantii Fructus for 14 d was stable， the species richness was high and the overall content of differential compounds was high， which was the optimal processing condition. ConclusionCompared with non-pressure-shelf natural fermentation， the traditional method has obvious advantages in terms of the stability of the microbial community structure and the content of chemical compounds， and the optimal condition is 14 days of fermentation. This study is helpful to promote the quality stability and fermentation bioavailability of fermented products of Aurantii Fructus， as well as to provide an experimental basis for the further improvement of the quality control methods of this variety.

ObjectiveTo investigate the effects of different fermentation methods and times on the fungal flora and chemical composition of Aurantii Fructus， in order to obtain the optimal fermentation conditions and flora structure， and to ensure the stability and controllability of the fermented varieties. MethodsScanning electron microscopy was used to observe and analyze the colony characteristics on the surface of Aurantii Fructus under different fermentation conditions. Internal transcribed spacer 2（ITS2） high-throughput sequencing， combined with fungal community diversity analysis and fungal community structure analysis， were used to obtain the fungal flora microbial categories of Aurantii Fructus under the conditions of traditional pressure-shelf fermentation and non-pressure-shelf natural fermentation for 7， 14， 21 d（numbered Y1-Y3 for the former， and numbered F1-F3 for the latter）， respectively. At the same time， the chemical components in the fermentation process were detected by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS/MS）， combined with principal component analysis（PCA）， partial least squares-discriminant analysis（PLS-DA） and compound retention time， parent ions， characteristic fragment ions and other information， the differential compounds between the different fermentation samples were screened and identified. ResultsThe analysis of fungal community diversity showed that the dominant flora did not change at different fermentation time points in the traditional pressure-shelf fermentation method， while in the non-pressure-shelf natural fermentation method， there was a significant difference with the fermentation process， and at the genus level， the dominant genus of samples Y1， Y2， Y3 and F2 was Aspergillus， while the dominant genera of samples F1 and F3 were both Rhizopus. This indicated that the microbial growth environment provided by the traditional fermentation method was more stable， and the microbial community structure was more stable， which was more conducive to the stable and controllable fermentation process and fermented products. A total of 155 compounds were identified by compositional analysis， including 70 flavonoids， 38 coumarins， 10 alkaloids， 34 organic acids and 3 other compounds. After fermentation， two new components of ribalinine and pranferin were produced. Different fermentation conditions also brought about differences in chemical composition， multivariate statistical analysis obtained 26 differential compounds under two different fermentation methods， mainly including flavonoids， organic acids and coumarins. Comprehensively， the microbial community structure of samples fermented by the traditional pressure-shelf method of Aurantii Fructus for 14 d was stable， the species richness was high and the overall content of differential compounds was high， which was the optimal processing condition. ConclusionCompared with non-pressure-shelf natural fermentation， the traditional method has obvious advantages in terms of the stability of the microbial community structure and the content of chemical compounds， and the optimal condition is 14 days of fermentation. This study is helpful to promote the quality stability and fermentation bioavailability of fermented products of Aurantii Fructus， as well as to provide an experimental basis for the further improvement of the quality control methods of this variety.

OBJECTIVE: To investigate the effectiveness of three-dimensional (3D) printed customized hemi-pelvic prosthesis for pelvic reconstruction after resection of massive pelvic tumors. METHODS: A retrospective analysis was conducted on 26 patients with massive pelvic tumors who met the selection criteria and were treated between November 2021 and May 2024. The cohort included 11 males and 15 females, with a mean age of 52.65 years (range, 17-73 years). Histopathological diagnoses were as follows: 9 cases of chondrosarcoma, 2 of undifferentiated pleomorphic sarcoma, 4 of spindle cell sarcoma, 2 of osteosarcoma, 1 of solitary fibrous tumor, 1 of myxoid chondroma, 1 of malignant peripheral nerve sheath tumor, 1 of chondromyxoid epithelioma, and 5 of metastatic malignant tumors. According to the Enneking classification, tumor involvement was distributed as 4 cases in zones Ⅰ+Ⅱ, 9 in zones Ⅱ+Ⅲ, 3 in zones Ⅰ+Ⅳ, 8 in zones Ⅰ+Ⅱ+Ⅲ, and 2 in zones Ⅰ+Ⅱ+Ⅳ. The disease duration ranged from 3 to 40 months, with a mean of 9.85 months. All patients underwent reconstruction with customized 3D-printed hemi-pelvic prostheses. The effectiveness was evaluated by Musculoskeletal Tumor Society (MSTS) score and Harris hip score before operation and at last follow-up, and pain levels were evaluated by visual analogue scale (VAS) score before operation, at 3 months after operation, and at last follow-up. RESULTS: The operation time ranged from 186 to 528 minutes, with a mean of 334.58 minutes. The intraoperative blood loss ranged from 1 400 to 4 000 mL, with a mean of 2173.08 mL, and the transfusion volume ranged from 750 to 3 500 mL, with a mean of 1 659.62 mL. All 26 patients were followed up 10-42 months (mean, 18.5 months). Postoperative complications included prosthetic dislocation in 2 cases, which were attributed to improper positioning during home care and an accidental fall, respectively. One patient developed a vesicocutaneous fistula and poor wound healing due to pre-existing tumor invasion into the bladder. One patient experienced failure and loosening of the internal fixation at 8 months after operation caused by local tumor recurrence, and subsequently died at 14 months postoperatively due to progression of brain metastases. Postoperative complications such as poor healing of incisions, prosthetic dislocation, or failure of internal fixation was not observed in the remaining patients. At last follow-up, the walking ability of most patients recovered to varying degrees. The VAS scores at 3 months and at last follow-up significantly improved when compared with those before operation, and the scores at last follow-up further improved when compared with 3 months after operation, all showing significant differences ( P<0.05). The MSTS scores and Harris scores at last follow-up were significantly higher than those before operation ( P<0.05). CONCLUSION 3D printed customized hemi-pelvic prosthesis is effective for reconstruction of massive pelvic tumors after resection, but there are still some limitations, and soft tissue reconstruction should be paid attention to.
Humans ; Printing, Three-Dimensional ; Female ; Male ; Adult ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Middle Aged ; Aged ; Pelvic Bones/surgery* ; Bone Neoplasms/surgery* ; Adolescent ; Pelvic Neoplasms/surgery* ; Prosthesis Design ; Young Adult ; Treatment Outcome ; Prostheses and Implants

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Myeloid neoplasms (MNs) belong to a group of hematological malignancies characterized by the abnormal biological functions of hematopoietic stem progenitor cells. The abnormal immune and hematopoietic microenvironment of patients with MN interact with malignant clonal hematopoietic stem cells, promoting the occurrence and development of their diseases. MN large granular lymphocyte proliferation (MN-LGLP) is a special and rare clinical phenomenon in this type of disease. Currently, research on this disease in domestic and international cohorts is limited. This study analyzes the clinical and laboratory characteristics of this type of patient and explores the impact of LGLP on the clinical characteristics and survival of patients with MN. Patients with MN-LGLP are prone to neutropenia and splenomegaly. The presence of LGLP is not a risk factor affecting the survival of patients with MN-LGLP. STAG, ASXL1, and TET2 are the most common accompanying gene mutations in MN-LGLP, and patients with MN-LGLP and STAG2 mutations have poor prognoses.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:Using intrapartum ultrasound monitoring to observe and analyse the impact of upright sit-ting delivery on fetal head descent and maternal and infant outcomes during the second stage of labor.Methods:This study used a prospective randomized controlled study,including 110 pregnant women with full-term and com-plete opening of the cervix who were able to undergo vaginal delivery at Beijing Obstetrics and Gynecology Hospi-tal,Capital Medical University from February to September 2023.They were randomly divided into a control group(n=56)and an upright group(n=54)by simple randomization.The control group was delivered in routine supine or semi-supine positions,and the upright group was delivered in upright positions.The parturients in both groups were examined by color Doppler ultrasound at the beginning of the second stage of labor when the cervix was full-y opened to guide delivery and 30 minutes after guidance of the second stage of labor.Abdominal and perineal two-dimensional ultrasound was used to detect fetal head angle of progression(AOP),fetal head perineal dis-tance(HPD),and fetal orientation.At the same time,the time of the second stage of labor and delivery outcome were recorded.The changes in AOP,angle and position of HPD,delivery duration,and maternal and fetal out-comes between the two groups were analyzed.Results:At the beginning of the second stage of labor,there was no significant difference in AOP,HPD,and the rate of non-occipital anterior position of fetal position between the two groups(P＞0.05).After 30 minutes of guiding delivery,compared with the control group,the AOP angle in-creased,the HPD distance shortened,and the proportion of non-occipital anterior fetal position was reduced in the upright position group,and all the differences were statistically significant(P＜0.05).At the same time,compared with the control group,the spontaneous delivery rate,the duration of the second stage of labor,forceps delivery rate,lateral perineal incision rate,perineal edema rate,and oxytocin use rate were significantly decreased in the upright position group,and all the differences were statistically significant(P＜0.05).All newborns were born a-live,and the 1-minute Apgar score was 10 for all newborns in both groups.There was no significant difference in birth weight between the two groups(P＞0.05).Conclusions:When the parturient delivers in an upright sitting position in the second stage of labor,the AOP increases,the HPD shortens,and the time of the second stage of labor is accelerated to increase the natural delivery rate,reduce medical intervention,and reduce maternal and in-fant complications during delivery.

Objective:Using intrapartum ultrasound monitoring to observe and analyse the impact of upright sit-ting delivery on fetal head descent and maternal and infant outcomes during the second stage of labor.Methods:This study used a prospective randomized controlled study,including 110 pregnant women with full-term and com-plete opening of the cervix who were able to undergo vaginal delivery at Beijing Obstetrics and Gynecology Hospi-tal,Capital Medical University from February to September 2023.They were randomly divided into a control group(n=56)and an upright group(n=54)by simple randomization.The control group was delivered in routine supine or semi-supine positions,and the upright group was delivered in upright positions.The parturients in both groups were examined by color Doppler ultrasound at the beginning of the second stage of labor when the cervix was full-y opened to guide delivery and 30 minutes after guidance of the second stage of labor.Abdominal and perineal two-dimensional ultrasound was used to detect fetal head angle of progression(AOP),fetal head perineal dis-tance(HPD),and fetal orientation.At the same time,the time of the second stage of labor and delivery outcome were recorded.The changes in AOP,angle and position of HPD,delivery duration,and maternal and fetal out-comes between the two groups were analyzed.Results:At the beginning of the second stage of labor,there was no significant difference in AOP,HPD,and the rate of non-occipital anterior position of fetal position between the two groups(P＞0.05).After 30 minutes of guiding delivery,compared with the control group,the AOP angle in-creased,the HPD distance shortened,and the proportion of non-occipital anterior fetal position was reduced in the upright position group,and all the differences were statistically significant(P＜0.05).At the same time,compared with the control group,the spontaneous delivery rate,the duration of the second stage of labor,forceps delivery rate,lateral perineal incision rate,perineal edema rate,and oxytocin use rate were significantly decreased in the upright position group,and all the differences were statistically significant(P＜0.05).All newborns were born a-live,and the 1-minute Apgar score was 10 for all newborns in both groups.There was no significant difference in birth weight between the two groups(P＞0.05).Conclusions:When the parturient delivers in an upright sitting position in the second stage of labor,the AOP increases,the HPD shortens,and the time of the second stage of labor is accelerated to increase the natural delivery rate,reduce medical intervention,and reduce maternal and in-fant complications during delivery.

Objective:Using intrapartum ultrasound monitoring to observe and analyse the impact of upright sit-ting delivery on fetal head descent and maternal and infant outcomes during the second stage of labor.Methods:This study used a prospective randomized controlled study,including 110 pregnant women with full-term and com-plete opening of the cervix who were able to undergo vaginal delivery at Beijing Obstetrics and Gynecology Hospi-tal,Capital Medical University from February to September 2023.They were randomly divided into a control group(n=56)and an upright group(n=54)by simple randomization.The control group was delivered in routine supine or semi-supine positions,and the upright group was delivered in upright positions.The parturients in both groups were examined by color Doppler ultrasound at the beginning of the second stage of labor when the cervix was full-y opened to guide delivery and 30 minutes after guidance of the second stage of labor.Abdominal and perineal two-dimensional ultrasound was used to detect fetal head angle of progression(AOP),fetal head perineal dis-tance(HPD),and fetal orientation.At the same time,the time of the second stage of labor and delivery outcome were recorded.The changes in AOP,angle and position of HPD,delivery duration,and maternal and fetal out-comes between the two groups were analyzed.Results:At the beginning of the second stage of labor,there was no significant difference in AOP,HPD,and the rate of non-occipital anterior position of fetal position between the two groups(P＞0.05).After 30 minutes of guiding delivery,compared with the control group,the AOP angle in-creased,the HPD distance shortened,and the proportion of non-occipital anterior fetal position was reduced in the upright position group,and all the differences were statistically significant(P＜0.05).At the same time,compared with the control group,the spontaneous delivery rate,the duration of the second stage of labor,forceps delivery rate,lateral perineal incision rate,perineal edema rate,and oxytocin use rate were significantly decreased in the upright position group,and all the differences were statistically significant(P＜0.05).All newborns were born a-live,and the 1-minute Apgar score was 10 for all newborns in both groups.There was no significant difference in birth weight between the two groups(P＞0.05).Conclusions:When the parturient delivers in an upright sitting position in the second stage of labor,the AOP increases,the HPD shortens,and the time of the second stage of labor is accelerated to increase the natural delivery rate,reduce medical intervention,and reduce maternal and in-fant complications during delivery.

Objective:Using intrapartum ultrasound monitoring to observe and analyse the impact of upright sit-ting delivery on fetal head descent and maternal and infant outcomes during the second stage of labor.Methods:This study used a prospective randomized controlled study,including 110 pregnant women with full-term and com-plete opening of the cervix who were able to undergo vaginal delivery at Beijing Obstetrics and Gynecology Hospi-tal,Capital Medical University from February to September 2023.They were randomly divided into a control group(n=56)and an upright group(n=54)by simple randomization.The control group was delivered in routine supine or semi-supine positions,and the upright group was delivered in upright positions.The parturients in both groups were examined by color Doppler ultrasound at the beginning of the second stage of labor when the cervix was full-y opened to guide delivery and 30 minutes after guidance of the second stage of labor.Abdominal and perineal two-dimensional ultrasound was used to detect fetal head angle of progression(AOP),fetal head perineal dis-tance(HPD),and fetal orientation.At the same time,the time of the second stage of labor and delivery outcome were recorded.The changes in AOP,angle and position of HPD,delivery duration,and maternal and fetal out-comes between the two groups were analyzed.Results:At the beginning of the second stage of labor,there was no significant difference in AOP,HPD,and the rate of non-occipital anterior position of fetal position between the two groups(P＞0.05).After 30 minutes of guiding delivery,compared with the control group,the AOP angle in-creased,the HPD distance shortened,and the proportion of non-occipital anterior fetal position was reduced in the upright position group,and all the differences were statistically significant(P＜0.05).At the same time,compared with the control group,the spontaneous delivery rate,the duration of the second stage of labor,forceps delivery rate,lateral perineal incision rate,perineal edema rate,and oxytocin use rate were significantly decreased in the upright position group,and all the differences were statistically significant(P＜0.05).All newborns were born a-live,and the 1-minute Apgar score was 10 for all newborns in both groups.There was no significant difference in birth weight between the two groups(P＞0.05).Conclusions:When the parturient delivers in an upright sitting position in the second stage of labor,the AOP increases,the HPD shortens,and the time of the second stage of labor is accelerated to increase the natural delivery rate,reduce medical intervention,and reduce maternal and in-fant complications during delivery.