OBJECTIVE: To study bioactive compounds from the endophytic fungus Penicillium sp. HJT-A-6 isolated from stem of Rhodiola tibetica, and evaluate its allelopathic activity. METHODS: The chemical constituents were isolated and purified by silica gel, Sephadex LH-20 column chromatography and semi-preparative HPLC. Their structures were elucidated by extensive spectroscopic analysis and electronic circular dichroism (ECD) calculations. In addition, the allelopathic activity of compound 1 was evaluated by measuring the seed germination rate of R. tibetica. RESULTS: Two new polyketides 4-hydroxy-3,6-dimethyl-2H-pyran-2-one (1) and penilactone E (2), together with six known compounds walterolactone A (3), 5-hydroxyhexan-4-olide (4), 3-methyl-2-penten-5-olide (5), chaetoquadrin F (6), (Z)-6-acetyl-3-(1,2-dihydroxypropylidene)-5-hydroxy-8-methylchroman-2-one (7) and 4-hydroxy-3-(4-hydroxyhexanoyl)-5-methylfuran-2(5H)-one (8) were isolated from Penicillium sp. HJT-A-6. Compound 1 showed moderate seed-germination-promoting activity at a concentration of 0.001 mg/mL while inhibiting the seed germination at concentrations of 0.1 and 0.01 mg/mL. Compared with the positive drug 6-benzyladenine (6-BA), compound 1 could extend the seed-germination period of R. tibetica (up to 11 d). CONCLUSION Two new compounds were isolated from R. tibetica endophytic fungus Penicillium sp. HJT-A-6. Compound 1 displayed plant hormone-like activity, which inhibited the seed germination of the host plant at high concentrations and promoted the seed germination of the host plant at low concentrations. The results not only enrich the chemical constituents of the endophytic fungi isolated from Rhodiola tibetica, but also provide a theoretical basis for understanding the interaction mechanism between Rhodiola tibetica endophytic fungi and the host plant.

Hepatocellular carcinoma (HCC) is characterized by high postoperative recurrence and mortality rates. In recent years, researchers have identified a significant correlation between microvascular invasion (MVI) and early postoperative recurrence and metastasis of HCC, making it a focal point of HCC research. Accurate preoperative prediction of MVI occurrence and the implementation of relevant interventions (such as expanded resection) could provide substantial benefits to patients. This study analyzes global research over the past decade on MVI predictive indicators based on tumor biological characteristics, genetic measurements, imaging examinations, and tumor markers. The aim is to use these predictive indicators to objectively forecast the occurrence of MVI, thereby aiding in preoperative individual assessments and enhancing treatment plans.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

ObjectiveTo observe the effect of Danshen injection （DAN） on platelet （PLT）-induced metastasis of breast cancer cells in vitro. MethodThe 3-（4，5-dimethylthiazol-2-yl）-2，5-diphenyltetrazolium bromide （MTT） assay was used to observe the effect of DAN on the growth of MDA-MB-231 cells in vitro. Oris™ migration assay was used to determine the effect of DAN （final mass concentrations 4， 8， 16 g·L^-1） on PLT （1.5×10¹⁰ cells/L）-induced migration of breast cancer cells in vitro. The effect of DAN on PLT-induced cell invasion was detected by Transwell assay. Immunofluorescence and Western blot were used to detect the effect of DAN on the protein expression associated with PLT-induced epithelial-mesenchymal transition （EMT）. In addition， enzyme-linked immune-sorbent assay （ELISA） was used to determine the effect of DAN （final mass concentrations 4， 8， 16， 32， 64 g·L^-1） on the secretion of transforming growth factor-β₁ （TGF-β₁）. Western blot was used to observe the effect of DAN on the expression of podoplanin （PDPN） protein in MDA-MB-231 cells induced by PLT. ResultCompared with the blank group， the DAN groups （32 and 64 g·L^-1） showed decreased A₅₇₀ （P<0.05， P<0.01）， and there was no significant difference in A₅₇₀ between DAN groups （4， 8， 16 g·L^-1）. Compared with the blank group， the PLT group showed increased cell migration and invasion， while DAN groups significantly inhibited PLT-induced cell migration and invasion. Compared with the blank group， the PLT group showed decreased expression of E-cadherin， while DAN could significantly reverse this effect of PLT. Compared with the blank group， the PLT group showed increased Slug and Snail protein expression （P<0.05， P<0.01）， while DAN significantly reversed Snail protein expression induced by PLT （P<0.05， P<0.01）. The content of TGF-β₁ in the PLT group increased （P<0.01）， while the secretion of TGF-β₁ induced by PLT decreased in the DAN groups （16， 32， and 64 g·L^-1） （P<0.05， P<0.01）， and the secretion of TGF-β₁ was not significantly affected in other DAN groups. PDPN protein expression in the PLT group increased （P<0.01）， while DAN could significantly inhibit PLT-induced PDPN expression （P<0.01）. ConclusionDAN can inhibit PLT-induced migration， invasion， and EMT of breast cancer cells. The mechanism may be related to the direct action between breast cancer cells and tumor cells by down-regulating PDPN expression and interfering with PLT and has nothing to do with the effect of TGF-β₁ secretion of PLT.

Background China's manufacturing industry is still labor-intensive, and assembly employees in manufacturing industry are facing a great risk of work-related musculoskeletal disorders (WMSDs). Objective To investigate and analyze the prevalence and distribution of WMSDs among assembly workers in manufacturing enterprises and explore the relationship between WMSDs and ergonomic exposure factors such as posture load and mental load. Methods From July to September 2017, by convenient sampling, a cross-sectional survey was conducted to select 670 workers engaged in electronic accessories assembly and railway vehicle manufacturing in three manufacturing enterprises in two cities in northern China as the research participants. The posture load assessment was based on the Chinese Musculoskeletal Questionnaire independently developed by our research group. The mental load assessment was based on a revised Chinese version of the Subjective Workload Assessment Technique. An unconditional logistic regression model was used to explore the relationship between ergonomic exposure and WMSDs. Results The overall prevalence rate of WMSDs was 39.6% (265/670) with 43.8% in males and 25.2% in females; the highest prevalence rate was 47.7% in the group aged 40 years and over. The prevalence rate of WMSDs in the electronic accessories assembly workers was 16.9%, that in the railway vehicle manufacturing workers was 57.3%, and the difference was statistically significant (\begin{document}$ {\chi ^2} $\end{document}=112.63, P<0.001). The mental load score [median (first quartile, third quartile)] was 55.6 (51.9, 83.3) points, and the posture load score was 27.1 (16.0, 41.5) points. The results of unconditional logistic regression model showed that women (OR=3.152, 95%CI: 1.458-6.813), drinkers (OR=1.934, 95%CI: 1.124-3.326), and railway vehicle manufacturing worker (OR=3.416, 95%CI: 1.756-6.644) had a higher risk of reporting WMSDs; The higher the mental load (OR=1.019, 95%CI: 1.007-1.031) and posture load (OR=1.034, 95%CI: 1.019-1.050), the higher the risk of reporting WMSDs. The hierarchical analysis results showed that the risk of reporting WMSDs was higher among the electronic accessories assembly workers who were older (compared with those aged <30 years, OR_30-39=2.526 and OR_≥40=12.263, respectively) and with higher posture load (OR=1.025, 95%CI: 1.002-1.049), as well as among the railway vehicle manufacturing workers who were drinking (OR=2.035, 95%CI: 1.155-3.583), obese (OR=3.094, 95%CI: 1.185-8.078), with higher mental load (OR=1.013, 95%CI: 1.001-1.025) and posture load (OR=1.033, 95%CI: 1.018-1.049). Conclusion There is a significant correlation between reporting WMSDs and ergonomic exposures such as posture load and mental load, and drinking is also a risk factor of WMSDs. The risk of reporting WMSDs in female workers in assembly manufacturing industry is higher than that in male workers. The overall prevalence rate of WMSDs in railway vehicle manufacturing workers is higher than that in electronic accessories assembly workers.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

ObjectiveTo study the relationship between the exposure to two kinds of phthalate esters （PAEs） ［Di-N-butyl phthalate，（DBP） and Di-（2-ethylhexyl）phthalate （DEHP）］ and estrogen homeostasis in pregnant women. MethodsIn 2021， we classified the Jiading District of Shanghai into five geographical areas， east， west， south， north and central. A total of 151 pregnant women from each area were selected for questionnaire survey， with random urine samples during first， second， and third trimesters collected. A DBP metabolite ［Mono-N-butyl phthalate （MBP）］ and two DEHP metabolites ［Mono（2-ethylhexyl） phthalate （MEHP）， Mono（2-ethyl5-oxohexyl） phthalate， （MEOHP）］ and three estrogens ［estrone （E₁）， 17β -estradiol （E₂）， and estriol （E₃）］ in urine were determined by ultra-performance liquid chromatography tandem quadrupole time-of-flight mass spectrometry. After a natural logarithmic transformation of PAEs metabolite levels and estrogen concentration， multivariable linear regression was used to control potential confounders and determine the relationship between PAEs metabolite levels and estrogen concentration. ResultsThe detection rates of three PAEs metabolites in urine of pregnant women were more than 98%. The median corrected concentrations of MBP， MEHP and MEOHP were 5.18， 0.59 and 4.23 mg·kg^-1， respectively. During the whole pregnancy， MEOHP was positively correlated with E₁ （β=0.450， 95%CI： 0.057‒0.844）， and MBP was positively correlated with E₃ （β=0.250， 95%CI： 0.034‒0.465）. Stratified by trimesters， MBP was positively correlated with E₃ in the first trimester （β=0.428， 95%CI： 0.103‒0.752）. MEOHP was positively correlated with E₁ in the second trimester （β=0.734， 95%CI： 0.130‒0.752）， and had a possitive trend with E₁ in the third trimester （β=0.744， 95%CI： -0.140‒1.629）. In addition， MEHP had a negative correlation with E₁ in the second trimester （β=-0.498， 95%CI： -1.063‒0.066）. MEOHP had a positive correlation trend with E₂ （β=0.628， 95%CI： -0.101‒1.356） in the third trimester. ConclusionPAEs exposure may interfere with estrogen homeostasis during pregnancy and differs by trimesters. Given the cross-sectional nature of this study， it warrants further study to validate the findings.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Objective:To understand the current situation of research in the field of sepsis caused by Gram positive bacteria (G + bacteria) in China, to clarify the research content and analyze its general research direction, so as to find the hot topics of research in recent years. Methods:The literatures in SinoMed related to sepsis caused by G + bacteria and published in Chinese from building database to October 2019 were screened. The distribution and trend of the published year, journals, research institutions and researchers of relevant literature were analyzed, and Ucinet 6.0 software was used to draw the social network graph of the researchers and to analyze their internal relations. The subject words of related literatures were extracted. The relationship among the subject words in related literatures was arranged according to the centrality by NetDraw in Ucinet 6.0 software, the bibliographic information co-occurrence analysis system software (BICOMS2 software) was used to classify the subject words and the visualization matrix was generated. The graph clustering tool software (gCLUTO software) was used to cluster the subject words, and the visualization surface graph was generated to analyze the current research hot spot, research trend and research direction of G + bacteria-induced sepsis. Results:A total of 1 976 literatures about sepsis caused by G + bacteria were retrieved, and 26 literatures in conference summaries, news reports, research information, missing content, or inconsistent with the theme were excluded. Finally, a total of 1 950 literatures were enrolled in final analysis. The number of published literatures analysis showed that from 1979 to 1992, there were few studies about sepsis caused by G + bacteria, which increased geometrically from 2008, and the number of literatures published from 2008 to 2018 was 1 144, accounting for 58.67% (1 144/1 950). From 1979 to 2019, 23 high-yield institutions published more than 5 literatures, of which 6 were institutions with 10 or more literatures, and only one institution with more than 20 literatures. There were only 5 journals with more than 100 articles, 5 381 authors involved in the literatures, but few authors with more than 10 literatures published, and no inter-provincial or inter-municipal cooperation was found. A social network analysis of 103 high-frequency subject words that appeared more than 5 times showed that the study of sepsis caused by G + bacteria mainly focused on "sepsis", including the incidence of sepsis caused by drug resistant Staphylococcus aureus was on the rise, especially in newborns and children with weakened immune systems, the selection of therapeutic drugs gradually developed to glycopeptides with strong anti-drug resistance and synthetic oxazolidinones. The research and development of drugs for the treatment of sepsis caused by G + bacteria might become a new research direction or field in the future. Cluster analysis of 103 high-frequency subject words showed that the research hot spots of G + bacteria-induced sepsis mainly focused on five topics, namely early diagnosis of sepsis; bacterial infection pathway of sepsis, nosocomial infection and bacterial drug resistance; the basis of epidemiological prevention and treatment of sepsis; venous catheter infection-related sepsis; the treatment, nursing and prognosis of patients with sepsis. Conclusion:The studies of sepsis caused by G + bacteria are winning more and more attention, but the resources sharing and academic exchanges among hospitals need to be further improved.