In the earliest existing pharmacological monograph in China,Shennong Bencao Jing,there is a record of a parasitic plant known as"desert ginseng"——Cistanche deserticola.It exerts beneficial effects on the function of the heart,kidney,spleen,and lung.As research into its pharmacological properties has progressed,the active components of Cistanche deserticola also have shown promise for treating intestinal disorders.Due to the complex pathological mechanisms of sepsis,which often accompany multiple organ dysfunction,aligns closely with the multi-target pharmacological characteristics of Cistanche deserticola's.Furthermore,because Cistanche deserticola is both edible and medicinal,and exhibits a wide therapeutic window,it has a natural advantage in the clinical transformation and application after drug development.Currently,to expand its medicinal range,a review of the main active components of Cistanche deserticola and their related pharmacological effects is conducted,and combined with the specific characteristics of intestinal injury in sepsis,the potential value of Cistanche deserticola in intestinal barrier protection,microbial coordination,and intestinal motility regulation is further elaborated,providing new ideas and a theoretical basis for the application of Cistanche deserticola in sepsis-induced intestinal injury.

In the earliest existing pharmacological monograph in China,Shennong Bencao Jing,there is a record of a parasitic plant known as"desert ginseng"——Cistanche deserticola.It exerts beneficial effects on the function of the heart,kidney,spleen,and lung.As research into its pharmacological properties has progressed,the active components of Cistanche deserticola also have shown promise for treating intestinal disorders.Due to the complex pathological mechanisms of sepsis,which often accompany multiple organ dysfunction,aligns closely with the multi-target pharmacological characteristics of Cistanche deserticola's.Furthermore,because Cistanche deserticola is both edible and medicinal,and exhibits a wide therapeutic window,it has a natural advantage in the clinical transformation and application after drug development.Currently,to expand its medicinal range,a review of the main active components of Cistanche deserticola and their related pharmacological effects is conducted,and combined with the specific characteristics of intestinal injury in sepsis,the potential value of Cistanche deserticola in intestinal barrier protection,microbial coordination,and intestinal motility regulation is further elaborated,providing new ideas and a theoretical basis for the application of Cistanche deserticola in sepsis-induced intestinal injury.

Purpose To analyze the precursor lesions,clinicopathological features and prognosis of mucinous carcinoma(MC).Methods A total of 303 MC cases diagnosed by surgi-cal specimens were included,including 193 pure mucinous car-cinomas(PMC)and 110 mixed mucinous carcinomas(MMC).PMC included 163 cases of type A(hypocellular type)and 30 cases of type B(hypercellular type).The histomorphological characteristics,surrounding breast tissue morphology,and im-mune markers were evaluated to analyze the clinicopathological features related to MC precursor lesions and prognosis.Results The median age at diagnosis of MC was 50 years,and the me-dian tumor size was 2.5 cm.Compared to PMC,MMC had more lymph node(LN)involvement,more grade Ⅲ-Ⅳ and Ki67＞20％tumors(P＜0.05).There were no significant differences in tumor size,LN involvement and clinical stage between type A and type B PMC.55 cases of MC(49 PMC and 6 MMC)with precursor lesions of mucocoele-like lesions(MLL)were all grade 1 to 2,most of them(54/55,98.2％)were T1-T2,and the proportions of MC component in all 6 MMCs were all ≥ 50％.There were 119 cases of MC whose precursor lesions were ductal carcinoma in situ(DCIS),of which 28.6％of cases(34/119)had LN involvement,and 16.8％(20/119)of cases showed high proliferative activity(Ki67＞20％).The precursor lesions of MC in 16 cases were solid papillary carcinoma(SPC)in situ,inclu-ding 7 cases of type BPMC and 9 cases of MMC.The median age of these patients was 67 years and no recurrence or metastasis was observed during follow-up.The disease-free survival(DFS)and overall survival(OS)of the 303 cases of MC was 93.5％and 98.6％,respectively.PMC had a better prognosis than MMC(DFS:95.2％vs.90.6％;OS:99.5％vs.97.2％),but there was no significant difference between type A and type B PMC.The prognosis of patients with LN involvement and clinical stage Ⅲ-Ⅳ was worse(P＜0.05).Conclusion MC of the breast is a kind of heterogeneous malignant tumors.Our findings support that MC with specific precursor lesions have different ev-olutionary pathways,that MC with precursor lesions of MLL and SPC have a good prognosis,and MC associated with high-grade DCIS are more aggressive.LN involvement,higher clinical grade,and younger age are associated with poor prognosis.Focu-sing on precursor lesions and high risk clinicopathological fea-tures can contribute to providing more effective treatments for these patients.

Objective To investigate the prognostic value of the age-adjusted Charlson comorbidity index(ACCI)in obstructive sleep apnea(OSA)patients over 60 years old.Methods A total of 1183 elderly OSA patients admitted in sleep centers of six hospitals between January 2015 and October 2017 were consecutively enrolled,and they were divided into low(ACCI＜5,847 cases)and high ACCI group(ACCI≥5,336 cases)based on the ACCI threshold.Demographic character-istics,clinical features,sleep parameters,and medical history were obtained from their medical re-cords.ACCI was calculated.All of them patients were followed up,and all-cause mortality was re-garded as the primary outcome.ROC curves were plotted,the AUC values were calculated,and log-rank test and Cox proportional hazards regression model were used for analysis with 5 as the threshold of ACCI.Results During a median follow-up of 43 months,63 deaths(5.3％)occurred.ROC curve analysis showed the optimal cut-off value of ACCI was 4.5,with an AUC value of 0.70(95％CI:0.63-0.77,P＜0.01).Compared with the low ACCI group,the high ACCI group showed significant increases in age,body mass index,smoking,alcohol consumption,hyperten-sion,average apnea time,creatinine,cystatin C,average platelet volume,and all-cause mortality rate,while the average SpO2 and minimum SpO2 were significantly reduced(P＜0.05,P＜0.01).Multivariate Cox regression analysis revealed that total sleep time(HR=1.258,95％CI:1.053-1.503,P=0.011),mean corpuscular volume(HR=1.047,95％CI:1.007-1.087,P=0.019),and ACCI(HR=1.585,95％CI:1.384-1.815,P=0.001)were independent predictors of all-cause mortality in elderly OSA patients.Kaplan-Meier survival analysis indicated that the 6-year surviv-al rate was 56.0％and 92.2％for the high and low ACCI groups,respectively.Stratified analysis by gender and severity suggested that the cumulative survival rate was obviously higher in the low ACCI group than the high ACCI group(Plog rank＜0.01).After adjusting for confounding varia-bles,the mortality risk of the high ACCI group was 3.32 times higher than that of the low ACCI group(95％CI:1.91-5.77,P＜0.01).Conclusion ACCI is a risk predictor for all-cause mortali-ty in elderly OSA patients,and it can provide reference for clinical decision making in elderly OSA patients.

Purpose To analyze the precursor lesions,clinicopathological features and prognosis of mucinous carcinoma(MC).Methods A total of 303 MC cases diagnosed by surgi-cal specimens were included,including 193 pure mucinous car-cinomas(PMC)and 110 mixed mucinous carcinomas(MMC).PMC included 163 cases of type A(hypocellular type)and 30 cases of type B(hypercellular type).The histomorphological characteristics,surrounding breast tissue morphology,and im-mune markers were evaluated to analyze the clinicopathological features related to MC precursor lesions and prognosis.Results The median age at diagnosis of MC was 50 years,and the me-dian tumor size was 2.5 cm.Compared to PMC,MMC had more lymph node(LN)involvement,more grade Ⅲ-Ⅳ and Ki67＞20％tumors(P＜0.05).There were no significant differences in tumor size,LN involvement and clinical stage between type A and type B PMC.55 cases of MC(49 PMC and 6 MMC)with precursor lesions of mucocoele-like lesions(MLL)were all grade 1 to 2,most of them(54/55,98.2％)were T1-T2,and the proportions of MC component in all 6 MMCs were all ≥ 50％.There were 119 cases of MC whose precursor lesions were ductal carcinoma in situ(DCIS),of which 28.6％of cases(34/119)had LN involvement,and 16.8％(20/119)of cases showed high proliferative activity(Ki67＞20％).The precursor lesions of MC in 16 cases were solid papillary carcinoma(SPC)in situ,inclu-ding 7 cases of type BPMC and 9 cases of MMC.The median age of these patients was 67 years and no recurrence or metastasis was observed during follow-up.The disease-free survival(DFS)and overall survival(OS)of the 303 cases of MC was 93.5％and 98.6％,respectively.PMC had a better prognosis than MMC(DFS:95.2％vs.90.6％;OS:99.5％vs.97.2％),but there was no significant difference between type A and type B PMC.The prognosis of patients with LN involvement and clinical stage Ⅲ-Ⅳ was worse(P＜0.05).Conclusion MC of the breast is a kind of heterogeneous malignant tumors.Our findings support that MC with specific precursor lesions have different ev-olutionary pathways,that MC with precursor lesions of MLL and SPC have a good prognosis,and MC associated with high-grade DCIS are more aggressive.LN involvement,higher clinical grade,and younger age are associated with poor prognosis.Focu-sing on precursor lesions and high risk clinicopathological fea-tures can contribute to providing more effective treatments for these patients.

Objective To investigate the prognostic value of the age-adjusted Charlson comorbidity index(ACCI)in obstructive sleep apnea(OSA)patients over 60 years old.Methods A total of 1183 elderly OSA patients admitted in sleep centers of six hospitals between January 2015 and October 2017 were consecutively enrolled,and they were divided into low(ACCI＜5,847 cases)and high ACCI group(ACCI≥5,336 cases)based on the ACCI threshold.Demographic character-istics,clinical features,sleep parameters,and medical history were obtained from their medical re-cords.ACCI was calculated.All of them patients were followed up,and all-cause mortality was re-garded as the primary outcome.ROC curves were plotted,the AUC values were calculated,and log-rank test and Cox proportional hazards regression model were used for analysis with 5 as the threshold of ACCI.Results During a median follow-up of 43 months,63 deaths(5.3％)occurred.ROC curve analysis showed the optimal cut-off value of ACCI was 4.5,with an AUC value of 0.70(95％CI:0.63-0.77,P＜0.01).Compared with the low ACCI group,the high ACCI group showed significant increases in age,body mass index,smoking,alcohol consumption,hyperten-sion,average apnea time,creatinine,cystatin C,average platelet volume,and all-cause mortality rate,while the average SpO2 and minimum SpO2 were significantly reduced(P＜0.05,P＜0.01).Multivariate Cox regression analysis revealed that total sleep time(HR=1.258,95％CI:1.053-1.503,P=0.011),mean corpuscular volume(HR=1.047,95％CI:1.007-1.087,P=0.019),and ACCI(HR=1.585,95％CI:1.384-1.815,P=0.001)were independent predictors of all-cause mortality in elderly OSA patients.Kaplan-Meier survival analysis indicated that the 6-year surviv-al rate was 56.0％and 92.2％for the high and low ACCI groups,respectively.Stratified analysis by gender and severity suggested that the cumulative survival rate was obviously higher in the low ACCI group than the high ACCI group(Plog rank＜0.01).After adjusting for confounding varia-bles,the mortality risk of the high ACCI group was 3.32 times higher than that of the low ACCI group(95％CI:1.91-5.77,P＜0.01).Conclusion ACCI is a risk predictor for all-cause mortali-ty in elderly OSA patients,and it can provide reference for clinical decision making in elderly OSA patients.

Humans ; Aminoquinolines/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation/genetics* ; Standard of Care

Objective:To evaluate the effect of general anesthesia combined with epidural block on postoperative sleep in the frail elderly patients undergoing gastrointestinal tumor surgery.Methods:Ninety frail patients of either sex, aged 65-80 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiology physical status Ⅱ-Ⅲ, scheduled for elective open gastrointestinal tumor surgery (FRAIL score >2), were divided into 2 groups ( n=45 each) using a random number table method: general anesthesia group (GA group) and general anesthesia combined with epidural block group (GE group). Combined intravenous-inhalational anesthesia was carried out in group GA.Epidural block was performed before induction of anesthesia, and the method of general anesthesia was the same as that described in group GA, and the consumption of propofol and remifentanil was adjusted according to the BIS value, sweat and tears, heart rate and blood pressure during operation in group GE.Postoperative intravenous analgesia was performed to maintain VAS score ≤3.Wearable devices were used to monitor sleep parameters at 1 day before surgery and 1, 3 and 7 days after surgery.Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of Recovery-15 questionnaire at 1 day before surgery and 1, 3, 7 and 30 days after surgery.The intraoperative consumption of propofol, sufentanil and remifentanil were recorded.The requirement for postoperative rescue analgesia and total pressing times of patient-controlled analgesia (PCA) within 48 h after surgery were recorded.Serum C-reactive protein concentrations were determined by immunoturbidimetry at 1 day before surgery and 1 day after surgery, and the adverse reactions at 7 days after surgery were recorded. Results:Compared with group GA, the consumption of remifentanil was significantly reduced, the total sleep score, deep sleep ratio, rapid eye movement ratio and Quality of Recovery-15 score were increased, the Pittsburgh Sleep Quality Index was decreased, and the incidence of postoperative nausea and vomiting was decreased on 1st and 3rd days after operation ( P<0.05), and no significant change was found in the serum C-reactive protein concentration and postoperative requirement for rescue analgesia, and total pressing times of PCA in group GE ( P>0.05). Conclusions:General anesthesia combined with epidural block can improve short-term sleep quality and recovery quality after gastrointestinal tumor surgery in elderly frail patients.

【Objective】 To genetically analyze the D^el sample from a blood donor in Jiangyin and make clear the molecular basis of the serological phenotype. 【Methods】 The EDTA anticoagulant blood were collected: buffy coat were used for nucleic acid extract and cDNA analysis; red blood cells for serological test. Tube method and microcolumn gel were used for serological test. Genotyping kit were used for exon analysis. Gene mutation was analyzed using the sequence analyzer. 【Results】 Serological analysis demonstrated the sample′s RhD phenotype was D^el. The phenotype of RhCE was CCEe. Real-time fluorescence quota PCR result demonstrated the existence of all exones. Weak D15 and RHD^* DEL1 [RHD(1227G>A)], which had a high frequency of occurrence in China, were excluded according to real-time fluorescence quota PCR result. Sequence analyzing result verified RHD(28C>T) SNP mutation in cDNA. The genotype of this sample was RHD^*01 W. 61[RHD(28C>T)]. 【Conclusion】 A weak D61 was found among blood donors in our city, Jiangyin.

P450 fatty acid decarboxylase OleT from Staphylococcus aureus (OleTsA) is a novel cytochrome P450 enzyme that catalyzes the oxidative decarboxylation of fatty acids to yield primarily terminal alkenes and CO2 or minor α-and β-hydroxylated fatty acids as side-products.In this work,the interactions between a series of cycloalkyl phosphorus heterocycles (CPHs) and OleTsA were investigated in detail by fluores-cence titration experiment,ultraviolet-visible (UV-vis) and 31p NMR spectroscopies.Fluorescence titration experiment results clearly showed that a dynamic quenching occurred when CPH-6,a repre-sentative CPHs,interacted with OleTsA with a binding constant value of 15.2 × 104 M-1 at 293 K.The thermodynamic parameters (△H,△S and △G) showed that the hydrogen bond and van der Waals force played major roles in the interaction between OleTsA and CPHs.The UV-vis and 31p NMR studies indicated the penetration of CPH-6 into the interior environment of OleTsA,which greatly affects the enzymatic activity of OleTsA.Therefore,our study revealed an effective way to use phosphorus hetero-cyclic compounds to modulate the activity of cvtochrome P450 enzymes.