This study aims to investigate the polarized microscopic mineral phase characteristics, inorganic element content, and potential health risks associated with the intake of raw and calcined fossil mineral Chinese medicinal material Draconis Os. Microscopy was employed to observe the mineralogical characteristics of Draconis Os and compare the microscopic features and phase composition of raw and calcined Draconis Os under monochromatic and orthogonal polarized light. Inductively coupled plasma mass spectrometry(ICP-MS) was employed to determine the content of 30 inorganic elements. Health risk assessment was conducted by calculating the single pollution index(P_i), average daily intake of elements for adults(ADI), target hazard quotient(THQ), non-carcinogenic assessment method-hazard quotient(HQ), and the carcinogenic risk of elements(CR). The results indicated that under monochromatic polarized light, the Draconis Os powder sections exhibited light gray-brown to gray-brown irregular fragments, some with undulating textures that were slightly curved. Under crossed polarized light, they appeared dark gray, grayish-white, and yellowish-white. Clear apatite was visible in the ground sections of Draconis Os under crossed polarized light. P_i results indicated that Draconis Os samples were free from contamination and were of good quality. According to the maximum allowable limits of heavy metals stipulated in ISO Traditional Chinese Medicine: Determination of heavy metals in herbal medicines used in Traditional Chinese Medicine, ADI, THQ, HQ, and CR were taken as assessment indicators. Only the THQ value for As(arsenic) in raw Draconis Os was greater than 1, while the THQ values for other heavy metal elements in the Draconis Os samples were all less than 1. The study demonstrates that the primary mineral phase of raw and calcined Draconis Os is apatite, with some samples co-existing with calcite, which can serve as one of the means for quality control of Draconis Os. The elemental analysis results from ICP-MS provide scientific evidence for the safety assessment of Draconis Os, indicating that Draconis Os is safe in clinical application.
Drugs, Chinese Herbal/analysis* ; Risk Assessment ; Minerals/chemistry* ; Fossils ; Humans ; Drug Contamination ; Mass Spectrometry

Objective:To analyze the relationship between cuprotosis-realted gene DLD expression in pan-cancer and progno-sis,tumor microenvironment and tumor immune infiltration by bioinformatics methods combined with multiple databases.Methods:TCGA,GTEx,TISDB,GEO,UCSC,TARGET,TIMER2.0,GEPIA2,SangerBox,PrognoScan and related R software packages were used to analyze the difference of DLD expression between human cancer and adjacent normal tissues,inestigate relationship between prognosis,explore expression of DLD in different immune subtypes and molecular subtypes of human cancer,analyze correlation between DLD expression and tumor immune infiltration and tumor microenvironment,detecet relationship between DLD expression and 60 immune checkpoint genes.Results:There were differences in expression of DLD in different tumor tissues;low DLD expression in 6 tumors and high DLD expression in 3 tumors were significantly associated with better prognosis;15 tumor immune subtypes,11 molecular subtypes of tumors were significantly correlated with DLD expression;DLD expression was significantly correlated with immune infiltration in 37 cancer types;DLD expression was significantly associated with immune infiltration in 23 tumor stroma scores,26 tumor immune scores and 25 tumor ESTIMATE scores;60 immune checkpoint genes in 39 tumors were significantly associated with DLD expression.Conclusion:Expression of DLD in pan-cancer is related to tumor prognosis and immune invasion,DLD may be a potential predictor of prognosis in tumors,and may be an immunomodulator of tumors.

OBJECTIVE To establish a method for determining the content of multiple components in Astragalus membranaceus,compare the content differences of Astragalus membranaceus in different regions and with different extraction methods in Gansu,and e-valuate the quality of Astragalus membranaceus from different origins of Gansu.METHODS Astragalus membranaceus samples from 40 origins in Gansu were collected on site.The content of Astragaloside Ⅳ,Calycosin-7-O-β-D-glucopyranoside,Ononin,Form-ononetin and Calycosin was determined by HPLC external standard method,and the quality differences of Astragalus membranaceus from 40 origins of Gansu were analyzed by combining bar graphs and line graphs.RESULTS Weiyuan County and Min County of Dingxi City showed high Astragaloside Ⅳ content in both extraction methods,indicating that the Astragalus membranaceus in these two regions has advantages in Astragaloside Ⅳ as an active component;for Calycosin-7-O-β-D-glucopyranoside and Ononin,although the performance of different regions in different extraction methods was different,in general,Weiyuan County and Min County of Dingxi City and Longnan City showed high content in both extraction methods.Water extraction method was more conducive to the extraction of Calycosin-7-O-β-D-glucopyranoside and Ononin,while alcohol extraction method was more conducive to the extraction of Astragalo-side Ⅳ,Calycosin and Ononin.CONCLUSION The content of chemical components of Astragalus membranaceus from different ori-gins is quite different,and the choice of extraction method has a significant effect on the content of active components,while the change trend of different compounds in the two extraction methods is basically the same.The established HPLC multi-component content de-termination method of Astragalus membranaceus is stable and reliable,which can provide a scientific basis for the quality control and comprehensive evaluation of Astragalus membranaceus medicinal materials.

Objective:To explore the clinical application value of artificial intelligence models in identifying bleeding events and hemorrhagic points during laparoscopic pancreatic surgery.Methods:This single-center retrospective cohort study collected surgical videos of 25 patients undergoing laparoscopic pancreatic surgery at the Department of General Surgery, Peking Union Medical College Hospital from January 2022 to December 2024. Videos within 5 seconds before and after representative bleeding events were captured at 30 frames/s, with 11 666 hemorrhagic-related video frames annotated. Two algorithm models were developed: a pigment-based model and a pigment+optical flow-based model for classification and target recognition of bleeding frames. The training and test sets for the pigment-based algorithm contained 4 692 hemorrhagic and 4 309 non-hemorrhagic frames, while those for the pigment+optical flow model included 1 339 hemorrhagic and 1 326 non-hemorrhagic frames. Performance evaluation was conducted using overlap thresholds, with accuracy and recall rates as key metrics.Results:The pigment-based model achieved 93.8% accuracy (134/143) and 43.3% recall (134/310) in hemorrhagic frame classification. At an overlap threshold of 0.3, the pigment-based model showed 84.1% accuracy (433/515) and 85.4% recall (433/507) in target recognition. When the threshold was increased to 0.5, the pigment+optical flow model demonstrated 88.1% accuracy (354/402) and 89.2% recall (354/397) in hemorrhagic target recognition.Conclusions:It is difficult to distinguish active bleeding from old bleeding completely by pigment information alone. The spatio-temporal features can be effectively extracted by combining pigment and optical flow information, and the bleeding can be accurately identified and located, which has potential clinical application value.

OBJECTIVE To establish a method for determining the content of multiple components in Astragalus membranaceus,compare the content differences of Astragalus membranaceus in different regions and with different extraction methods in Gansu,and e-valuate the quality of Astragalus membranaceus from different origins of Gansu.METHODS Astragalus membranaceus samples from 40 origins in Gansu were collected on site.The content of Astragaloside Ⅳ,Calycosin-7-O-β-D-glucopyranoside,Ononin,Form-ononetin and Calycosin was determined by HPLC external standard method,and the quality differences of Astragalus membranaceus from 40 origins of Gansu were analyzed by combining bar graphs and line graphs.RESULTS Weiyuan County and Min County of Dingxi City showed high Astragaloside Ⅳ content in both extraction methods,indicating that the Astragalus membranaceus in these two regions has advantages in Astragaloside Ⅳ as an active component;for Calycosin-7-O-β-D-glucopyranoside and Ononin,although the performance of different regions in different extraction methods was different,in general,Weiyuan County and Min County of Dingxi City and Longnan City showed high content in both extraction methods.Water extraction method was more conducive to the extraction of Calycosin-7-O-β-D-glucopyranoside and Ononin,while alcohol extraction method was more conducive to the extraction of Astragalo-side Ⅳ,Calycosin and Ononin.CONCLUSION The content of chemical components of Astragalus membranaceus from different ori-gins is quite different,and the choice of extraction method has a significant effect on the content of active components,while the change trend of different compounds in the two extraction methods is basically the same.The established HPLC multi-component content de-termination method of Astragalus membranaceus is stable and reliable,which can provide a scientific basis for the quality control and comprehensive evaluation of Astragalus membranaceus medicinal materials.

Objective:To analyze the relationship between cuprotosis-realted gene DLD expression in pan-cancer and progno-sis,tumor microenvironment and tumor immune infiltration by bioinformatics methods combined with multiple databases.Methods:TCGA,GTEx,TISDB,GEO,UCSC,TARGET,TIMER2.0,GEPIA2,SangerBox,PrognoScan and related R software packages were used to analyze the difference of DLD expression between human cancer and adjacent normal tissues,inestigate relationship between prognosis,explore expression of DLD in different immune subtypes and molecular subtypes of human cancer,analyze correlation between DLD expression and tumor immune infiltration and tumor microenvironment,detecet relationship between DLD expression and 60 immune checkpoint genes.Results:There were differences in expression of DLD in different tumor tissues;low DLD expression in 6 tumors and high DLD expression in 3 tumors were significantly associated with better prognosis;15 tumor immune subtypes,11 molecular subtypes of tumors were significantly correlated with DLD expression;DLD expression was significantly correlated with immune infiltration in 37 cancer types;DLD expression was significantly associated with immune infiltration in 23 tumor stroma scores,26 tumor immune scores and 25 tumor ESTIMATE scores;60 immune checkpoint genes in 39 tumors were significantly associated with DLD expression.Conclusion:Expression of DLD in pan-cancer is related to tumor prognosis and immune invasion,DLD may be a potential predictor of prognosis in tumors,and may be an immunomodulator of tumors.

Objective:To explore the clinical application value of artificial intelligence models in identifying bleeding events and hemorrhagic points during laparoscopic pancreatic surgery.Methods:This single-center retrospective cohort study collected surgical videos of 25 patients undergoing laparoscopic pancreatic surgery at the Department of General Surgery, Peking Union Medical College Hospital from January 2022 to December 2024. Videos within 5 seconds before and after representative bleeding events were captured at 30 frames/s, with 11 666 hemorrhagic-related video frames annotated. Two algorithm models were developed: a pigment-based model and a pigment+optical flow-based model for classification and target recognition of bleeding frames. The training and test sets for the pigment-based algorithm contained 4 692 hemorrhagic and 4 309 non-hemorrhagic frames, while those for the pigment+optical flow model included 1 339 hemorrhagic and 1 326 non-hemorrhagic frames. Performance evaluation was conducted using overlap thresholds, with accuracy and recall rates as key metrics.Results:The pigment-based model achieved 93.8% accuracy (134/143) and 43.3% recall (134/310) in hemorrhagic frame classification. At an overlap threshold of 0.3, the pigment-based model showed 84.1% accuracy (433/515) and 85.4% recall (433/507) in target recognition. When the threshold was increased to 0.5, the pigment+optical flow model demonstrated 88.1% accuracy (354/402) and 89.2% recall (354/397) in hemorrhagic target recognition.Conclusions:It is difficult to distinguish active bleeding from old bleeding completely by pigment information alone. The spatio-temporal features can be effectively extracted by combining pigment and optical flow information, and the bleeding can be accurately identified and located, which has potential clinical application value.

Objective:To analyze the clinical characteristics of invasive intervention-related intestinal fistula in patients with acute pancreatitis (AP).Methods:We retrospectively analyzed the clinical data of 177 moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) patients who received invasive intervention in Peking Union Medical College Hospital from January 2003 to December 2022. Patients were divided into fistula group and non-fistula group based on the presence or absence of fistula after or during receiving invasive interventions. The age, gender, etiology, systemic inflammatory response syndrome(SIRS), impairment of organ function, revised Atlanta classification, bedside index of severity of acute pancreatitis(BISAP), Balthazar CT classification, extra-pancreatic involvement and secondary infection of local complications, indications, timing and modalities of invasive interventions, length of hospitalization, length of intensive care and outcomes were recorded. The differences on clinical characteristics were compared between the two groups.Results:Intestinal fistulae were found in 21(11.9%) cases during or after invasive intervention, including 8 during or after percutaneous drainage and 13 during or after surgeries. 51 cases received endoscopic drainage or debridement and no intestinal fistula occurred after endoscopic management. Compared to patients without fistula, the median age was younger in the fistula group (36 vs 45 years, P=0.014), and the occurrence of SIRS (95.2% vs 59.6%, P=0.001), extra-pancreatic invasion (100.0% vs 67.3%, P=0.002), and secondary infection (71.4% vs 36.5%, P=0.002) were higher. Patients with fistula had a longer median length of hospitalization (71 vs 40 days, P=0.016) and intensive care (8 vs 0 days, P=0.002). All patients in the fistula group had peri-pancreatic, abdominal and retroperitoneal involvement seen on imaging or intraoperatively. The intestinal fistulae mainly occurred in the colon ( n=13, 61.9%) and the duodenum ( n=6, 28.6%). The confirmed diagnosis of fistulae was based on transfistula imaging ( n=11) or digestive tract imaging ( n=5). Among 13 cases with colonic fistulae, nonsurgical treatment was preferred in 9 cases, and surgeries of fistula repairmen or proximal ostomy were preferred in 4 cases. Among 8 cases with non-colonic fistulae, nonsurgical treatment was preferred in 7 cases, and only 1 case repaired the fistula immediately during the intraoperative detection. Conclusions:Intestinal fistula is an important complication of severe AP, and it is closely associated with invasive interventions. Improved invasive intervention strategies may help prevent intestinal fistula formation; timely and effective management of intestinal fistula may help avoid complications and shorten hospitalization.

ObjectiveIt is very important to monitor the disease activity and complications of patients in the treatment of rheumatoid arthritis (RA). In this paper, we evaluated the level of platelet-lymphocyte ratio (PLR) of peripheral blood in patients with rheumatoid arthritis and discussed the relationship between PLR and the system involvement, laboratory indexes, and disease activity in patients with rheumatoid arthritis.MethodsFrom September 2013 to May 2017, 123 patients with rheumatoid arthritis who were first diagnosed in the General Hospital of Eastern Theater Command were analyzed retrospectively. 123 healthy persons(healthy control group) and 123 patients with other autoimmune diseases(disease control group) were matched according to the sex and age in a ratio of 1:1. According to the disease activity score 28 joints C-reactive protein (DAS28-CRP), RA patients were divided into the high activity group and the low activity group, and the PLR levels of high-activity and low-activity patients, healthy control group and disease control group were compared, respectively. To evaluate the relationship between system involvement and PLR level in RA patients; to analyze the correlation between PLR and DAS28-CRP and traditional inflammatory indexes by Spearman; to evaluate the application effect of receiver operating characteristic curve(ROC) in the diagnosis of RA and the differentiation of disease activity of RA patients.ResultsThe PLR level of RA patients was significantly higher than that of healthy people [133.63 (103.17, 140.99)] and disease control group [159.83(104.22, 203.55)], and the difference was statistically significant(P<0.01); the PLR level of RA patients in the high activity group was significantly higher than that in the low activity group [200.00 (150.00, 264.50) vs 137.00 (116.50, 183.25),P<0.01]; the level of PLR in RA group with circulatory system involvement and infectious diseases were significantly higher than that in the none group [198.91 (139.99, 261.18) vs 146.26 (117.61, 185.71),P<0.01; 219.28 (176.54, 468.17) vs 171.90 (127.39, 247.21), P<0.05]. The PLR level of RA patients with rheumatoid factor (RF) positive group was significantly higher than that of RF negative group [189.77 (147.18, 252.20) vs 142.35 (115.17, 231.96), P<0.05]. However, there was no statistically significant difference in PLR levels between the positive and negative groups of anti-cyclic citrullinated peptide antibody (A-CCP) [181.92 (139.03, 250.13) vs 149.16 (114.94, 248.66), P>0.05]. There was a significant positive correlation between PLR and DAS28 CRP, C-reactive protein (CRP), ESR (r=0.433, 0.501, 0.592, P all <0.01）. The AUC of PLR in diagnosing RA and evaluating RA was 0.68 and 0.73 respectively. When cut off value was 134.47 and 147.61 respectively, sensitivity was 74.8% and 77.5%, specificity was 56.5% and 63.2%.ConclusionThe level of PLR of peripheral blood in patients with RA is increased, especially in patients with circulatory system involvement, infectious diseases or RF positive, and related to disease activity. PLR is expected to be an effective supplement for RA disease diagnosis and disease activity assessment and has potential application value.

Objective To analyze the blood of patients with hepatitis B cirrhosis complicated with iron deficiency anemia(IDA).Methods The 100 cases with hepatitis B cirrhosis complicated with IDA and hepatitis B cirrhosis complicated with non-iron deficiency anemia (NIDA) were recruited in our hospital from December 2013 to May 2015,and were divided into observation group (50 cases) and control group(50 cases) according to whether complicated with IDA.The liver function,blood routine,liver cirrhosis patients with coagulation test and measurement of the platelet parameters of two groups of patients were detected and analyzed.Results After treatment,no statistically significant difference were observed the levels of albumin,bilirubin,bile acid and alkaline phosphatase between two groups (P>0.05).The levels of alanine amino transferase (ALT),gamma glutamyltransferase (GGT) in the observation group were significantly higher than those in the control group(P<0.05).The hemoglobin,serum ferritin (SF),mean corpuscular volume (MCV),mean corpuscular hemoglobin (MCH) values in the observation group were lower than those in the control group,while level of folic acid was significantly higher than that of the control group(P<0.05).There was no significant difference on the red blood cell count (RBC) between two groups (P>0.05).The prothrombin time (PT),International normalized ratio (INR),activated partial thromboplastin time (APTT),thrombin time (TT) of observation group were higher than the control group(P<0.05);while the levels of fibrinogen (FIB),platelet count (Plt) were significantly lower than those of control group(P<0.05).There was no significant difference in platelet distribution width (PDW) between the two groups (P>0.05).Conclusion The detection of blood in patients with hepatitis B cirrhosis complicated with IDA is of great significance in the evaluation of the degree of liver damage and the diagnosis of the disease,which is worthy of clinical application in the future.