Objective: To investigate the correlation between the color parameters (L^*, a^*, b^*, Eab^* values) of Polygoni Multiflori Radix Praeparata powder prepared by different processing techniques and the contents of 2,3,5,4’-tetrahydroxystilbene-2-O-β-D-glucopyranoside, emodin, physcion, emodin-8-O-β-D-glucopyranoside, physcion-8-O-β-D-glucopyranoside.
Methods: The L^*, a^*, b^* and Eab^* values of Polygoni Multiflori Radix Praeparata powder prepared by different processing techniques were determined by spectrophotometer, and the contents of the five components were determined by high performance liquid chromatography. Secondly, SPSS 26.0 software and Simca 14.1 software were used to analyze the correlation.
Results: Through the hierarchical cluster analysis (HCA), it was found that the steamed samples and black bean steamed samples could be obviously divided into two categories: raw products and processed products. The processed products could be further divided into 2-8 h and 12-48 h. Pearson correlation analysis showed that the content of stilbene glycoside was significantly positively correlated with L^*, a^* and b^* values (P<0.01). The a^* value was significantly positively correlated with the content of emodin and physcion (P<0.01). Emodin-8-O-β-D-glucoside was positively correlated with L^* value and b^* value, while physcion-8-O-β-D-glucoside was negatively correlated with a^* value. Partial least squares discriminant analysis (PLS) showed that 2,3,5,4’-tetrahydroxystilbene-2-O-β-D-glucoside (VIP=1.69) and emodin-8-O-β-D-glucoside (VIP=1.06) were the key variables affecting chromaticity characteristics (P<0.01).
Conclusion: The three processes of steaming, black bean steaming and black bean stewing are consistent in composition transformation and chromaticity variation, and stilbene glycoside can be used as a specific index component to characterize the processed color. Chromatic parameters can effectively reflect the processing progression and serve as quality monitoring indicators during production.

Objective:To explore the early clinical effect of arthroplasty with rotating hinge knee prosthesis in the treatment of severe knee deformity.Methods:A retrospective study was conducted on 55 patients who underwent primary rotating hinge knee arthroplasty at Shanghai Sixth People's Hospital from January 2017 to October 2023, including 19 male patients and 36 female patients, with an average age of 60.9±9.0 years (ranging from 31 to 74 years). The four main indications were end-stage deformity of osteoarthritis (valgus/varus>20°, 16 cases), post-traumatic joint deformity (15 cases), severe joint ligament instability (12 cases), and neuromuscular or immune diseases (12 cases). The patients were divided into two age groups: ≥60 years old group (32 cases) and <60 years old group (23 cases). Various pre-operative and post-operative data, including knee society score (KSS), range of motion (ROM), forgotten joint score (FJS), degree of force line offset and post-operative complications, were collected and compared.Results:All the 55 cases successfully underwent the operation. The operation time was 102.3±15.8 min. The intraoperative blood loss was 63±23.7 ml. The follow-up time was 37.2±7.9 months. KSS clinical score increased from 27.5(12, 45) before surgery to 90.5(85, 95) after surgery ( P<0.001) and the mean score of KSS function increased from 50.4(45, 60) before surgery to 84.3(85, 95) after surgery ( P<0.001), both with significant difference ( P<0.05). Similarly, the average postoperative ROM improved from 97.2°±34.4° to 120.1°±10.9°with significant difference ( P<0.05). The postoperative FJS was 81.0±6.6. Up to the last follow-up, the implant survival rate was 98%[95% CI(90.4%, 99.6%)]. For the all four groups of end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, both the KSS score and the ROM of the knee joint were significantly improved. There was no significant difference in neither the KSS score or the ROM of the knee joint between the ≥60 years old group and the <60 years old group ( P>0.05). The incidence of complications was 24% (13/55). The complication rates for patients with end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases were 12.5% (2/16), 20% (3/15), 25% (3/12), and 41.7% (5/12) respectively, without significant difference. The incidence of complications in elderly patients (85%, 11/13) was much higher than that in younger patients (5%, 2/42),with significant difference ( P<0.05). Conclusions:For end-stage deformity of osteoarthritis (valgus or varus >20°), post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, the rotating hinge knee can provide good clinical improvement effects. For neuromuscular or immune diseases, the incidence of complications was relatively high. The therapeutic effect of patients over 60 years old showed no significant difference in the early postoperative efficacy compared with younger patients, but the complications of elderly patients were much higher than those of younger patients.

Objective:To explore the early clinical effect of arthroplasty with rotating hinge knee prosthesis in the treatment of severe knee deformity.Methods:A retrospective study was conducted on 55 patients who underwent primary rotating hinge knee arthroplasty at Shanghai Sixth People's Hospital from January 2017 to October 2023, including 19 male patients and 36 female patients, with an average age of 60.9±9.0 years (ranging from 31 to 74 years). The four main indications were end-stage deformity of osteoarthritis (valgus/varus>20°, 16 cases), post-traumatic joint deformity (15 cases), severe joint ligament instability (12 cases), and neuromuscular or immune diseases (12 cases). The patients were divided into two age groups: ≥60 years old group (32 cases) and <60 years old group (23 cases). Various pre-operative and post-operative data, including knee society score (KSS), range of motion (ROM), forgotten joint score (FJS), degree of force line offset and post-operative complications, were collected and compared.Results:All the 55 cases successfully underwent the operation. The operation time was 102.3±15.8 min. The intraoperative blood loss was 63±23.7 ml. The follow-up time was 37.2±7.9 months. KSS clinical score increased from 27.5(12, 45) before surgery to 90.5(85, 95) after surgery ( P<0.001) and the mean score of KSS function increased from 50.4(45, 60) before surgery to 84.3(85, 95) after surgery ( P<0.001), both with significant difference ( P<0.05). Similarly, the average postoperative ROM improved from 97.2°±34.4° to 120.1°±10.9°with significant difference ( P<0.05). The postoperative FJS was 81.0±6.6. Up to the last follow-up, the implant survival rate was 98%[95% CI(90.4%, 99.6%)]. For the all four groups of end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, both the KSS score and the ROM of the knee joint were significantly improved. There was no significant difference in neither the KSS score or the ROM of the knee joint between the ≥60 years old group and the <60 years old group ( P>0.05). The incidence of complications was 24% (13/55). The complication rates for patients with end-stage deformity of osteoarthritis, post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases were 12.5% (2/16), 20% (3/15), 25% (3/12), and 41.7% (5/12) respectively, without significant difference. The incidence of complications in elderly patients (85%, 11/13) was much higher than that in younger patients (5%, 2/42),with significant difference ( P<0.05). Conclusions:For end-stage deformity of osteoarthritis (valgus or varus >20°), post-traumatic joint deformity, severe joint ligament instability and neuromuscular or immune diseases, the rotating hinge knee can provide good clinical improvement effects. For neuromuscular or immune diseases, the incidence of complications was relatively high. The therapeutic effect of patients over 60 years old showed no significant difference in the early postoperative efficacy compared with younger patients, but the complications of elderly patients were much higher than those of younger patients.

Polygoni multiflori radix praeparata is a processed product of Polygoni multiflori radix(Polygonum multiflorum Thunb.),and its main components include stilbene glycosides,anthraquinones,flavonoids,alkaloids,phenolic acids,etc.It has antioxidant,antianemic,anti-tumor,hypoglycemic,anti-inflammatory effects,etc,and is widely used in clinical practice.The processing technology is mainly stewinging with black bean juice,steaming,processing for 9 times and braising and simmering.After processing,the color deepens and the content of composition changes.By consulting domestic and foreign literature,the research on Polygoni multiflori radix praeparata is not comprehensive enough compared with Polygoni multiflori radix.Therefore,this paper mainly summarizes the processing technology,chemical composition and pharmacological activity of Polygoni multiflori radix preparata reported in the past 20 years,and provides a reference for further development of Polygoni multiflori radix preparata.

Background::Adamantinomatous craniopharyngioma (ACP) is the commonest pediatric sellar tumor. No effective drug is available and interpatient heterogeneity is prominent. This study aimed to identify distinct molecular subgroups of ACP based on the multi-omics profiles, imaging findings, and histological features, in order to predict the response to anti-inflammatory treatment and immunotherapies.Methods::Totally 142 Chinese cases diagnosed with craniopharyngiomas were profiled, including 119 ACPs and 23 papillary craniopharyngiomas. Whole-exome sequencing (151 tumors, including recurrent ones), RNA sequencing (84 tumors), and DNA methylome profiling (95 tumors) were performed. Consensus clustering and non-negative matrix factorization were used for subgrouping, and Cox regression were utilized for prognostic evaluation, respectively.Results::Three distinct molecular subgroups were identified: WNT, ImA, and ImB. The WNT subgroup showed higher Wnt/β-catenin pathway activity, with a greater number of epithelial cells and more predominantly solid tumors. The ImA and ImB subgroups had activated inflammatory and interferon response pathways, with enhanced immune cell infiltration and more predominantly cystic tumors. Mitogen-activated protein kinases (MEK/MAPK) signaling was activated only in ImA samples, while IL-6 and epithelial-mesenchymal transition biomarkers were highly expressed in the ImB group, mostly consisting of children. The degree of astrogliosis was significantly elevated in the ImA group, with severe finger-like protrusions at the invasive front of the tumor. The molecular subgrouping was an independent prognostic factor, with the WNT group having longer event-free survival than ImB (Cox, P = 0.04). ImA/ImB cases were more likely to respond to immune checkpoint blockade (ICB) therapy than the WNT group ( P <0.01). In the preliminary screening of subtyping markers, CD38 was significantly downregulated in WNT compared with ImA and ImB ( P = 0.01). Conclusions::ACP comprises three molecular subtypes with distinct imaging and histological features. The prognosis of the WNT type is better than that of the ImB group, which is more likely to benefit from the ICB treatment.

Objective To carry out a proficiency testing of content determination of geniposide in Gardeniae fructus,evaluate the content determination ability of index components in traditional Chinese medicine in the laboratory of inspection and detection in drug-related fields,and improve the quality control ability of content determination of related laboratories.Methods The laboratory's capability-verification activities were conducted based on the CNAS-RL02 Rules for Proficiency Testing and ISO/IEC 17043 Conformity Assessment-General Requirements for Proficiency Testing.After preparing the sample,the results of homogeneity and stability tests were analyzed according to CNAS-GL003 Guidance on Evaluating the Homogeneity and Stability of Samples Used for Proficiency Testing.After the test results were qualified,they were used as proficiency testing samples and randomly distributed to participants.The results were collected,and the robust statistical method and the Z scores were used to analyze the results of these laboratories'reports.Results 403 laboratories in this proficiency testing program reported the results,of which 367 results were acceptable,accounting for 91.07％,17(4.22％)laboratories obtained suspicious results,and 19 laboratories gave unsatisfactory results,with the dissatisfaction rate of 4.71％.Conclusion The majority of the 403 participant laboratories have the ability to determine the content of geniposide in Gardeniae fructus by HPLC and the laboratory testing ability and quality management level of the drug monitoring system are high.This proficiency testing provides a basis for understanding the technical reserve capacity and management level of China's pharmaceutical inspection and testing laboratories,and provides technical support for future government supervision.

Objective:To assess the clinical efficacy and infection control outcomes of two-stage revision in managing periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) utilizing either a low or high constrained prosthesis.Methods:A retrospective analysis was performed on 40 patients who underwent revision TKA in the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from February 2019 to February 2022. According to the type of prosthesis selected in primary TKA, they were divided into low constrained prosthesis group and high constrained prosthesis group. There were 28 patients (28 knees) in the low constrained group, including 12 males and 16 females, aged 69.0(63.0, 74.0) years, with a body mass index of 25.18±0.55 kg/m 2. And there were 12 patients (12 knees) in the high-constrained group, including 5 males and 7 females, aged 66.5(65.0, 71.5) years, with a body mass index of 23.94±0.51 kg/m 2. All patients underwent two-stage revision surgery, with RHK used in 1 case and LCCK in 27 cases in the low-constrained prosthesis group. In the high-constrained prosthesis group, 3 patients were treated with RHK, 1 patient with PFC Sigma MBT, and 8 patients with LCCK. The preoperative and postoperative range of motion (ROM), Knee Society score (KSS), and postoperative infection control rate were compared between the two groups. Results:All patients were followed up. The follow-up time was 22.79±8.02 months in the low-constrained prosthesis group and 23.92±7.04 months in the high-constrained prosthesis group, with no significant difference between the two groups ( t=0.426, P=0.680). At the last follow-up, the KSS and ROM in the low-constrained prosthesis group were 77.96±9.74 and 93.48°±7.45°, respectively, significantly higher than 38.93±8.01 and 68.89°±9.44° before the operation ( P<0.05). The KSS score and ROM in the high-constrained prosthesis group were 67.83±8.31 and 80.08°±5.89° at the last follow-up, which were also significantly higher than those before operation (34.25±6.31 and 66.50°±10.48°, P<0.05). There was no significant difference in KSS and ROM between the two groups before operation ( P>0.05), but the KSS score and ROM in the low-constrained prosthesis group were significantly higher than those in the high-constrained prosthesis group at the last follow-up ( P<0.05). Bacterial culture results revealed that the primary infectious agents were coagulase-negative Staphylococcus and Staphylococcus aureus, with an overall infection control rate of 80% (32/40). The infection control rate was 89% (25/28) in the low-constrained prosthesis group and 58% (7/12) in the high-constrained prosthesis group, but the difference between the two groups was not statistically significant (χ 2=3.283, P=0.070). Conclusion:Two-stage revision effectively controls PJI, and the clinical outcomes of two-stage revision for PJI after primary TKA with a high-constrained prosthesis are inferior to those with a low-constrained prosthesis. Further exploration is needed to enhance efficacy.

Objective:To explore the assessment value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and tumor markers in assessing the curative effect of neoadjuvant chemotherapy for breast cancer.Methods:A total of 75 patients with breast cancer who received neoadjuvant chemotherapy combined with surgical intervention in Jining No.1 People's Hospital from May 2019 to May 2022 were selected,and they were divided into effective group(54 cases)and ineffective group(21 cases)according to the Response Evaluation Criteria In Solid Tumour(RECIST).The Ve,Kep and Ktrans of DCE-MRI quantitative parameters and CEA,CA125 and CA15-3 levels of tumor markers between two groups were compared before and after chemotherapy,and the receiver operating characteristics(ROC)curve was adopted to analyze the predictive efficiency of each diagnostic method.Results:After chemotherapy,the differences of the Ve,Kep and Ktrans of quantitative parameters between the two groups were significant(t=7.237,51.695,16.879,P<0.05),respectively.The differences of the CEA,CA125 and CA15-3 of tumor markers between two groups were significant(t=44.201,6.736,6.885,P<0.05),respectively.The AUC value of combined prediction of 6 indicators included Ve,Kep,Ktrans,CEA,CA125 and CA15-3 was 0.979 in predicting the curative effect of neoadjuvant chemotherapy for breast cancer,which was significantly higher than the AUC value of each alone indicator,and the differences of them were statistically significant(Z=2.993,2.679,2.510,2.731,3.215,3.071,P<0.05),respectively.Conclusion:The combination of tumor markers and DCE-MRI quantitative parameters can better predict the curative effect of neoadjuvant chemotherapy for breast cancer,which can indirectly assess the prognosis.

Objective:To analyze the factors affecting the relative height change of the patella after primary robotic-assisted total knee arthroplasty (R-TKA).Methods:The data of 97 patients with osteoarthritis of the knee treated with R-TKA admitted from June 2021 to March 2022 were retrospectively analyzed, including 15 males and 82 females, aged 70.0±5.4 years (range, 58-80 years). The bone resection parameters of the robotic system were recorded intraoperatively, including the bone resection amount of the medial and lateral distal femur, medial and lateral posterior femoral condyle and medial and lateral tibial plateau. The Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI) were used to measure the preoperative and postoperative relative patellar height on lateral radiographs, as well as the posterior tibial slope (PTS) and the change in patellar ligament length before and after surgery. The relationship between the change in relative patellar height and the variables of interest was analyzed using partial correlation and multiple linear regression.Results:The mean postoperative CDI was lower than preoperatively (0.79±0.15 vs. 0.91±0.13, t=9.69, P<0.001), and the percentage of patients with postoperative CDI<0.6 was higher than preoperatively (9.3% vs. 0; χ 2=12.92, P<0.001); the differences in mean postoperative BPI and percentage of patients with postoperative BPI<0.45 were not statistically significant compared to preoperatively (0.69±0.13 vs. 0.71±0.17, t=1.35, P=0.182; 11.3% vs. 17.5%, χ 2=1.50, P=0.220). The mean patellar ligament length on the first postoperative day was 2.29 mm shorter than preoperatively, there was a statistically significant difference ( t=5.90, P<0.001). Partial correlation analysis showed that the amount of patellar ligament length change was positively correlated with the amount of BPI and CDI change ( r=0.84, P<0.001; r=0.70, P<0.001), and the amount of PTS change and the mean distal femoral bone resection were negatively correlated with the amount of BPI ( r= -0.41, P<0.001; r=-0.32, P=0.002) and CDI ( r=-0.23, P=0.029; r=-0.25, P=0.017) change. In contrast, the amount of posterior femoral condyle bone resection and tibial plateau bone resection did not correlate with the change of BPI and CDI. Multiple linear regression analysis showed that the amount of patellar ligament length change, PTS change and the distal femoral bone resection were factors influencing the change of BPI ( β=0.03, P<0.001; β=-0.01, P<0.001; β=-0.02, P=0.021) and CDI ( β=0.02, P<0.001; β=-0.01, P=0.001; β=-0.02, P=0.008). Conclusion:Amount of patellar ligament length change, PTS change and the distal femoral bone resection are factors affecting the BPI. In order to obtain a better relative patellar height in the primary R-TKA, attention should be paid to the adjustment of the distal femoral bone resection and PTS, while taking the necessary measures to reduce the postoperative patellar ligament length changes.

Digital orthopedic technologies are increasingly being applied to the clinical practice of joint surgery. These technologies include artificial intelligence, virtual/augmented/mixed reality, 3D printing, computer navigation, robotic-assisted joint replacement surgery, and other digital orthopedic technologies. Digital orthopedic technologies continue to empower joint surgeons, simplify complex operations, achieve precision in simple operations, and to make precise operations more individualized. Thus, they are becoming important development directions for joint surgery in the future. With the help of advances in computer-aided design and additive manufacturing technology, customized joint prostheses and bone tissue repair materials provide great convenience for reconstruction of complex bone defects during revision surgery. Various types of computer-assisted navigation technologies and robot-assisted surgery technologies can help doctors improve the accuracy of osteotomy and prosthesis implantation significantly. However, to fundamentally improve patients' satisfaction after joint replacements, we need to use digital orthopedics technologies to explore the ideal target value of arthroplasty. Further, we use personalized preoperative planning with objective and accurate assessment technology of soft tissue balance, precise intraoperative operations, and the use of customized prostheses to achieve individualized and precise joint arthroplasty. Various digital orthopedic technologies have their own advantages and disadvantages. Joint surgeons should have an in-depth understanding of these technologies and make full and reasonable use of these technologies to benefit the majority of patients.