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.

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:To investigate the relationship between plasma fluoride content, daily calcium intake and blood cell parameters in children and adolescents.Methods:This study was based on the National Health and Nutrition Examination Survey (NHANES) database of the United States from 2013 to 2016, with 3 684 children and adolescents aged 6 - 19 as the research subjects. Information on plasma fluoride content, daily calcium intake and blood cell parameters from the database were collected. Non-linear relationships between plasma fluoride content, daily calcium intake and blood cell parameters were analyzed using restricted cubic splines. If there was a non-linear relationship, the optimal inflection point was calculated using threshold/saturation effect analysis method. Subsequently, multiple linear regression models were used to analyze the associations among the three, and the modification effect of daily calcium intake (binary classification, stratified by median daily calcium intake) on the association between plasma fluoride content and blood cell parameters was analyzed.Results:There was no non-linear relationship between plasma fluoride content and white blood cell count, hemoglobin content and platelet count ( Pnon-linear > 0.05), but there was a non-linear relationship between plasma fluoride content and erythrocyte count and hematocrit ( Pnon-linear < 0.001). After adjusting for confounding factors, the optimal inflection points of the effects of plasma fluoride content on erythrocyte count and hematocrit were 0.54 and 0.31 μmol/L, respectively. There was no non-linear relationship between daily calcium intake and blood cell parameters ( Pnon-linear > 0.05). After adjusting for confounding factors, for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.49 × 10 9/L ( P = 0.009). There was a saturation effect in the association between plasma fluoride content, erythrocyte count and hematocrit: when plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.46 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 6.29% for every 1 μmol/L increase ( P = 0.006). The above associations were not statistically significant when plasma fluoride content was higher than the optimal inflection points ( P > 0.05). After stratification according to the median daily calcium intake, in the low-calcium group (daily calcium intake < 0.87 g), for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.77 × 10 9/L ( P = 0.001). When plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.41 × 10 12/L for every 1 μmol/L increase ( P = 0.002). When plasma fluoride content was ≥0.54 μmol/L, erythrocyte count decreased by 0.47 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When the plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 8.29% for every 1 μmol/L increase ( P = 0.011). The above associations were not statistically significant in the high-calcium group (daily calcium intake ≥0.87 g, P > 0.05). There was an interaction of daily calcium intake and plasma fluoride content on platelet count ( Pinteraction = 0.070), as demonstrated by an increase in platelet count of 12.68 × 10 9/L ( P = 0.013) in the low-calcium group and a decrease in platelet count of 9.05 × 10 9/L ( P = 0.035) in the high-calcium group for every 1 μmol/L increase in plasma fluoride content. Conclusions:The blood cell parameters of children and adolescents are closely related to plasma fluoride content, but not directly related to daily calcium intake. However, the correlation between plasma fluoride content and blood cell parameters varies among different calcium intake populations, and daily calcium intake can modify the association between plasma fluoride content and platelet count.

ObjectiveTo explore the association between short-term exposure to atmospheric fine particulate matter （PM_2.5） and ozone （O₃） and systemic inflammatory indicators in patients with pneumonia， and to identify the susceptible populations. MethodsFrom September 2018 to April 2020， data of 1 480 patients admitted for pneumonia was collected from a tertiary hospital in Taiyuan City. Generalized additive models （GAMs） were used to explore the associations between PM_2.5 and O₃ exposure and inflammatory indicators of patients with pneumonia； and to explore the susceptibility factors and susceptible populations to PM_2.5 and O₃ exposures through stratified analyses. ResultsThe short-term exposure to PM_2.5 was associated with changes in peripheral blood C-reation protein （CRP）， erythrocyte sedimentation （ESR）， easinophil （EOS）， neutrophil （NEU） and neutrophil-lymphocyte ratio （NLR） in patients with pneumonia， and there were different degrees of hysteresis effects， with the effect values reaching a maximum at lag03， lag03， lag0， lag03， lag03， respectively， which were 4.13% （95%CI： 0.43%‒7.84%）， 3.10% （95%CI： 0.24%‒5.97%）， 5.27% （95%CI： 3.12%‒7.42%）， 1.85% （95%CI： 0.36%‒3.34%）， and 2.53% （95%CI： 0.53%‒4.74%） for every 10 μg·m^-3 of PM_2.5. The changes in O₃ concentration were associated with the elevation of peripheral blood PCT and ESR in patients with pneumonia， and their effect values all reached the maximum at lag01 d， every 1 μg·m^-3 of O₃ elevation increased by 0.38% （95%CI： 0.04%‒0.73%） and 0.47% （95%CI： 0.19%‒0.76%）， respectively. Stratified analyses showed that the associations of PM_2.5 with peripheral blood CRP， ESR， NEU， and NLR in pneumonia patients were more significant in males， the elderly， and those with onset in the cold season； the associations of O₃ with peripheral blood PCT and ESR in pneumonia patients were more significant in the elderly and those with onset in the warm season， and the peripheral blood CRP and PCT in female patients with pneumonia were more susceptible to the changes of O₃. ConclusionShort-term exposure to atmospheric PM_2.5 and O₃ are positively associated with changes in inflammatory indicators in patients with pneumonia， and the effects of PM_2.5 on patients with pneumonia are more extensive than those of O₃， with a longer lag effect. In addition， elderly patients with pneumonia are more sensitive to air pollution， male patients with pneumonia are more sensitive to PM_2.5， and female patients with pneumonia are more sensitive to O₃. Cold and warm seasons can exacerbate the effects of PM_2.5 and O₃ on inflammatory indicators in patients with pneumonia， respectively， and the patients must be protected well.

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.