In this study, araucarene diterpenes, characterized by a pimarene skeleton with a variably oxidized side chain at C-13, were investigated. A total of 16 araucarene diterpenoids and their derivatives were isolated from the woods of Agathis dammara, including 11 previously unreported compounds: dammaradione (1), dammarones D-G (2, 5, 14, 15), dammaric acids B-F (8-12), and dammarol (16). The structures of these new compounds were elucidated using high-resolution electrospray ionization mass spectroscopy (HR-ESI-MS) and one-dimensional/two-dimensional (1D/2D) nuclear magnetic resonance (NMR), while their absolute configurations were determined through the electronic circular dichroism (ECD) exciton chirality method and Snatzke's method. The hypoglycemic activity of all isolated compounds was evaluated using a transgenic zebrafish model, and a structure-activity relationship (SAR) analysis was conducted. Araucarone (3) and dammaric acid C (9), serving as representative compounds, demonstrated significant hypoglycemic effects on zebrafish. The primary mechanism involves the promotion of pancreatic β cell regeneration and glucose uptake. Specifically, these compounds enhance the differentiation of pancreatic endocrine precursor cells (PEP cells) into β cells in zebrafish.
Zebrafish ; Animals ; Diterpenes/isolation & purification* ; Insulin-Secreting Cells/cytology* ; Glucose/metabolism* ; Hypoglycemic Agents/isolation & purification* ; Molecular Structure ; Structure-Activity Relationship ; Plant Extracts/pharmacology* ; Regeneration/drug effects*

Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.

Objective:To evaluate the efficacy and safety of radiotherapy combined with sintilimab and bevacizumab (anti-angiogenic agent) in patients with unresectable advanced hepatocellular carcinoma (HCC).Methods:Clinical data of 80 patients with unresectable advanced HCC admitted to Shanghai Mengchao Cancer Hospital from January 2021 to September 2023 were retrospectively analyzed. All patients were divided into two groups based on treatment regimens: the systemic therapy group ( n=41) receiving sintilimab combined with bevacizumab, and combined radiotherapy group ( n=39) receiving radiotherapy plus sintilimab and bevacizumab. Efficacy was evaluated using the response evaluation criteria in solid tumors (RECIST) 1.1 version and modified RECIST for HCC. Treatment-related adverse events (TRAE) were assessed by the common terminology criteria for adverse events (CTCAE) 4.03 version. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and TRAE. Independent sample t-test was used for normally distributed quantitative data, and Chi-square test for qualitative data. Survival analysis was performed via Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression models were applied to analyze prognostic factors. Results:In terms of efficacy, no patient obtained complete response (CR) in the systemic therapy group, while 2 cases achieved CR in the combined radiotherapy group. The ORR was 22% (9/41) in the systemic therapy group and 59% (23/39) in the combined radiotherapy group ( P=0.001). The DCR was 85% (35/41) and 97% (38/39) in the two groups ( P=0.130), with the incidence of progressive disease of 15% (6/41) and 3% (1/39) ( P=0.130), respectively. The median PFS was 8.0 months (95% CI=6.8-9.2 months) in the combined radiotherapy group and 4.4 months (95% CI=4.1-4.7 months) in the systemic therapy group ( P=0.002). The median OS was 19.0 months (95% CI=15.5-22.5 months) in the combined radiotherapy group and 12.5 months (95% CI=9.4-15.6 months) in the systemic therapy group ( P=0.006). Radiotherapy was an independent protective factor for both PFS ( HR=0.474, 95% CI=0.289-0.778, P=0.003) and OS ( HR=0.403, 95% CI=0.218-0.744, P=0.004). The number of tumors >3 was an independent risk factor for both PFS ( HR=2.658, 95% CI=1.485-4.755, P=0.001) and OS ( HR=3.245, 95% CI=1.773-5.939, P=0.001). There was no significant difference in TRAE between two groups ( P > 0.05). Conclusions:Radiotherapy combined with sintilimab and bevacizumab shows high efficacy and acceptable safety in patients with unresectable advanced HCC.

Objective:To investigate the impact of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion (TLIF) on postoperative coronal plane imbalance in degenerative scoliosis.Methods:A retrospective analysis was conducted on the data of 108 patients with type A degenerative scoliosis in the Nanjing classification who underwent primary multi-segment posterior column osteotomy (PCO) with deformity correction and internal fixation at Nanjing Gulou Hospital from June 2017 to June 2021. Patients were divided into two groups based on the presence of preoperative rotational subluxation: the rotational subluxation group and the non-rotational subluxation group. The rotational subluxation group consisted of 60 patients, with 8 males and 52 females, aged 63.7±5.5 years (range, 56-75 years). The non-rotational subluxation group included 48 patients, with 5 males and 43 females, aged 64.4±5.2 years (range, 53-72 years). Within the rotational subluxation group, depending on whether TLIF was performed on the rotational subluxation segment, they were further categorized into the TLIF group and the PCO group. The TLIF group comprised 28 patients, while the PCO group had 32 patients. Full-spine anteroposterior and lateral X-rays were taken preoperatively, postoperatively, and at the last follow-up to measure coronal balance types and radiographic parameters. The differences in the lumbar Cobb angle, coronal balance distance (CBD), and the Cobb angle of the lumbosacral curve (Cobb-Fra angle) were compared between the rotational subluxation group and the non-rotational subluxation group, as well as between the TLIF group and the PCO group.Results:The average surgery duration ranged from 200 to 310 min, with a mean of 235±47 min. The intraoperative blood loss ranged from 700 to 2,400 ml, with an average of 950±355 ml. The number of fused segments in the rotational subluxation group was 7.6±2.1, ranging from 5 to 11 segments, while in the non-rotational subluxation group, it was 7.4±2.0, ranging from 5 to 10 segments. Postoperatively, 13%(8/60) of patients in the rotational subluxation group developed type C coronal imbalance, significantly higher than the 2%(1/48) in the non-rotational subluxation group. The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the rotational subluxation group were 20.60°±10.73° and 20.33°±10.92°, 22.53±16.45 mm and 18.53±17.31 mm, 13.14°±4.40° and 11.23°±4.92°, respectively, which were higher than those in the non-rotational subluxation group (13.92°±7.02° and 12.92°±6.64°, 18.62±17.44 mm and 8.83±8.95 mm, 11.91°±3.03° and 9.52°±3.30°), with statistical significance ( P<0.05).. Among patients in the rotational subluxation group, the probability of new-onset coronal imbalance postoperatively was 4%(1/28) in the TLIF group, which was lower than the 22%(7/32) in the PCO group, with a statistically significant difference (χ 2=4.330, P=0.037). The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the PCO group were 25.63°±11.00° and 25.13°±11.04°, 27.37±18.95 mm and 25.25±18.67 mm, 15.50°±3.62° and 14.08°±4.77°, respectively, which were significantly higher than those in the TLIF group (14.86°±6.96° and 14.86°±5.37°, 17.08±10.94 mm and 10.86±7.86 mm, 10.14°±3.37° and 8.46°±2.66°), with statistical significance ( P<0.05). Conclusion:For patients with Type A degenerative scoliosis combined with rotational subluxation according to the Nanjing classification, performing a 360-degree circumferential release and interbody fusion at the segment with rotatory subluxation can reduce the risk of developing new postoperative coronal imbalances.

Objective:To investigate the impact of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion (TLIF) on postoperative coronal plane imbalance in degenerative scoliosis.Methods:A retrospective analysis was conducted on the data of 108 patients with type A degenerative scoliosis in the Nanjing classification who underwent primary multi-segment posterior column osteotomy (PCO) with deformity correction and internal fixation at Nanjing Gulou Hospital from June 2017 to June 2021. Patients were divided into two groups based on the presence of preoperative rotational subluxation: the rotational subluxation group and the non-rotational subluxation group. The rotational subluxation group consisted of 60 patients, with 8 males and 52 females, aged 63.7±5.5 years (range, 56-75 years). The non-rotational subluxation group included 48 patients, with 5 males and 43 females, aged 64.4±5.2 years (range, 53-72 years). Within the rotational subluxation group, depending on whether TLIF was performed on the rotational subluxation segment, they were further categorized into the TLIF group and the PCO group. The TLIF group comprised 28 patients, while the PCO group had 32 patients. Full-spine anteroposterior and lateral X-rays were taken preoperatively, postoperatively, and at the last follow-up to measure coronal balance types and radiographic parameters. The differences in the lumbar Cobb angle, coronal balance distance (CBD), and the Cobb angle of the lumbosacral curve (Cobb-Fra angle) were compared between the rotational subluxation group and the non-rotational subluxation group, as well as between the TLIF group and the PCO group.Results:The average surgery duration ranged from 200 to 310 min, with a mean of 235±47 min. The intraoperative blood loss ranged from 700 to 2,400 ml, with an average of 950±355 ml. The number of fused segments in the rotational subluxation group was 7.6±2.1, ranging from 5 to 11 segments, while in the non-rotational subluxation group, it was 7.4±2.0, ranging from 5 to 10 segments. Postoperatively, 13%(8/60) of patients in the rotational subluxation group developed type C coronal imbalance, significantly higher than the 2%(1/48) in the non-rotational subluxation group. The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the rotational subluxation group were 20.60°±10.73° and 20.33°±10.92°, 22.53±16.45 mm and 18.53±17.31 mm, 13.14°±4.40° and 11.23°±4.92°, respectively, which were higher than those in the non-rotational subluxation group (13.92°±7.02° and 12.92°±6.64°, 18.62±17.44 mm and 8.83±8.95 mm, 11.91°±3.03° and 9.52°±3.30°), with statistical significance ( P<0.05).. Among patients in the rotational subluxation group, the probability of new-onset coronal imbalance postoperatively was 4%(1/28) in the TLIF group, which was lower than the 22%(7/32) in the PCO group, with a statistically significant difference (χ 2=4.330, P=0.037). The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the PCO group were 25.63°±11.00° and 25.13°±11.04°, 27.37±18.95 mm and 25.25±18.67 mm, 15.50°±3.62° and 14.08°±4.77°, respectively, which were significantly higher than those in the TLIF group (14.86°±6.96° and 14.86°±5.37°, 17.08±10.94 mm and 10.86±7.86 mm, 10.14°±3.37° and 8.46°±2.66°), with statistical significance ( P<0.05). Conclusion:For patients with Type A degenerative scoliosis combined with rotational subluxation according to the Nanjing classification, performing a 360-degree circumferential release and interbody fusion at the segment with rotatory subluxation can reduce the risk of developing new postoperative coronal imbalances.

Objective:To evaluate the efficacy and safety of radiotherapy combined with sintilimab and bevacizumab (anti-angiogenic agent) in patients with unresectable advanced hepatocellular carcinoma (HCC).Methods:Clinical data of 80 patients with unresectable advanced HCC admitted to Shanghai Mengchao Cancer Hospital from January 2021 to September 2023 were retrospectively analyzed. All patients were divided into two groups based on treatment regimens: the systemic therapy group ( n=41) receiving sintilimab combined with bevacizumab, and combined radiotherapy group ( n=39) receiving radiotherapy plus sintilimab and bevacizumab. Efficacy was evaluated using the response evaluation criteria in solid tumors (RECIST) 1.1 version and modified RECIST for HCC. Treatment-related adverse events (TRAE) were assessed by the common terminology criteria for adverse events (CTCAE) 4.03 version. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and TRAE. Independent sample t-test was used for normally distributed quantitative data, and Chi-square test for qualitative data. Survival analysis was performed via Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression models were applied to analyze prognostic factors. Results:In terms of efficacy, no patient obtained complete response (CR) in the systemic therapy group, while 2 cases achieved CR in the combined radiotherapy group. The ORR was 22% (9/41) in the systemic therapy group and 59% (23/39) in the combined radiotherapy group ( P=0.001). The DCR was 85% (35/41) and 97% (38/39) in the two groups ( P=0.130), with the incidence of progressive disease of 15% (6/41) and 3% (1/39) ( P=0.130), respectively. The median PFS was 8.0 months (95% CI=6.8-9.2 months) in the combined radiotherapy group and 4.4 months (95% CI=4.1-4.7 months) in the systemic therapy group ( P=0.002). The median OS was 19.0 months (95% CI=15.5-22.5 months) in the combined radiotherapy group and 12.5 months (95% CI=9.4-15.6 months) in the systemic therapy group ( P=0.006). Radiotherapy was an independent protective factor for both PFS ( HR=0.474, 95% CI=0.289-0.778, P=0.003) and OS ( HR=0.403, 95% CI=0.218-0.744, P=0.004). The number of tumors >3 was an independent risk factor for both PFS ( HR=2.658, 95% CI=1.485-4.755, P=0.001) and OS ( HR=3.245, 95% CI=1.773-5.939, P=0.001). There was no significant difference in TRAE between two groups ( P > 0.05). Conclusions:Radiotherapy combined with sintilimab and bevacizumab shows high efficacy and acceptable safety in patients with unresectable advanced HCC.

Objective To evaluate the application value of 18 F‐FDG PET/CT in patients with fever of unknown origin (FUO) to improve the etiological diagnosis accuracy of PET/CT in patients with FUO and provide better service for clinical prac‐tice .Methods Clinical data and imaging results of 144 cases of FUO patients diagnosed through 18 F‐FDG PET/CT examination in Wuhan union hospital from December 2009 to December 2011 were retrospectively analyzed .The final diagnoses were based on sur‐gical pathology ,aspiration cytology ,or discharge diagnosis combined with more than 12 months of follow‐up results .All the PET/CT images were analyzed and the clinical application value of PET/CT in FUO patients were evaluated through the diagnose rate , diagnose efficiency and clinical staging of malignant tumor .Results Among the 144 patients ,there were 130 cases ultimately had clear diagnosis ,which including 41 cases of malignant tumor ,89 cases of benign lesions and 14 cases the cause of unknown .PET/CT detected abnormal lesions for 97 .6% (40/41) of patients with malignant lesions and 88 .7% (79/89) of patients with benign le‐sions ,and the diagnostic sensitivity ,specificity ,accuracy ,positive predictive value ,and negative predictive value were :97 .6% (40/41) ,86 .5% (77/89) ,90% (117/130) ,76 .9% (40/52) and 98 .7% (77/78) .PET/CT detected the primary lesions for the first time in 46 .3% (19/41) patients with malignant tumor ,and detected more lesions than the traditional imaging methods in 92 .7% (38/41) of these patients .Conclusion 18 F‐FDG PET/CT imaging can provided important reference value for the detection of primary lesions ,the qualitative diagnosis of benign and malignant lesions and clinical staging of malignant lesions .

According to the talented persons development project to the clinical medical profession promulgated by the university in 2005,we have been taking great effort on the reformation of the course system,the teaching content,method and the teaching form for organic chemistry experiment,and we compiled the new experimental teaching material of organic chemistry which has been published in the university.From the teaching practice of the class of clinical medical profession of 2005,we have obtained satisfatory teaching result.