ObjectiveTo characterize the quality differences among different germplasm and introduced varieties of Bupleurum scorzonerifolium roots（BSR）， and explore the underlying molecular mechanisms， providing a basis for high-quality production and quality control. MethodsWild BSR from Yulin（YLW） served as the quality reference， we conducted comparative analysis among YLW， locally domesticated wild germplasm in Yulin（YLC3）， Daqing germplasm introduced and cultivated in Yulin（YLDQC3）， and locally cultivated germplasm in Daqing（DQC3）. A combination of traditional pharmacognostic methods and modern multi-omics analyses was employed， including macroscopic traits（appearance， odor）， microscopic features（proportions of cork， phloem， xylem）， cell wall component contents（hemicellulose， cellulose， lignin）， carbohydrate contents（starch， water-soluble polysaccharides）， marker compound contents（ethanol-soluble extracts， total saponins， liposoluble extracts， and saikosaponins A， B₂， C， D）， metabolomics， and transcriptomics， in order to systematically characterize quality differences and investigate molecular mechanisms among these samples. ResultsMacroscopically， Yulin-produced BSR（YLW， YLC3， YLDQC3） exhibited significantly greater weight， length， and upper and middle diameters than Daqing-produced BSR（DQC3）. Odor-wise， YLW and YLC3 had a a fragrance taste， YLDQC3 had a rancid oil odor， and DQC3 had a sweet and fragrant taste. Microscopically， Yulin germplasm（YLW， YLC3） and Daqing germplasm（YLDQC3， DQC3） shared similar structural features， respectively. However， Yulin germplasm showed significantly higher proportions of cork and phloem， as well as stronger xylem vessel staining intensity compared to Daqing germplasm. Regarding various component contents， Yulin germplasm contained significantly higher levels of ethanol-soluble extracts， total saponins， and saikosaponins A， B₂， C， D， while Daqing germplasm had significantly higher levels of hemicellulose， starch， and liposoluble extracts. After introduction to Yulin， the Daqing germplasm（YLDQC3） showed increased starch， water-soluble polysaccharides and liposoluble extracts contents， decreased cell wall component content， but no significant difference in other component contents. Metabolomics revealed that saponins and terpenes accumulated significantly in Yulin germplasm， while alcohols and aldehydes accumulated predominantly in Daqing germplasm. Transcriptomics indicated similar gene expression patterns within the same germplasm but specificity between different germplasms. Integrative metabolomic-transcriptomic analysis identified 145 potential key genes associated with the saikosaponin biosynthesis pathway， including one acetyl-coenzyme A（CoA） acetyltransferase gene（ACAT）， one 3-hydroxy-3-methylglutaryl-coenzyme A synthase gene（HMGS）， two hydroxymethylglutaryl-CoA（HMG-CoA） reductase genes（HMG）， one phosphomevalonate kinase gene（PMK）， one 1-deoxy-D-xylose-5-phosphate synthase gene（CLA）， one hydroxymethylbuten-1-aldol synthase gene（HDR）， two farnesyl pyrophosphate synthase genes（FPPS）， one squalene synthase gene（SQS）， one β-amyrin synthase gene（BAS）， 102 cytochrome P450（CYP450） gene family members， and 32 uridine diphosphate-glucuronosyltransferase（UGT） gene family members. ConclusionAmong the three cultivated types， YLC3 most closely resembles YLW in appearance， microscopic features， contents of major bioactive constituents， metabolomic and transcriptomic profiles. Yulin germplasm exhibits superior saponin synthesis capability compared to Daqing germplasm， and Yulin region is more suitable for the growth of B. scorzonerifolium. Based on these findings， it is recommended that artificial cultivation in northern Shaanxi and similar regions utilize the local Yulin germplasm source cultivated for at least three years.

Bone organoids can simulate the complex structure and function of the bone tissues, which makes them a frontier technology in organoid researches. Bone organoids show a tremendous potential of applications in bone disease modeling, bone injury repair, and medicine screening. Although advancements have been made so far in constructing bone organoids with functional structures like mineralization, bone marrow, trabecular bone, callus, woven bone, etc, the researches in this field are confronted with numerous challenges such as lack of standardized construction strategies and unified evaluation criteria, which limits their further promotion and application. To standardize researches in bone organoids, the Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, the Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, the Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and the Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine organized related experts to formulate Expert consensus on the construction, evaluation, and application of bone organoids ( version 2024) based on an evidence-based approach. A total of 17 recommendations were put forth, aiming to standardize researches and clinical applications of bone organoids and enhance their value in scientific research and clinical practice.

Objective:To analyze the clinical effect of real-time virtual sonography (RVS) surgical navigation combined with indocyanine green fluorescence imaging technology in the anatomical liver segmentectomy for hepatocellular carcinoma (HCC).Methods:The clinical data of 35 patients who underwent anatomical liver segmentectomy using RVS surgical navigation combined with indocyanine green fluorescence imaging technology in the Department of Hepatobiliary Surgery of Peking University International Hospital from January 2020 to January 2022 were retrospectively analyzed. There were 22 males and 13 females, aged (60.0±10.0) years. RVS is real-time virtual sonography, which fuses real-time intraoperative ultrasound images with corresponding preoperative CT or MRI images to guide the surgical plane. Methods of operation, time of operation, intraoperative blood loss, operative margin, hospital stay and postoperative complications were analyzed. Postoperative complications were graded by Clavien-Dindo system. The 1-year overall survival and tumor-free survival rates of patients were followed up by outpatient or telephone review.Results:Anatomical liver segmentectomy was performed on 36 patients, including 1 patient (2.9%) of segment Ⅱ, 1 patient (2.9%) of segment Ⅲ, 5 patients (14.3%) of segment Ⅳ, 6 patients (17.1%) of segment Ⅴ, 10 patients (28.6%) of segment Ⅵ, 7 patients (20.0%) of segment Ⅶ, 4 patients (11.4%) of segment Ⅷ, and 1 patient (2.9%) of segments Ⅴ+ Ⅷ. The operation time of 35 patients was (310.2±81.6) min, with an intraoperative blood loss of [ M( Q1, Q3)] 390.0(250.0, 500.0) ml. The hospital stay was (11.6±2.1) d. There was no postoperative death. Postoperative complications occurred in 3 cases (8.6%), of which 2 cases (5.7%) were ascites, Clavien-Dindo grade Ⅰ; Postoperative hemorrhage occurred in 1 case (2.9%), Clavien-Dindo grade Ⅱ. HCC was confirmed by pathology in all cases, and the operative margins were negative. The median follow-up time was 14 months (12 to 20 months). The 1-year overall survival rate after surgery was 100.0%(35/35), three patients (8.6%) had tumor recurrence, and the 1-year tumor-free survival rate was 91.4% (32/35). Conclusion:RVS surgical navigation combined with indocyanine green fluorescence imaging technology could be feasible in anatomical segmental hepatectomy for HCC.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.

Objective:To explore the safety and feasibility of optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation(DKT)and evaluate its effectiveness to provide more alternative protocols for kidney transplantation from extended criteria donors.Methods:DKT was performed in 10 recipients using the same protocol from June 2019 to May 2021.And retrospective reviewing was performed for clinical data, including characteristics of donors and recipients, optimized pathological evaluation system, modified surgery, treatment regimens, complications and follow-ups.Results:There were 8 male and 2 female donors with an age of(57.9±12.8)years and BMI(24.1±4.1)kg/m 2.The percentage of DCD was 70% and DBD 30%.The serum creatinine before procurement was 107.6(93.3-163.5)μmol/l.Zero-point puncture biopsy was performed for both kidneys and optimized pathological evaluation system was implemented(Banff criteria & Remuzzi score). The pathological results indicated that glomerular sclerosis for left and right kidneys were 2.0(1.5-2.0)and 1.5(1.0-2.0). And Remuzzi score for left and right kidneys were(4.4±1.2)and(3.6±1.5)points respectively.All recipients were male with an age of(43.1±9.0)years and BMI(22.2±1.9)kg/m 2.All PRAs were negative pre-operation.Modified surgery was performed in all recipients(two kidneys were implanted outside iliac vessels without patch and artery of superior kidney was anastomosed to internal iliac artery). Operative duration was(195±54.3)min and serum creatinine before discharge 125.0(102.0-199.0)μmol/L.Renal dynamic scintigraphy indicated that glomerular filtration rate was(30.0±8.2)ml/min for left kidney and(29.2±13.9)ml/min for right kidney.MRA results indicated that morphologies of renal arteries and veins were regular.The time between operation and discharge was(22.4±4.7)days.Compared with SKT, serum creatinine before discharge of DKT was lower and DGF incidence of DKT was higher without statistical significance.The time between operation and discharge was longer for DKT than that for SKT( P<0.05). The complications consisted of 20% donor derived infection(DDI)and 50% DGF.And there was no surgical complication associated with vessels and ureter.Renal function remained stable during 6-month follow-ups. Conclusions:Optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation are both safe and feasible.The postoperative function of transplanted dual kidney is successfully restored.However, long-term follow-ups are required for evaluating its effectiveness.

Pancreas transplantation and pancreas-kidney transplantation are the optimal treatment for renal failure caused by type 1 diabetes mellitus, partial type 2 diabetes mellitus and their complications. Pancreas transplantation mainly includes simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation after kidney transplantation (PAK) and pancreas transplantation alone (PTA). Among all types of pancreas transplantation, biopsy of pancreas allograft remains the best method for definitively diagnosing rejection and differentiate it from other complications. In this article, biopsy methods of pancreas allograft and related research progress, diagnostic criteria and research progress on rejection of pancreas allograft biopsy, and main complications and pathological manifestations of pancreas allograft were illustrated, aiming to provide reference for guiding the clinical diagnosis of the above mentioned complications and ensuring the long-term survival of pancreas allografts and recipients.

Objective:To summarize the medium-term outcomes of single kidney transplantation from senile deceased donors aged above 65 years.Methods:Forty-three kidney recipients from donors aged above 65(old-aged donor group, OAD) and 43 kidney recipients of the same age and gender from donors aged 18 to 49 years(standard-criteria donor group, SCD) were retrospectively reviewed.The survival outcomes of patients and grafts, renal functions, the incidence of delayed graft function(DGF)and other complications were recorded within the 3-year follow-up post-transplantation.Results:The 3-year patient survival rates were 95.3% both in OAD and SCD and the 3-year death-censored graft survival rates 92.7% and 97.6% respectively.The serum levels of creatinine were significantly higher in OAD than that in SCD( P<0.05). And lower estimated glomerular filtration rate(eGFR)was found in OAD as compared with SCD( P<0.05). No significant difference existed in the incidence of DGF(OAD 20.9% and SCD 18.6%, P>0.05), acute rejection (OAD 4.7% and SCD 2.3%, P>0.05)or proteinuria(OAD 27.9%and SCD 14.0%, P>0.05). Conclusions:Single kidney transplantation from old-aged deceased donors may achieve excellent medium-term survival outcomes of patients and grafts.It can expand the donor pool though kidney functions were not as good as those of SCD.

Gastric schwannoma is a tumor originating from mesenchymal tissue. The clinical incidence is relatively rare, accounting for 6.3% of all gastric stromal tumors. The tumor is more likely to occur in the body of the stomach and usually originates from the gastric submucosal nerve. Most gastric schwannomas do not have any clinical symptoms. Imaging examination can play a diagnostic role, but the diagnosis still requires pathological examination, especially S-100 protein which is the gold standard for the diagnosis of gastric schwannomas. Gastric schwannoma usually needs to be distinguished from gastrointestinal stromal tumors and gastrointestinal autonomic nerve tumors. In terms of treatment, complete surgical resection is the first choice.

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.

Objective Using Z-score to assess the prevalence of proximal aorta dilatation in middle-aged and aged individuals during routine transthoracic echocardiogram examinations and to identify its risk factors. Methods A total of 823 middle-aged or elderly patients on routine transthoracic echocardiogram examinations were consecutively enrolled. The internal diameters of the sinus of Valsalva (SoV ) and the ascending aorta (AA ) were measured. Z-scores were calculated according to the proposed equation for SoV and AA. A dilated aortic root was defined as a Z-score ≥1.96 or the diameter of SoV or AA ≥ 40 mm. The prevalence of proximal aorta dilatation and associated factors were analyzed. Results The prevalences of proximal aorta dilatation ,SoV dilatation ,and AA dilatation were 26.1%(25/823 ) ,6.0%(49/823 ) ,and 23.7%(195/823 ) , respectively.In the aortic root dilatation group ,age and the proportion of obesity were higher (both P＜0.05) ,and there were more female subjects (30.5% or 117/384 vs.22.3% or 98/439 ,P＜0.01) . The incidences of left atrial dilation ,left ventricular dilation ,left ventricular hypertrophy ,and aortic regurgitation in the aortic root dilatation group were higher than those in the non-aortic root dilatation group(P＜0.05 ) .Logistic regression analysis demonstrated that sex (OR＝ 1.827 ,95% CI :1.248-2.673 ,P＝0.002) ,hypertension (OR＝1.441 ,95% CI :1.000-2.075 ,P＝0.050)and left ventricular hypertrophy (OR＝1.827 ,95% CI :1.248-2.673 ,P＝0.002)were independently correlated with aortic root dilatation. Conclusions The prevalence of proximal aorta dilatation is high in middle-aged and aged individuals. Proximal aorta dilatation is related to sex ,age ,and body size ,and it is often accompanied by structural abnormalities of the heart.