Five saponins were isolated from the kernels of Momordica cochinchinensis, by macroporous resin, silica gel, ODS column chromatography, and semi preparative HPLC. Based on MS and NMR analysis, combining with alkaline hydrolysis and acid hydrolysis, their structures were identified as: gypsogenin-3-O-{β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonosyl}-28-O-β-D-xylopyranosyl (1→3)-[β-D-xylopyranosyl (1→4)]-α-L-rhamnopyranosyl (1→2)-β-D-fucopyranoside (1), quillaic acid-3-O-{β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonosyl}-28-O-β-D-xylopyranosyl (1→3)-[β-D-xylopyranosyl (1→4)]-α-L-rhamnopyranosyl (1→2)-β-D-fucopyranoside (2), gypsogenin-3-O-β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonoside sodium (3), quillaic acid-3-O-β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonoside sodium (4), 18α-quillaic acid-3-O-β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonoside (5). Compounds 1-5 were new compounds, and named as mubezhisides A, B, C, D, E, respectively. They all could obviously inhibited the growth of Candida albicans, C. parapsilosis, and C. tropicalis.

BACKGROUND: Blood glucose and serum albumin have been associated with cardiovascular disease prognosis, but the impact of admission-blood-glucose-to-albumin ratio (AAR) on adverse outcomes in critical ill coronary artery disease (CAD) patients was not investigated. METHODS: Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR. The primary outcome was 1-year mortality, and secondary endpoints were in-hospital mortality, acute kidney injury (AKI), and renal replacement therapy (RRT). A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients. Kaplan-Meier survival analysis determined differences in endpoints across subgroups. RESULTS: A total of 8360 patients were included. There were 726 patients (8.7%) died in the hospital and 1944 patients (23%) died at 1 year. The incidence of AKI and RRT was 63% and 4.3%, respectively. High AAR was markedly associated with in-hospital mortality (HR = 1.587, P = 0.003), 1-year mortality (HR = 1.502, P < 0.001), AKI incidence (HR = 1.579, P < 0.001), and RRT (HR = 1.640, P < 0.016) in CAD patients in the completely adjusted Cox proportional hazard model. Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles. Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes. CONCLUSIONS The results highlight that AAR may be a potential indicator for assessing in-hospital mortality, 1-year mortality, and adverse renal prognosis in critical CAD patients.

Clear aligner treatment is a novel technique in current orthodontic practice. Distinct from traditional fixed orthodontic appliances, clear aligners have different material features and biomechanical characteristics and treatment efficiencies, presenting new clinical challenges. Therefore, a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique. This expert consensus discusses case selection and grading of treatment difficulty, principle of clear aligner therapy, clinical procedures and potential complications, which are crucial to the clinical success of clear aligner treatment.
Humans ; Consensus ; Orthodontic Appliance Design ; Orthodontic Appliances, Removable ; Tooth Movement Techniques/methods* ; Malocclusion/therapy* ; Orthodontics, Corrective/instrumentation*

Cervical spondylotic radiculopathy(CSR)is a condition caused by the degeneration of cervical intervertebral discs and facet joints,primarily manifesting as the pain,sensory abnormalities,and motor dysfunction in the cervical nerve innervation area of neck,shoulder,and upper limb.For the treatment of CSR,tendon-bone syndrome differentiation in traditional Chinese medicine often faces the issues of conceptual confusion and non-standard syndrome differentiation.Based on the traditional tendon-bone syndrome differentiation and by integrating modern anatomical insights,Professor LIN Ding-Kun,an esteemed scholar of Traditional Chinese Medicine,proposed a classification system for the cervical spine that includes the categories of tendons,joints,bones and marrow.This paper explored the thoughts of Professor LIN for the tendon-bone syndrome differentiation of CSR,summarized the targets of manual therapy,and proposed the four kinds of pathological changes such as tendon overstrain,joint dislocation,bone lesion,and marrow injury,as well as the four techniques of traditional Chinese medicine manipulations,i.e.relaxation of tendons,reduction of joints,protection of marrow,and treatment of bones.The aim is to improve the syndrome-differentiation and treatment for CSR with orthopedic and traumatologic manipulations,and to provide reference for clinical practice.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization(TACE)combined with lenvatinib and camrelizumab in the treatment of advanced hepatocellular carcinoma(HCC).Methods The clinical data of a total of 63 patients with advanced HCC,who received TACE combined with lenvatinib and camrelizumab(triple therapy)or TACE combined with lenvatinib(dual therapy)at the Jingmen Municipal People's Hospital of China between April 2020 and December 2021,were retrospectively analyzed.Triple therapy group had 30 patients,and dual therapy group had 33 patients.The post-treatment tumor response,disease progression-free survival(PFS),overall survival(OS),and the incidence of adverse drug reactions were recorded.Results The median follow-up period of the two groups was 14 months(range of 4-26 months).Compared with the dual therapy group,in the triple therapy group the objective response rate(ORR)was remarkably higher(83.3%vs.57.6%,P=0.026),the disease control rate(DCR)was obviously higher(93.3%vs.69.7%,P=0.039),the median PFS was significantly longer(8.0 months vs.5.0 months,P＜0.01),and the median OS was strikingly longer(24.0 months vs.12.0 months,P=0.004).No statistically significant difference in the incidence of adverse drug reactions existed between the two groups(P＞0.05).Conclusion For the treatment of advanced HCC,TACE combined with lenvatinib and camrelizumab is clinically safe and effective.(J Intervent Radiol,2024,32:57-62)

ObjectiveTo explore the recognition of oral breath odor map of chronic atrophic gastritis （CAG） patients with dampness-heat syndrome by electronic nose technique. MethodsPatients with chronic gastritis were recruited， including 60 cases in CAG group of dampness-heat syndrome， 50 cases in CAG group of non-dampness-heat syndrome， 60 cases in chronic non-atrophic gastritis （CNAG） group of dampness-heat syndrome， 50 cases in CNAG group of non-dampness-heat syndrome， and 30 cases of healthy volunteers were selected to set up the health control group. Ten cases in the CAG dampness-heat group and 50 cases in the CAG non-dampness-heat group were selected to form the CAG group， and 10 cases in CNAG dampness-heat group and 50 cases in CNAG non-dampness-heat group were selected to form the CNAG group. In addition to the health control group， the remaining patients were tested for Helicobacter pylori （Hp）； the electronic nose （GISXM-MQWA01） was used to collect the oral breath odor of all the participants to draw the mapping， and amplitudes and slopes of each curve （including curves A， B， C， D， E， F， G， H， I， J） of the oral odor mapping of health control group， CAG group， CNAG group， CAG dampness-heat group， CAG non-dampness-heat group， and CNAG dampness-heat group was compared. The modified transformer model was used to classify the odor mapping characteristics， and the confusion matrix method was used to evaluate the classification model， with metrics including accuracy and area under ROC curve （AUC）. ResultsThe Hp positivity rate in CAG dampness-heat group was 80.00% （48/60）， CAG non-dampness-heat group was 62.00% （31/50）， CNAG dampness-heat group was 46.67% （28/60）， and CNAG non-dampness-heat group was 42.00% （21/50）； the difference in Hp positivity rate between CAG dampness-heat group and CAG non-dampness-heat group was statistically significant （P＜0.05）. The amplitudes of response curves A， B， C， D， F， G， and I， and slopes of A and F in the odor mapping of the CAG group were lower than those in health control group， while the amplitude and slope of curve E were higher than those in the health control group and CNAG group （P＜0.05 or P＜0.01）； The amplitude of the response curves A， B， C， D， F， G， and I， and slopes of A， D， and F in the CNAG group were lower than those in the health control group （P＜0.05 or P＜0.01）. The amplitude of response curve D and slope of response curve J in the odor mapping of the CAG dampness-heat group were higher than those in CNAG dampness-heat group， the amplitude of curve F was lower than that in CAG non-dampness-heat group， and the amplitude of curve H and slopes of curve A， H， and J were higher than those in CAG non-dampness-heat group （P＜0.05）. The recognition accuracy of CAG group and health control group reached 77.78%， AUC = 0.88； the recognition accuracy of CAG group and CNAG group was 69.44%， AUC = 0.61； the recognition accuracy of CAG dampness-heat group and CAG non-dampness-heat group reached 75.8%， AUC=0.70. ConclusionElectronic nose technology can make a more accurate identification of the oral breath odor in CAG patients with dampness-heat syndrome， with a decrease in the amplitude of the curve F and an increase in the amplitude of the curve H and in the slopes of the curves A， H， and J may as the characteristics of their odor mapping.

In order to study the compounds from Glechoma longituba (Nakai) Kupr. and explore the substance bases of its dissipating blood stasis, MCI, silica gel, Sephadex LH-20, ODS column chromatography and preparative thin layer chromatography were used to isolate and purify the compounds. The structures were identified by MS, 1D NMR, and 2D NMR spectra analysis, etc. Eight triterpenoids were isolated from dichloromethane fraction of ethanol extract from G. longituba and identified as 2α,3α,16β-trihydroxy-13α,27-cyclours-11-en-28-oic acid (1), 28-norurs-12-ene-3β,17β-diol (2), 28-norolean-12-ene-3β,17β-diol (3), oleanonic acid (4), 3β,13β-dihydroxyurs-11-en-28-oic acid (5), uvaol (6), oleanolic acid (7), ursolic acid (8). Compound 1 is a new hexacyclic triterpene with 13α,27-cyclopropane structure, named euscaphic acid H; compounds 2 and 3 were isolated from Lamiaceae for the first time while compounds 4 and 5 were isolated from this genus. The in vitro anticoagulant activity of triterpenoids was evaluated by four coagulation indexes (activated partial thromboplastin time, APTT; thrombin time, TT; prothrombin time, PT; fibrinogen, FIB). Among them, compounds 1 and 6 showed obvious anticoagulant effects.

OBJECTIVE To evaluate the effects of different fresh processing methods on the quality of Puerarial Lobatae Radix using entropy weight TOPSIS model and multi-index. METHODS By optimizing the specifications of fresh cut(thick slices of 2, 3, 4 mm thick, the side length of 0.5, 1, 1.5 cm), drying method(drying at 45, 65, 85 ℃, freeze drying) and other parameters, Puerarial Lobatae Radix medicinal materials were processed at the origin, and Puerarial Lobatae Radix decoction pieces were obtained. Using the content of 3′-hydroxy puerarin, puerarin, puerarin apioside, 3′-methoxy puerarin, puerarin-6″-O-xyliside, daidzin, genistin, daidzein, ethanol soluble extractives, as well as moisture and ash content limits as evaluation indicators, through the entropy and TOPSIS method to analyze the index component data and optimizing the Puerarial Lobatae Radix best when fresh herbs processing technology. RESULTS Different fresh processing methods had a certain influence on the content of the index components of Puerarial Lobatae Radix, and the best cutting specification was 0.5 cm thick, and the best drying method was freezed drying. CONCLUSION The entropy weight TOPSIS method can be used to evaluate the effects of different processing methods on the quality of Puerarial Lobatae Radix, and the best processing technology obtained has good stability and repeatability, which can provide guidance for the standardization of processing technology of Puerarial Lobatae Radix.

Objective To explore the method for measurement of tritium in nuclear power plant liquid effluent purified by a mixed ion-exchange resin, to verify the feasibility of the method by experiments, and to provide technical support for the development of standard methods for the measurement of tritium in liquid effluent of nuclear power plants. Methods The purification effect of the mixed ion-exchange resin was determined by measuring the quenching factor, conductivity, and β-nuclide adsorption efficiency of the samples purified using the resin. A comparison was made between the ion-exchange resin method and the atmospheric distillation method for tritium determination. The precision and accuracy of the method were verified by calculating the relative standard deviation and the recovery in repeated measurement of samples with different activity concentrations and spiked samples. Results There were no significant differences in quenching factor, conductivity, and tritium activity concentration between the two methods. The adsorption efficiencies of EC20MB resin for common β-nuclides such as carbon, iron, nickel, strontium, yttrium, and cesium ranged from 99.28% to 99.88%. Repeated measurement of the same sample showed relative standard deviations of 5.2%-9.4% and recoveries of 86.8%-107%. Conclusion There were no significant differences between the results of the ion-exchange resin purification method and the atmospheric distillation method. The precision and accuracy of the method met the requirements of the ecological and environmental management authorities for monitoring tritium in liquid effluent from nuclear power plants. This method can be widely used in daily monitoring work.