ObjectiveBased on traditional quality evaluation of Gardeniae Fructus（GF） recorded in historical materia medica， this study systematically compared the quality differences between wild and cultivated GF from morphological characteristics， microscopic features， and contents of primary and secondary metabolites. MethodsVernier calipers and analytical balances were used to measure the length， diameter and individual fruit weight of wild and cultivated GF， and the aspect ratio was calculated. A colorimeter was used to determine the chromaticity value of wild and cultivated GF， and the paraffin sections of them were prepared by safranin-fast green staining and examined under an optical microscope to observe their microstructure. Subsequently， the contents of water-soluble and alcohol-soluble extracts of wild and cultivated GF were detected by hot immersion method under the general rule 2201 in volume Ⅳ of the 2020 edition of the Pharmacopoeia of the People's Republic of China， the starch content was measured by anthrone colorimetric method， the content of total polysaccharides was determined by phenol-sulfuric acid colorimetric method， the sucrose content was determined by high performance liquid chromatography coupled with evaporative light scattering detection（HPLC-ELSD）， and the contents of representative components in them were measured by ultra-performance liquid chromatography（UPLC）. Finally， correlation analysis was conducted between quality traits and phenotypic traits， combined with multivariate statistical analysis methods such as principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， key differential components between wild and cultivated GF were screened. ResultsIn terms of traits， the wild GF fruits were smaller， exhibiting reddish yellow or brownish red hues with significant variation between batches. While the cultivated GF fruits are larger， displaying deeper orange-red or brownish red. The diameter and individual fruit weight of cultivated GF were significantly greater than those of wild GF， while the blue-yellow value（b^*） of wild GF was significantly higher than that of cultivated GF. In the microstructure， the mesocarp of wild GF contained numerous scattered calcium oxalate cluster crystals， while the endocarp contained stone cell class round， polygonal or tangential prolongation， undeveloped seeds were visible within the fruit. In contrast， the mesocarp of cultivated GF contained few calcium oxalate cluster crystals， or some batches exhibited extremely numerous cluster crystals. The stone cells in the endocarp were predominantly round-like， with the innermost layer arranged in a grid pattern. Seeds were basically mature， and only a few immature seeds existed in some batches. Regarding primary metabolite content， wild GF exhibited significantly higher total polysaccharide level than cultivated GF（P<0.01）. In category-specific component content， wild GF exhibited significantly higher levels of total flavonoids and total polyphenols compared to cultivated GF（P<0.01）. Analysis of 12 secondary metabolites revealed that wild GF exhibited significantly higher levels of Shanzhiside， deacetyl asperulosidic acid methyl ester， gardenoside and chlorogenic acid compared to cultivated GF（P<0.01）. Conversely， the contents of genipin 1-gentiobioside， geniposide and genipin were significantly lower in wild GF（P<0.01）. ConclusionThere are significant differences between wild and cultivated GF in terms of traits， microstructure， and contents of primary and secondary metabolites. At present， the quality evaluation system of cultivated GF remains incomplete， and this study provides a reference for guiding the production of high-quality GF medicinal materials.

Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

ObjectiveTo explore the clinical characteristics and risk factors for 30-day mortality in hospitalized patients with bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). MethodsData were obtained retrospectively from the electronic medical records of inpatients at a tertiary A-grade hospital in Shanghai from January 2016 to December 2023. The collected variables included age, gender, department, surgical treatment, empirical antibiotic therapy, Pitt Bacteremia score (PBS), Charlson comorbidity index (CCI), INCREMENT-CPE score (ICS), length of hospital stay, the time from CRKP-BSI to discharge and, etc. The follow-up period ended upon discharge, with the follow-up outcomes defined as in-hospital mortality or discharge. The endpoint was defined as death within 30 days (including day 30) caused by CRKP-BSI or infection-related complications. Patients who survived within 30 days after CRKP-BSI were classified into the survival group, while those who died within 30 days were classified into the death group. Independent risk factors for 30-day mortality in patients with CRKP-BSI were analyzed using univariate and multivariate Cox regression analysis. ResultsA total of 71 hospitalized patients with CRKP-BSI, comprising 51 males and 20 females, with an average age of (65.12±18.25) years, were included during the study period. The M (P₂₅, P₇₅) of hospital stay were 37.00 (24.00, 56.00) days, and M (P₂₅, P₇₅) of the duration from CRKP-BSI to discharge or death were 18.00 (7.00, 35.00) days. There were 20 deaths (28.17%) in the death group and 51 survivors (71.83%) in the survival group. The results of multivariate Cox regression analysis showed that the ICS as an independent risk factor for 30-day mortality in CRKP-BSI patients (HR=1.379, 95%CI: 1.137‒1.671, P=0.001). Each 1-point increase in the ICS was associated with a 37.9% increase in the risk of mortality. ConclusionThe ICS is found to be a risk factor for 30-day mortality in patients with CRKP-BSI, which may facilitate the prediction for the risk of 30-day mortality and thereby support clinical decision-making for patients with CRKP-BSI.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

The European Federation of Periodontology (EFP) and the Association for Dental Education in Europe (ADEE) jointly held the second European Consensus Workshop on Education in Periodontology in February, 2023. Building on the first consensus workshop in 2009, expert working groups from European Workshop Committee updated four educational levels: undergraduate, specialist, continuing professional development (CPD), as well as teaching methods, culminating in the updated consensus report in March, 2024. This article introduces and interprets the contents of the 2024 consensus report. Specific to China′s national conditions, we also propose future perspectives and considerations on different levels of periodontal education in China based on this consensus.

Objective:To observe the clinical efficacy of unilateral biportal endoscopy (UBE) assisted bilateral decompression in the treatment of lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side.Methods:A total of 20 patients with lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side treated with UBE from January 2022 to January 2024 in the Affiliated Hospital of Binzhou Medical University were retrospectively analyzed. There were 9 males and 11 females, aged 50.4±14.0 years (range, 23-72 years). The intervertebral disc herniation level included L 3-4 in 1 case, L 4-5 in 15 cases, and L 5S 1 in 4 cases. There were 10 cases on the left side and 10 cases on the right side. The duration of symptoms was 24.1±33.7 months (range, 1-120 months). Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate postoperative pain relief and functional recovery. The clinical efficacy was evaluated by modified MacNab criteria at 6 months after operation. Results:All patients successfully completed the operation. The operation time was 90.3±24.6 min (range, 55-134 mins). The VAS scores of patients at 3 days, 1 month, 3 months and 6 months after operation were 3.6±0.9, 2.2±0.7, 1.2±0.5 and 1.0±0.6, respectively, which were lower than those before operation (6.4±0.8), and the differences were statistically significant ( F=668.728, P<0.001). The ODI at 3 days, 1 month, 3 months and 6 months after operation were 34.2%±4.7%, 28.7%±2.8%, 24.3%±2.1% and 20.5%±2.0%, respectively, which were lower than 69.4%±5.2% before operation, and the differences were statistically significant ( F=515.578, P<0.001). The clinical efficacy was evaluated by modified MacNab criteria at 6 months after operation. Among 20 patients, 18 cases were excellent, 1 case was good, and 1 case was fair. All patients were followed up for 9.1±2.1 months (range, 6-14 months). One patient had a dural tear during the operation, but the range was small and there was no defect, and no further treatment was performed. Numbness of the lower limbs occurred 1 day after operation, and the symptoms disappeared after symptomatic treatment. There was no recurrence of lower limb symptoms, lumbar instability, intervertebral space infection or other complications at the last follow-up. Conclusion:Bilateral decompression with UBE is effective in the treatment of lumbar disc herniation with imaging herniation on one side and clinical symptoms on the contralateral side, which can improve the lumbar pain and function of patients.

Objective:Treat-to-target strategies for psoriatic arthritis (PsA) have been proposed for several years, however, the status of target and goal achievement in China is unknown. Therefore, we aimed to investigate the target achievement of PsA patients, and differences of treatment goals were further analyzed.Methods:A total of 360 PsA patients from Peking University First Hospital PsA patient cohort (PKUPsA) between January 2016 and March 2024 were included. We retrospectively analyzed the disease activity of patients at their enrollment. Minimal disease activity (MDA), disease activity index for PsA (DAPSA), clinical DAPSA (cDAPSA) and disease activity score based on 28 joint counts (DAS28) were evaluated. Interclass correlation coefficient (ICC) was used to test the consistency of all these assessments.Results:Three hundred and sixty patients were included in this study, with 149 females (41.4%), median age 47 (36, 57) years and duration of PsA for 2.0(1.0, 6.8) years. 129 (35.8%) patients reported family history of PsO. The most common comorbidities were hyperlipidemia (101, 28.1%) and hypertension (78, 21.7%). There were 217 (60.3%), 75 (20.8%) and 18 (5.0%) patients treated with conventional synthetic DMARDs, biologics and JAK inhibitors respectively. Forty-nine (13.6%) patients ever received intra-articular injection of glucocorticoid. Based on the different definitions, the rates of target achievement were 33.9% (MDA), 56.1% (DAPSA), 60.8% (DAS28-ESR), 63.9% (DAS28-CRP) and 64.2% (cDAPSA). The main limiting factors for MDA attainment among those who had achieved DAPSA or DAS-defined targets were pain VAS, Psoriasis Area and Severity Index (PASI), tender/swollen joint count, patient global assessment, HAQ, and number of enthesitis, based on leeds Enthesitis Index(LEI). The ICCs of these evaluation methods were 0.489~0.819 ( P<0.001). The consistency was the best between DAPSA and cDAPSA, medium between DAS28-CRP and DAS28-ESR, and worst between MDA and DAS28-CRP. Moreover, DAPSA was more consistent with DAS28 than cDASPA. MDA showed moderate consistency with all other assessments. Conclusion:33.9%~64.2% of PsA patients achieved targets based on different definitions. MDA was the most stringent target, while cDAPSA was the most loose one. In general, MDA was not well consistent with other assessments.

Chronic pain causes physical suffering and can have major psychological impacts in patients.Chronic pain can induce depressive disorder,and clinical studies have consistently shown that chronic pain and depression frequently co-occur,suggesting the possibility of shared pathogenic mechanisms underlying these conditions.Acupuncture,as an alternative therapy,has been widely used for analgesia and to treat depression,with demonstrated clinical efficacy.The therapeutic mechanism of acupuncture is related to neural and endocrine regulation.This review considers the mechanism of chronic pain accompanied by depression,in relation to the brain regions and neural circuits affected by acupuncture treatment.This review provides a new approach for the treatment of depression caused by chronic pain.

Objective:To investigate the current situation of knowledge, attitude and practice of medical personnel in areas with high incidence of fever with thrombocytopenia syndrome (SFTS) in Anhui Province, in order to provide a scientific basis for conducting systematic training for medical personnel.Methods:From July to August 2024, a multi-stage random sampling method was used to select medical personnel from village, township, county, and city level medical institutions in high incidence areas of SFTS in Anhui Province (Hefei City, Liu'an City, Chuzhou City, Xuancheng City) for an online questionnaire survey on their knowledge, attitude, and practice status. The survey included demographic data, knowledge, attitude, and practice related to SFTS, and a binary logistic regression model was used to analyze the influencing factors of SFTS knowledge qualification rate.Results:A total of 2 718 valid questionnaires were collected, with an effective response rate of 99.60% (2 718/2 729). Among them, 1 384 were males, accounting for 50.92%. The majority were medical personnel aged 41 to 50 years old, with undergraduate degrees, junior professional titles, working in township health centers or community health service centers, as clinical physicians, and with a working experience of no more than 10 years. They accounted for 31.97% (869/2 718), 50.48% (1 372/2 718), 35.54% (966/2 718), 38.52% (1 047/2 718), 62.33% (1 694/2 718), and 30.61% (832/2 718), respectively. The overall correct rates of medical personnel's relevant knowledge, attitude and practice were 77.52% (31 605/40 770), 94.53% (12 847/13 590) and 89.73% (12 194/13 590), respectively. There were statistically significant differences in the knowledge qualification of medical personnel of different genders, ages, education levels, professional titles, hospital levels, job positions, and years of work experience ( P < 0.05). The results of binary logistic regression analysis showed that professional title, hospital level, work position, and work experience were the influencing factors of knowledge qualification rate ( P < 0.05). Conclusions:Medical personnel have a relatively positive attitude and high level of practice towards SFTS, but their knowledge level still needs to be improved. It is recommended to provide targeted knowledge training for medical personnel in different positions to promote early detection, diagnosis, and treatment of SFTS.

AIM:To investigate the effects of Kuntai capsule combined with stem cell therapy on oxidative stress damage in rats with premature ovarian failure(POF),focusing on the Nrf2-ARE signaling pathway.METHODS:Bone marrow mesenchymal stem cells(BMSCs)from Sprague-Dawley rats were cultured from primary to third generation.Female Sprague-Dawley rats were selected,and mesenchymal stem cells were isolated.A POF rat model was established through intraperitoneal injection of cyclic phosphamide,and the model was randomly divided into five groups:POF group,Kuntai group,stem cell group,combination group,and combination+Brusatol group.Normal rats injected with physio-logical saline served as the control group,with 10 rats in each group.After the intervention,changes in body weight and ovarian index were analyzed.Serum levels of estrogen indicators[luteinizing hormone(LH),follicle-stimulating hormone(FSH),serum estradiol(E2),and anti-Müllerian hormone(AMH)]and oxidative stress markers[malondialdehyde(MDA),glutathione(GSH),and superoxide dismutase(SOD)]were measured.Ovarian tissue was isolated for histologi-cal examination using HE staining and for expression analysis of anti-apoptotic BCL-2 and pro-apoptotic BAX mRNA via RT-qPCR.Western blot analysis was conducted to assess the expression of Nrf2 and heme oxygenase-1(HO-1)proteins.RESULTS:Compared to the control group,the POF group exhibited fewer mature follicles and disorganized ovarian mor-phology,along with significantly reduced body weight gain,ovarian index,E2,AMH,SOD and GSH levels,BCL-2 mRNA,and Nrf2 and HO-1 protein expression.Conversely,LH,FSH,MDA levels,and BAX mRNA expression were significantly increased(P＜0.05).In comparison to the POF group,the Kuntai group,stem cell group,and combination group showed improved ovarian morphology,with the combination group demonstrating the most significant improvement.In these groups,body weight gain,ovarian index,E2,AMH,SOD,GSH levels,BCL-2 mRNA,and Nrf2 and HO-1 pro-tein expression were markedly increased,while LH,FSH,MDA levels,and BAX mRNA expression were notably de-creased,with significant statistical differences observed between the combination group and the Kuntai and stem cell groups(P＜0.05).In contrast,the combination+Brusatol group exhibited a reduction in mature follicles and disrupted follicular structure compared to the combination group,along with decreased body weight gain,ovarian index,E2,AMH,SOD and GSH levels,BCL-2 mRNA,and Nrf2 and HO-1 protein expression,while LH,FSH and MDA levels,and BAX mRNA expression were significantly increased(P＜0.05).CONCLUSION:The combination of Kuntai capsule and stem cell therapy effectively mitigates oxidative stress damage in POF rats,potentially through the activation of the Nrf2-ARE signaling pathway.