Seven novel acylphloroglucinol-sesquiterpenoid adducts, designated as dryatraols J-P (1-7), were isolated from the rhizomes of Dryopteris atrata (Wall. ex Kunze) Ching. The structures, including absolute configurations, were elucidated using comprehensive spectroscopic data, calculated ¹³C Nuclear Magnetic Resonance-Diastereotopic Probability Assignment Plus (¹³C NMR-DP4+) probability analysis, and ECD calculations. These structures represent a rare subclass of carbon skeleton of acylphloroglucinol-sesquiterpenoid adducts with a furan ring connecting the acylphloroglucinol and sesquiterpenoid moieties. Notably, compounds 1-6 are the first reported examples of acylphloroglucinol-sesquiterpenoid adducts with dimeric acylphloroglucinol incorporated into the aristolane- or rulepidanol-type sesquiterpene, while compound 7 features a hydroxylated monomeric acylphloroglucinol motif. A preliminary evaluation of their antiviral activities revealed that compounds 1-6 exhibited more potent activities against respiratory syncytial virus (RSV) with IC₅₀ values ranging from 0.75 to 3.12 μmol·L^-1 compared to the positive control (ribavirin).
Antiviral Agents/isolation & purification* ; Phloroglucinol/isolation & purification* ; Sesquiterpenes/isolation & purification* ; Molecular Structure ; Dryopteris/chemistry* ; Respiratory Syncytial Viruses/drug effects* ; Humans ; Rhizome/chemistry* ; Drugs, Chinese Herbal/pharmacology*

Objective To investigate the clinical manifestations,molecular genetics and gonadal pathol-ogy characteristics of patients with disorders of sex development(DSD),and to summarize the clinical experi-ence of identifying rare diseases from common symptoms.Methods The clinical data of 416 patients with DSD diagnosed and treated in the multidisciplinary center of DSD of Guangzhou Women and Children's Medical Cen-ter from May 2018 to August 2023 were retrospectively analyzed,summarized and discussed.Results Accord-ing to chromosome karyotype,416 cases of DSD were classified into three types:92 cases(22.1％)of abnormal sex chromosome karyotype,285 cases(68.5％)of 46,XY karyotype and 39 cases(9.4％)of 46,XX karyotype.Among the 92 patients with abnormal sex chromosome karyotype,59 cases were raised as males,18 cases(30.5％)complained of short penis with hypospadias and cryptorchidism.The most common karyotype was 45,X/46,XY(58 cases,63.0％).Among the 285 patients with 46,XY karyotype,238 cases were raised as males,and 63 cases(26.5％)complained of short penis and hypospadias;47 cases were raised as females,and 13 ca-ses(27.7％)complained of inguinal mass.A total of 216 patients with 46,XY karyotype were subjected to whole exome gene detection,and 155 cases(71.8％)were found to have molecular pathogenesis with the clinical phe-notype.Among the 39 patients with 46,XX karyotype,19 cases were raised as males,and 8 cases(42.1％)com-plained of short penis and hypospadias.In the 18 cases of gonad biopsy,17 cases showed testicular tissue in go-nads.Whole exome sequencing was performed in 14 cases.NR5A1 gene heterozygous mutation,SRY gene muta-tion and SOX3 gene mutation were found in 2 cases,respectively(14.3％).Twenty cases were raised as females,and 14 cases(70.0％)complained of clitoral hypertrophy.Gonad biopsy was performed in 8 cases,with 7 cases of ovotestis(87.5％)and 1 case of NR5A1 gene heterozygous mutation(14.3％).Conclusions The etiologies of DSD are complex and diverse,and the clinical manifestations are various,which can be manifested as hypospa-dias,micropenis,cryptorchidism and other common symptoms of the urinary system.Different etiologies have dif-ferent treatment options.Therefore,chromosome karyotype,molecular genetic testing and gonadal pathology can be used to clarify the cause of disease,especially for rare diseases,improve the detection rate,reduce the rate of missed diagnosis,and ensure reasonable treatment,especially sex selection.

Spinal cord injury(SCI)is a central nervous system disease with high morbidity,disability,and mortality.A series of pathological and physiological changes after SCI,including oxidative stress,can promote further deterioration of the microenvironment at the injury site,resulting in impaired neurological function.Nuclear factor E2-related factor 2(Nrf2)is highly correlated with oxidative stress,suggesting that targeting the regulation of Nrf2 and alleviating oxidative stress may be an effective treatment for SCI.We consider the application of Nrf2 in post-SCI oxidative stress,based on the occurrence of oxidative stress after SCI and the relationship between oxidative stress and Nrf2.We also summarize the strategies for targeting and regulating Nrf2,including genes,non-coding RNAs,and drugs,with the aim of providing new ideas for targeted therapy of SCI.

Spinal cord injury(SCI)is a central nervous system disease with high morbidity,disability,and mortality.A series of pathological and physiological changes after SCI,including oxidative stress,can promote further deterioration of the microenvironment at the injury site,resulting in impaired neurological function.Nuclear factor E2-related factor 2(Nrf2)is highly correlated with oxidative stress,suggesting that targeting the regulation of Nrf2 and alleviating oxidative stress may be an effective treatment for SCI.We consider the application of Nrf2 in post-SCI oxidative stress,based on the occurrence of oxidative stress after SCI and the relationship between oxidative stress and Nrf2.We also summarize the strategies for targeting and regulating Nrf2,including genes,non-coding RNAs,and drugs,with the aim of providing new ideas for targeted therapy of SCI.

Objective To evaluate the clinical efficacy of the local drug resistance spectrum antibiotics and foreign guideline in the treatment of patients with community acquired pneumonia(CAP). Methods A prospective,randomized,single blind,and positive drug parallel controlled design was used in the treatment. CAP patients with no underlying disease outpatients and inpatients<48 hours were selected as the research object. The patients in the trial group were given sensitive local drug resistance spectrum antibiotics: moxifloxacin,400 mg and 1 times a day. The patients in the control group were given azithromycin tablets(each 500 mg,once daily) promulgated by the 2007 version of the IDSA / ATS adult CAP guideline. Results There were 106 cases of CAP patients,of which 77 cases completed treatment,including 39 cases in the experimental group and 38 cases in the control group. There were significant differences in the clinical efficacy and bacterial clearance rate between the two groups,with the clinical efficacy of 89.7% and 68.4%(P < 0.01),the bacterial clearance rate of 87.9% and 54.5%(P < 0.05),respectively. Conclusion The clinical efficacy of drug resistant spectrum sensitive antibiotics in the treatment of CAP in Kunming was better than that of IDSA/ATS. Clinicians should pay attention to the characteristics and composition of resistance of common pathogenic bacteria in our country during the study and reference from foreign guideline,and adjust the therapeutic regimen according to the changes of the local drug resistance monitoring data rather than copy the recommended treatment plan by foreign countries.

Objective: To study clinical characteristics and anatomical distributions of pulmonary embolism (PE) in suspicious PE patients and to explore if CT coronary angiography (CTCA) may simultaneously exclude PE. Methods: A total of 403 consecutive patients with suspicious PE admitted to cardiology department of our hospital from 2013-01 to 2014-10 were retrospectively studied. According to embolus distribution by CT pulmonary angiography (CTPA) and CTCA, the patients were divided into 2 groups: PE group,n=261 and Non-PE group,n=142. The clinical symptoms and imaging characteristics were analyzed and compared between 2 groups. Results: The overall prevalence of PE was 64.8% (261/403), suspicious PE patients were all with chest distress, palpitation, chest pain and syncope. Compared with Non-PE group, the patients in PE group were with more female gender and palpitation, while less chest pain,P<0.05; the symptoms of syncope and chest distress were similar between 2 group,P>0.05. In PE group, the sign of emboli were found in 245/261 patients (93.9%) at CTCA scanning area, the rest 16 patients (6.1%) had the small area of PE, and the emboli were only located at both upper pulmonary arteries. Conclusion: In patients with dififculty of breath, palpitation, chest pain and syncope, coronary artery disease (CAD) and PE should be simultaneously considered for accurate diagnosis. CTCA may meanwhile ifnd PE during CAD diagnosis.

BACKGROUND:It is wel-known that mechanical stimulation could promote fracture healing. However, what kind of mechanical stimulation induced by treadmil exercise can increase the bone conductibility of bone material and promote the healing of bone defect is stil unclear.
OBJECTIVE:To evaluate the influence of indirect mechanical stimulation produced by treadmil exercise on bone defect healing and osteogenesis of bone materials.
METHODS:Sprague-Dawley rats at 12 weeks old were used in this study to establish a bone defect of 3 mm in diameter and height at the left distal femur. Afterwards, calcium sulphate scaffolds were implanted into the defects. The rats were divided into treadmil exercise group and control group. Treadmil exercise was began at 1 week postoperatively, 10 m/min, 45 minutes per day, 5 days per week, for 3 weeks. Control group did not receive any exercise. Micro-computed tomography was used to determine bone formation in the bone defects at 1, 2, 3, and 4 weeks after surgery. The sections of left distal femur were subject to hematoxylin-eosin staining, the new bone formation and degradation of bone materials in the bone defects were observed.
RESULTS AND CONCLUSION:Micro-CT analysis showed that, a smal amount of new bone formed in both treadmil exercise group and control group at 1 week after surgery. In treadmil exercise group, new bone formation was significantly higher than the control group at 2, 3, 4 weeks (P<0.05). At 4 weeks, histological results also confirmed the difference of new bone formation in bone defect between treadmil exercise group and control group. In addition, bone mineral density of treadmil exercise group was higher than that of control group at 2, 3, 4 weeks, but no significant difference was found (P>0.05). The results suggest that moderate treadmil exercise could promote bone defect healing and enhance osteoconductivity of bone substitute.

Objective To systematically review the efficacy and safety of erythromycin on enteral nutrition (EN) tolerance in adult critical care patients.Methods Databases including PubMed,EMbase,the Cochrane Library,CNKI and Wangfang data were retrieved up to June,2013 to collect the randomized controlled trial (RCT) concerning erythromycin in improving EN tolerance or increasing the successful rate of postpyloric EN tube as compared with other treatments.Two reviewers independently screened the literature,extracted the data,and assessed the quality of methodology.Then Meta-analysis was performed using RevMan 5.2 software.Results A total of 16 RCTs were included.Ten RCTs involving 668 patients were included for evaluating erythromycin in improving EN tolerance.Six RCTs involving 353 patients were included for evaluating erythromycin to increase the successful rate of postpyloric EN tube.The result of Meta-analysis showed that compared with placebo,erythromycin could significantly improve the successful rate of postpyloric EN tube placement [relative risk (RR) =1.82,95％ confidence interval (95％CI) 1.40-2.37,P＜0.000 01],while there was no significant difference between erythromycin and metoclopramide (RR=1.04,95％ CI 0.79-1.36,P=0.799).In patients who needed early EN,compared with placebo or blank control,erythromycin had higher successful gastric feeding rate over 5 days (RR =1.89,95％ CI 1.19-3.00,P=0.007).In patients who failed EN,compared with metoclopramide,erythromycin could significantly increase the successful gastric EN rate for 24 hours (RR=1.30,95％CI 1.02-1.66,P=0.03),72 hours (RR=1.57,95％CI 1.15-2.14,P=0.005) and 144 hours (RR=2.04,95％CI 1.23-3.37,P=0.006).The median time of EN intolerance was postponed in erythromycin group than that in metoclopramide group.Adverse reactions were reported in 5 studies.There was no statistic difference except for the higher diarrhea rate in the combination treatment group compared with erythromycin group.Conclnsions Postpyloric EN tube placement rate can be improved by erythromycin,which could be a choice of substitute for bedside intubation without fluoroscopy or endoscopic assistance.Based on the evidence,we recommended that intravenous erythromycin in a small dose of approximately 3 mg/kg weight as an option for EN intolerance in critical patients.

ObjectiveTo investigate the expression and the clinical significance of diacylglycerol kinase α (DGKα) and protein kinase C (PKC) in human hepatocellular carcinoma (HCC).MethodsDGKα and PKC expressions in the samples from 60 pathologically confirmed HCC patients were analyzed by immunohistochemistry. The relationship between DGKo expression and clinical pathology factors was analyzed.ResultsThe expression positive rates of DGKo and PKC were highest in normal liver tissues [90.0％ (9/10) and 100.0％ (10/10)].The positive rates were 81.7 ％ (49/60) and 71.7 ％ (43/60) in HCC tissues,respectively,and were 58.3 ％ (35/60) and 61.7 ％ (37/60) in carcinoma adjacent tissues,respectively.In three liver tissues,the positive rates of DGKα and PKC were significantly different (P ＜0.05).The location of both kinases in hepatocytes translocated from cytoplasm/nucleus to membrane.The expressions of DGKα and PKC were positively correlation(r =0.495, P ＜ 0.05), The DGKα expression was correlated to differentiation type,portal venous tumor thrombus and TNM staging(all P ＜ 0.05).ConclusionDGKa is expressed with high activity in advanced stage and poorly differentiated HCC. It may be promote the pathological process of HCC.