A method for simultaneous determination of 21 kinds of Aconitum alkaloids(ATS)in biological specimens and infused liquor using ultra-performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS)was developed.The biological samples were pretreated with methanol-acetonitrile(1∶2,V/V)for protein precipitation,while infused liquors were diluted 100-fold with acetonitrile,followed by centrifugation,and filtration by a 0.22-μm membrane.Chromatographic separation was carried out on an EC-C18 column using gradient elution with the mixture of 10 mmol/L ammonium acetate and 0.2%formic acid as mobile phase A and acetonitrile as mobile phase B.With this method,all the analytes were separated within 9.5 min.The samples were detected in positive ESI mode with dynamic multiple reaction monitoring(MRM)and quantified via external standard calibration.The results showed that the concentrations of the analytes in the range of 2-1000 ng/mL had excellent linearity(R2>0.9992)with the peak area.The developed method was successfully used for detection of 21 kinds of aconitum alkaloids,with limits of detection of 0.5-2 ng/mL,quantification limits of 2-6 ng/mL,intra/inter-day precision≤6.0%,spiked recoveries of 89.4%-100.9%,extraction recoveries of 74.2%-104.4%,and matrix effects ranging from-11.1%to 9.2%in blood/urine.The method was applied to detection of 12 samples from 4 fatal aconite poisoning cases,and all 21 kinds of ATS with total alkaloid concentrations of 0.04-4.18 μg/mL in blood and 154.96-422.83 μg/mL in medicinal liquors were detected.Tissue distribution revealed that the order of concentrations from highest to lowest is as follows:urine(157.22 μg/mL)>gastric contents(51.37 μg/mL)>kidney(21.6 μg/g)>whole blood(4.18 μg/mL)>liver(0.03 μg/g).This method showed many advantages such as simple pretreatment,low detection limits,accurate quantification,broad analyte coverage,and superior anti-interference capability in complex matrices,proving ideal for forensic and toxicological analysis of aconitum alkaloids.

Objective To explore the mechanism by which the triggering receptor expressed on Myeloid cells-like 4(TREML4)regulates nuclear factor-kappaB(NF-κB)pathway mediates neutrophil extracellular traps(NETs)aggravating rheumatoid arthritis(RA).Methods RA model was induced by subcutaneous injection of Freund adjuvant and bovine collagen type Ⅱ in DBA/1J mice.We used phorbol 12-myristate 13-acetate(PMA)to induce neutrophils to form NETs.We observed the degree of joint swelling and other morphological indicators,used hematoxylin-eosin staining(HE)staining to observe the pathology of the ankle joint,used enzyme-linked immunosorbent assay(ELISA)to measure the levels of inflammatory factors interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in serum,used western blot to detect the expression of myeloperoxidase(MPO)and citrullinated histone H3(CitH3)for assess the release of NETs in the ankle joint of mice,used western blot to detect the expression of TREML4 and NF-κB pathway-associated proteins nuclear factor kappa B inhibitor α(IκBα)and NF-κB p65,used immunofluorescence to detect the distribution of MPO and CitH3 in neutrophils to assess the formation of NETs.Results Compared with the control group,the RA group exhibited joint swelling,bone erosion,excessive infiltration of immune cells and cartilage damage,and the serum inflammatory fac-tors IL-6,TNF-α and IL-1β were significantly increased(P＜0.01),the expression of IκBα was significantly decreased(P＜0.01),and the expression of NF-κB p65 was significantly increased(P＜0.01).Compared with control group,the number of NETs formed by neutrophils in PMA group was significantly increased,the expression of TREML4 and NF-κB p65 was significantly increased(P＜0.01),and the expression of IκBα was significantly decreased(P＜0.01).Compared with the PMA+si-NC group,the number of NETs formed by neutrophils in the PMA+si-TREML4group was significantly reduced(P＜0.01),the expression of TREML4 and NF-κB p65 was significantly decreased(P＜0.01),and the expression of IκBα was significantly increased(P＜0.01).Conclusion TREML4 can regulate the formation of NETs mediated by NF-κB pathway to aggravate RA.

Objective:Based on the background of high-quality development,we analyze the operational efficiency of traditional Chinese medicine(TCM)hospitals in China's Yangtze River Economic Belt in 2021 and explore the impact of external environmental factors on operational efficiency,so as to provide a reference for promoting the high-quality development of TCM hospitals in the Yangtze River Economic Belt.Methods:The three-stage DEA model was used to analyze the operational efficiency of TCM hospitals in 11 provinces and cities in the Yangtze River Economic Zone in China in 2021.Results:After three-stage DEA analysis,the values of comprehensive efficiency,pure technical efficiency and scale efficiency of TCM hospitals in China's Yangtze River Economic Belt are 0.976,0.986 and 0.990,respectively.5 provinces and cities,Shanghai,Jiangsu,Hunan,Chongqing and Guizhou,are efficient before and after the adjustment,and the comprehensive efficiency of Zhejiang,Anhui,Hubei,Jiangxi,Sichuan and Yunnan have increased compared with that before the adjustment.Ranking of the average value of the comprehensive efficiency of TCM hospitals operation in the three major city clusters of the Yangtze River Economic Belt after adjustment:Chengdu-Chongqing city cluster(0.998)>city cluster in the Yangtze River Delta(0.964)>city cluster in the middle reaches of the Yangtze River(0.962).Conclusion:The operational efficiency of TCM hospitals in the Yangtze River Economic Zone has been underestimated,and the comprehensive efficiency is mainly affected by scale efficiency;there are differences in the operational efficiency of TCM hospitals in the three major urban agglomerations,and balanced development is needed between regions;the operational efficiency of TCM hospitals is affected by the external environment,and it is necessary to improve the external environment;it is necessary to strengthen the construction of digital and informatization of TCM,and to pay attention to the role of talents in TCM,so as to promote the high-quality development of TCM hospitals.

Objective:To evaluate the effectiveness of splenic circulation control technology in minimally invasive radical resection surgery for pancreatic neck/body cancer.Methods:This is a retrospective case series study. Retrospective analysis of clinical data of 12 patients who underwent laparoscopic or robotic radical resection for pancreatic neck/body cancer at the Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital between January 2024 and January 2025. There were 7 males and 5 females,with mean age of 68 years (range: 52 to 79 years). Clinical data including preoperative,intra-operative and postoperative outcomes were analyzed. Postoperative follow-up was conducted via outpatient visits and telephone interviews,with the follow-up ending on April 1,2025.Results:All 12 patients underwent minimally invasive radical resection of pancreatic neck/body cancer using splenic circulation control technology,consisted of 3 laparoscopic and 9 robotic procedures. The mean operative time was 185 minutes (range: 140 to 315 minutes),and the average blood loss was 100 ml (range: 30 to 300 ml). Two cases involved combined organ resection.There was no conversion to open surgery. Postoperative complications were observed in 2 patients. One patient developed grade B pancreatic leakage,managed by ultrasound-guided puncture.The patient was discharged with drainage tube. The other patient experienced chylous leakage,recovered with conservative treatment. No delayed gastric emptying,hemorrhage or reoperations were observed. The median postoperative hospital stay was 13 days (range: 8 to 20 days).Conclusion:The splenic circulation control technique is simple and safe,and shows certain application prospects in minimally invasive radical resection of pancreatic neck and body cancer.

By systematically combing ancient and modern literature， this paper examined Tribuli Fructus and Astragali Complanati Semen（ACS） used in the famous classical formulas from the aspects of name， origin， production area， harvesting and processing， clinical efficacy， so as to provide a basis for the development of famous classical formulas containing such medicinal materials. The results showed that the names of Tribuli Fructus in the past dynasties were mostly derived from its morphology， and there were nicknames such as Baijili， Cijili and Dujili. The name of ACS in the past dynasties were mostly originated from its production areas， and there were nicknames such as Baijili， Shayuan Jili and Tongjili. Because both of them had the name of Baijili， confusion began to appear in the Song dynasty. In ancient and modern times， the main origin of Tribuli Fructus were Tribulus terrestris， and ancient literature recorded the genuine producing areas of Tribuli Fructus was Dali in Shaanxi and Tianshui in Gansu， but today it is mainly cultivated in Anhui and Shandong. The fruit is the medicinal part， harvested in autumn throughout history. There is no description of the quality of Tribuli Fructus in ancient times， and the plump， firm texture， grayish-white color is the best in modern times. Traditional processing methods for Tribuli Fructus included stir-frying and wine processing， while modern commonly used is purified， fried and salt-processed. The ancient records of Tribuli Fructus were spicy， bitter， and warm in nature， with modern research adding that it is slightly toxic. The main effects of ancient and modern times include treating wind disorders， improving vision， promoting muscle growth， and treating vitiligo. The mainstream base of ACS used throughout history is Astragalus complanatus. Ancient texts indicated ACS primarily originated from Shaanxi province. Today， the finest varieties come from Tongguan and Dali in Shaanxi. The medicinal part is the seed， traditionally harvested in autumn. Modern harvesting occurs in late autumn or early winter， followed by sun-drying. Ancient texts valued seeds with a fragrant aroma as superior， while modern standards prioritize plump， uniform and free of impurities. Traditional processing methods for ACS included frying until blackened and wine-frying， while modern practice commonly employs purification methods. In terms of medicinal properties， the ancient and modern records are sweet and warm in nature. Due to originally classified under Tribuli Fructus， its effects were thus regarded as equivalent to those of Tribuli Fructus， serving as the medicine for treating wind disorders， additional functions included tonifying the kidneys and treating vitiligo. The present record of its efficacy is to tonify the kidney and promote Yang， solidify sperm and reduce urine， nourish the liver and brighten the eye， etc. Based on the textual research results， it is suggested that when developing the famous classical formulas of Tribuli Fructus medicinal materials， we should pay attention to the specific reference object of Baijili， T. terrestris and A. complanatus should be identified and selected， and the processing method should be in accordance with the requirements of the formulas.

Objective:Based on the background of high-quality development,we analyze the operational efficiency of traditional Chinese medicine(TCM)hospitals in China's Yangtze River Economic Belt in 2021 and explore the impact of external environmental factors on operational efficiency,so as to provide a reference for promoting the high-quality development of TCM hospitals in the Yangtze River Economic Belt.Methods:The three-stage DEA model was used to analyze the operational efficiency of TCM hospitals in 11 provinces and cities in the Yangtze River Economic Zone in China in 2021.Results:After three-stage DEA analysis,the values of comprehensive efficiency,pure technical efficiency and scale efficiency of TCM hospitals in China's Yangtze River Economic Belt are 0.976,0.986 and 0.990,respectively.5 provinces and cities,Shanghai,Jiangsu,Hunan,Chongqing and Guizhou,are efficient before and after the adjustment,and the comprehensive efficiency of Zhejiang,Anhui,Hubei,Jiangxi,Sichuan and Yunnan have increased compared with that before the adjustment.Ranking of the average value of the comprehensive efficiency of TCM hospitals operation in the three major city clusters of the Yangtze River Economic Belt after adjustment:Chengdu-Chongqing city cluster(0.998)>city cluster in the Yangtze River Delta(0.964)>city cluster in the middle reaches of the Yangtze River(0.962).Conclusion:The operational efficiency of TCM hospitals in the Yangtze River Economic Zone has been underestimated,and the comprehensive efficiency is mainly affected by scale efficiency;there are differences in the operational efficiency of TCM hospitals in the three major urban agglomerations,and balanced development is needed between regions;the operational efficiency of TCM hospitals is affected by the external environment,and it is necessary to improve the external environment;it is necessary to strengthen the construction of digital and informatization of TCM,and to pay attention to the role of talents in TCM,so as to promote the high-quality development of TCM hospitals.

Objective To explore the mechanism by which the triggering receptor expressed on Myeloid cells-like 4(TREML4)regulates nuclear factor-kappaB(NF-κB)pathway mediates neutrophil extracellular traps(NETs)aggravating rheumatoid arthritis(RA).Methods RA model was induced by subcutaneous injection of Freund adjuvant and bovine collagen type Ⅱ in DBA/1J mice.We used phorbol 12-myristate 13-acetate(PMA)to induce neutrophils to form NETs.We observed the degree of joint swelling and other morphological indicators,used hematoxylin-eosin staining(HE)staining to observe the pathology of the ankle joint,used enzyme-linked immunosorbent assay(ELISA)to measure the levels of inflammatory factors interleukin-1β(IL-1β),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in serum,used western blot to detect the expression of myeloperoxidase(MPO)and citrullinated histone H3(CitH3)for assess the release of NETs in the ankle joint of mice,used western blot to detect the expression of TREML4 and NF-κB pathway-associated proteins nuclear factor kappa B inhibitor α(IκBα)and NF-κB p65,used immunofluorescence to detect the distribution of MPO and CitH3 in neutrophils to assess the formation of NETs.Results Compared with the control group,the RA group exhibited joint swelling,bone erosion,excessive infiltration of immune cells and cartilage damage,and the serum inflammatory fac-tors IL-6,TNF-α and IL-1β were significantly increased(P＜0.01),the expression of IκBα was significantly decreased(P＜0.01),and the expression of NF-κB p65 was significantly increased(P＜0.01).Compared with control group,the number of NETs formed by neutrophils in PMA group was significantly increased,the expression of TREML4 and NF-κB p65 was significantly increased(P＜0.01),and the expression of IκBα was significantly decreased(P＜0.01).Compared with the PMA+si-NC group,the number of NETs formed by neutrophils in the PMA+si-TREML4group was significantly reduced(P＜0.01),the expression of TREML4 and NF-κB p65 was significantly decreased(P＜0.01),and the expression of IκBα was significantly increased(P＜0.01).Conclusion TREML4 can regulate the formation of NETs mediated by NF-κB pathway to aggravate RA.

Objective:To evaluate the effectiveness of splenic circulation control technology in minimally invasive radical resection surgery for pancreatic neck/body cancer.Methods:This is a retrospective case series study. Retrospective analysis of clinical data of 12 patients who underwent laparoscopic or robotic radical resection for pancreatic neck/body cancer at the Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital between January 2024 and January 2025. There were 7 males and 5 females,with mean age of 68 years (range: 52 to 79 years). Clinical data including preoperative,intra-operative and postoperative outcomes were analyzed. Postoperative follow-up was conducted via outpatient visits and telephone interviews,with the follow-up ending on April 1,2025.Results:All 12 patients underwent minimally invasive radical resection of pancreatic neck/body cancer using splenic circulation control technology,consisted of 3 laparoscopic and 9 robotic procedures. The mean operative time was 185 minutes (range: 140 to 315 minutes),and the average blood loss was 100 ml (range: 30 to 300 ml). Two cases involved combined organ resection.There was no conversion to open surgery. Postoperative complications were observed in 2 patients. One patient developed grade B pancreatic leakage,managed by ultrasound-guided puncture.The patient was discharged with drainage tube. The other patient experienced chylous leakage,recovered with conservative treatment. No delayed gastric emptying,hemorrhage or reoperations were observed. The median postoperative hospital stay was 13 days (range: 8 to 20 days).Conclusion:The splenic circulation control technique is simple and safe,and shows certain application prospects in minimally invasive radical resection of pancreatic neck and body cancer.

AIM:To observe the effect of curcumin on a C57BL/6J mouse liver cancer model induced by N-ni-trosodiethylamine(DEN)combined with carbon tetrachloride(CCl4),and to explore its mechanism.METHODS:Forty young male C57BL/6J mice were intraperitoneally injected with DEN(25 mg/kg)14 d after birth and randomly divided in-to the following 4 groups at the 4th week(10 in each group):model control group and curcumin(100,200 and 400 mg/kg)groups.Ten male mice of the same age were used as normal control group.The mice in model group and curcumin groups were gavaged with 10%CCl4(5 mL/kg)twice a week from the 8th week on.At the same time,the mice in curcumin groups were gavaged with curcumin,and the mice in normal control group were gavaged with the same volume of distilled water once a day for 14 weeks.After administration,the mice were sacrificed,the liver surface was observed,and the number of tumor nodules was compared.The activity of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in serum was detected by an automatic biochemical instrument.The pathological changes of liver tissues were ob-served by HE staining.The mRNA expression levels of heme oxygenase-1(HO-1)and NAD(P)H-quinone oxidoreductase 1(NQO1)were detected by RT-qPCR,and the protein expression levels of HO-1,NQO1 and Ki67 were detected by Western blot and immunohistochemistry.RESULTS:Compared with normal control group,the body weight of the mice in model group was decreased significantly(P＜0.01),the liver index was increased significantly(P＜0.01),and the se-rum levels of ALT and AST were increased obviously(P＜0.01).There was no significant difference in the mRNA expres-sion levels of HO-1 and NQO1(P＞0.05),the protein levels of HO-1 and NQO1 were increased distinctly(P＜0.05),and the positive expression rate of Ki67 was increased significantly(P＜0.05).After curcumin treatment,the body weight of the mice was significantly increased(P＜0.01),the liver index was not changed(P＞0.05),and the number of tumor nodules in the liver was decreased significantly(P＜0.05 or P＜0.01).The serum level of AST was decreased significantly(P＜0.01),the mRNA and protein expression levels of HO-1 and NQO1 were decreased significantly(P＜0.05),and the posi-tive expression rate of Ki67 was decreased significantly(P＜0.05).CONCLUSION:Curcumin significantly protects against liver cancer in a C57BL/6J mouse model induced by DEN combined with CCl4,and its mechanism may be related to the inhibition of HO-1 and NQO1 expression.

In recent years, great progress has been made in the diagnosis and treatment of pancreatic tumors. In terms of diagnosis, three-dimensional CT reconstruction, PET-CT scan, endoscopic ultrasound with needle biopsy are used to evaluate the benign or malignant stage and biological characteristics of the tumor, to make treatment decisions more scientific and reasonable. In terms of treatment, new technologies, such as arterial priority arterial sheath dissection and radical resection of the retroperitoneal lipo-lymphatic layer, have continuously emerged to improve radical curability of tumors. For benign or low-grade malignant pancreatic tumors, function-preserving surgery is adopted to avoid long-term complications. Minimally invasive pancreatic surgery has advanced in leaps and bounds. Both standard radical surgery and function-preserve surgery can be performed under a laparoscope or robot. Non-surgical treatment has developed quickly with each passing day; for locally advanced or metastatic pancreatic cancer, neoadjuvant therapy is expected to be down-staged or transformed into surgery. These advances in diagnosis and treatment technology have led to multidisciplinary teamwork. Based on accurate assessment, giving full play to the advantages of laparoscopic and robotic systems in diagnosis and treatment, attaching importance to comprehensive nonsurgical treatment and doctor-patient communication with care throughout the process, these are keys to improve the clinical efficacy of pancreatic tumors in the era of minimally invasive surgery.