Objective To establish a UV method for the determination of the functional compositions(cinnamic acid derivatives,total flavonoids)in Ligustrum robustum,to predict the contents of trans-p-hydroxycinnamic acid,trans-p-hydroxycinnamic acid esters,and rhoifolin based on UV/HPLC,and to optimize the technological conditions of ultrasonic-assistant extraction of L.robustum.Methods ①In the determination of the functional compositions in L.robustum,total cinnamic acid derivatives were determined by dual-wavelength isobestic point UV method(detection wavelength 316 nm,reference wavelength 268 nm),and total flavonoids were determined by single-wavelength UV method(detection wavelength 268 nm),while rhoifolin was determined by HPLC(C 18 column,eluting with methanol-0.1％acetic acid=40∶60,detection wavelength 310 nm).②The conversion factors were used to establish a UV/HPLC-based prediction model,and the precision of the predicted results was evaluated with other 3 test samples.③ The technological conditions of ultrasonic-assisted extraction were optimized by an orthogonal test.Results ① The linear ranges of total cinnamic acid derivatives,total flavonoids,and rhoifolin were 4.64-20.88,8.24-28.84,5.15-51.50 μg·mL-1(r≥0.999 5),respectively.RSDs of the precision,stability,and reproducibility tests were no more than 1.4％.The recoveries were 97.9％-100.5％(RSD≤ 1.2％,n=6).②The relative errors of the values predicted by UV/HPLC from the results measured by HPLC were from-5.3％to 1.7％.There was no significant difference between the UV/HPLC predicted values and the HPLC determined results(P＞0.05)for the contents of trans-p-hydroxycinnamic acid and rhoifolin.③The optimal technological conditions of ultrasonic-assistant extraction of L.robustum were as follows:ethanol concentration 80％,temperature 50 ℃,liquid-solid ratio 20 mL·g 1,extraction frequency 2 times,extraction time 20 min.The total yield of functional compositions under above conditions was 42.0％.Conclusion The above determination methods are accurate and rapid,and the above extraction technology is effective,energy-saving and rapid,which provide an experimental base for the quality control and application of L.robustum.

Objective To establish a UV method for the determination of the functional compositions(cinnamic acid derivatives,total flavonoids)in Ligustrum robustum,to predict the contents of trans-p-hydroxycinnamic acid,trans-p-hydroxycinnamic acid esters,and rhoifolin based on UV/HPLC,and to optimize the technological conditions of ultrasonic-assistant extraction of L.robustum.Methods ①In the determination of the functional compositions in L.robustum,total cinnamic acid derivatives were determined by dual-wavelength isobestic point UV method(detection wavelength 316 nm,reference wavelength 268 nm),and total flavonoids were determined by single-wavelength UV method(detection wavelength 268 nm),while rhoifolin was determined by HPLC(C 18 column,eluting with methanol-0.1％acetic acid=40∶60,detection wavelength 310 nm).②The conversion factors were used to establish a UV/HPLC-based prediction model,and the precision of the predicted results was evaluated with other 3 test samples.③ The technological conditions of ultrasonic-assisted extraction were optimized by an orthogonal test.Results ① The linear ranges of total cinnamic acid derivatives,total flavonoids,and rhoifolin were 4.64-20.88,8.24-28.84,5.15-51.50 μg·mL-1(r≥0.999 5),respectively.RSDs of the precision,stability,and reproducibility tests were no more than 1.4％.The recoveries were 97.9％-100.5％(RSD≤ 1.2％,n=6).②The relative errors of the values predicted by UV/HPLC from the results measured by HPLC were from-5.3％to 1.7％.There was no significant difference between the UV/HPLC predicted values and the HPLC determined results(P＞0.05)for the contents of trans-p-hydroxycinnamic acid and rhoifolin.③The optimal technological conditions of ultrasonic-assistant extraction of L.robustum were as follows:ethanol concentration 80％,temperature 50 ℃,liquid-solid ratio 20 mL·g 1,extraction frequency 2 times,extraction time 20 min.The total yield of functional compositions under above conditions was 42.0％.Conclusion The above determination methods are accurate and rapid,and the above extraction technology is effective,energy-saving and rapid,which provide an experimental base for the quality control and application of L.robustum.

Objective To evaluate the prognostic value of radiation-induced lymphocytopenia in the survival of patients with primary hepatocellular carcinoma receiving radiation therapy. Methods The clinical data of 98 patients with unresectable primary hepatocellular carcinoma who received radiotherapy were retrospectively analyzed. The minimum absolute lymphocyte count (min ALC) was graded in accordance with CTCAE V4.0. The optimal threshold of min ALC for prognosis was calculated by using the receiver operating characteristic curve, and the correlation of min ALC with clinical characteristics and dosimetry parameters was analyzed. The Kaplan-Meier method was employed to analyze the survival of patients with different levels of min ALC. Univariate and multivariate Cox proportional regression models were applied to analyze prognostic factors. Results The baseline and min ALC of 98 patients during radiotherapy were 1.52×10⁹/L and 0.45×10⁹/L, respectively(P<0.001). The optimal cut-off value of min ALC for the prediction of the one-year survival rate was 0.38×10⁹/L. GTV, the mean dose of the liver and spleen, the V5 and V10 of the liver and spleen, and the V15 of the spleen were correlated with min ALC, and the V5 of the liver was an independent predictor of min ALC. The overall survival of patients with high min ALC was higher than that of patients with low min ALC. Independent prognostic factors were min ALC≤0.38×10⁹/L (HR=0.515, P=0.024), min ALC≥grade 3 (HR=0.576, P=0.032), tumor thrombus in the portal/vena cava, Child-Pugh grade A, increase of ≥2 points in the Child-Pugh score after radiotherapy, and received more than two other therapies. Conclusion Min ALC≤0.38×10⁹/L and min ALC≥grade 3 have independent prognostic value in patients with unresectable hepatocellular carcinoma receiving radiotherapy.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

Objective:To investigate the effects of Feiji Formula on the migration and invasion of lung cancer cells,as well as lung metastasis in animal models and explore its possible mechanisms.Methods:TNMplot,TCGA,and DAVID databases were used to analyze the expression of complement-related proteins(CFHR5[complement factor H-related protein 5],MBL2[mannose-binding lectin 2],C9[complement component 9])in lung metastatic tissues and their relationship with immune cell infiltration,as well as related biological processes and signaling pathways.A subcutaneous xenograft mice model was established using 2LL cells.Mice were administered 2 g/mL Feiji Formula decoction(0.2 mL per dose)via oral gavage for 21 days.The effects of Feiji Formula on the incidence of lung metastasis,the number of lung metastatic nodules,and the protein expression of CFHR5/MBL2/C9 in the lung tissues of the model mice were observed.Exosome tracing assay was performed to observe the secretion and uptake of exosomes by CTC-TJH-01 and H1299 cells.Different concentrations of Feiji Formula were applied to treat H1299 and CTC-TJH-01 cells,and its effects on cell viability,invasion,migration,and CFHR5/MBL2/C9 protein expression were detected by CCK-8,scratch healing assay,Transwell assay,and WB method.Results:Network pharmacology analysis showed that CFHR5/MBL2/C9 proteins were highly expressed in lung metastatic tissues(all P<0.05)and were closely related to the complement system involved in immune response regulation.Compared with the control group,the Feiji Formula group demonstrated a significant reduction in the number of lung metastatic nodules(P<0.05).Feiji Formula(0-200 μg/mL)had no significant effect on the viability of H1299 and CTC-TJH-01 cells(both P>0.05).Both CTC-TJH-01 and H1299 cells could secrete and uptake each other's exosomes.Compared with the 0 μg/mL control group,Feiji Formula at concentrations of 50-200 μg/mL significantly inhibited the migration and invasion abilities of H1299 and CTC-TJH-01 cells(P<0.05 or P<0.01),and significantly reduced the protein expression levels of CFHR5 and MBL2(P<0.05 or P<0.01).Notably,the expression level of C9 protein in CTC-TJH-01 cells increased only after treatment with 200 μg/mL Feiji Formula(P<0.05).Conclusion:Feiji Formula can inhibit the migration and invasion of lung cancer cells as well as lung metastasis in model mice by regulating complement-associated proteins CFHR5/MBL2/C9.This effect may be related to exosome-mediated intercellular communication.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

Objective To evaluate the short-term efficacy and quality of life of primary hepatocellular carcinoma patients after radiotherapy and pregabalin treatment for neuropathic pain with bone metastasis. Methods 32 patients with primary hepatocellular carcinoma bone metastases were treated with radiotherapy combined with pregabalin treatment.Then, we prospectively studied the analgesic efficacy for neuropathic pain and quality of life, used the brief pain inventory and douleur neuropathique 4 questionnaire (DN4) to evaluate pain at baseline, one and two months after radiotherapy, assessed pain response using the international consensus endpoint definition of bone metastasis, and used European Organization for Research and Treatment of Cancer Research and Treatment Quality of Life Questionnaire (EORTC QLQ-C30) and bone metastasis module (QLQ-BM22) for quality of life assessment. Results One and two months after radiotherapy, the average DN4 score of neuropathic pain decreased, and the objective pain relief rates were 62.8% and 68.6%, respectively.The physical, emotional, social, and role functional scores of EORTC QLQ-C30 functional scale significantly increased in the first month after radiotherapy.Symptom scale of pain (P=0.015), insomnia (P=0.035), and loss of appetite (P=0.022) improved, and fatigue was aggravated (P < 0.05).Two months after radiotherapy, the mean overall health score and all functional scale scores significantly increased than those at baseline.The scores of all symptom scales decreased, except fatigue, constipation, and financial difficulties (P < 0.05).In addition, pain responders showed significant improvement in emotional function (P=0.025) and physical function (P=0.029) in the functional scale and in pain (P=0.014) and fatigue (P=0.035) in the symptom scale.The QLQ-BM22 score showed that the painful sites (P=0.021) and pain characteristics (P=0.04) of the responders significantly improved compared with those of nonresponders two months after radiotherapy. Conclusion Radiotherapy combined with pregabalin can relieve neuropathic pain caused by bone metastasis from primary hepatocellular carcinoma and greatly improve the quality of life, particularly in pain responders.

Objective:To explore the correlation of apparent diffusion coefficient (ADC) of magnetic resonance diffusion weighted imaging (DWI) examination before radiotherapy in patients with advanced cervical squamous cell carcinoma with clinicopathological characteristics and radiotherapy efficacy.Methods:The clinical data of 80 patients with advanced cervical cancer who were admitted to the Second Hospital of Nanjing from September 2019 to March 2022 were retrospectively analyzed. All patients underwent magnetic resonance imaging (MRI) DWI examination. The differences in ADC values among cervical squamous cell carcinoma patients with different clinicopathological characteristics were analyzed. The patients were divided into the effective group (complete remission+partial remission) and the ineffective group (stable disease+progressive disease) based on the radiotherapy effect, and the differences in ADC values between the two groups were compared. The logistic regression model was used to analyze the factors affecting the radiotherapy efficacy of patients with advanced cervical squamous cell carcinoma.Results:Among 80 patients with advanced cervical squamous cell carcinoma, 21 achieved complete remission, 31 achieved partial remission, 25 achieved stable disease, and 3 achieved progressive disease after radiotherapy; there were 52 cases in the effective group and 28 cases in the ineffective group. The ADC value of the effective group before radiotherapy was higher than that of the ineffective group [(0.99±0.14)×10 -3mm 2/s vs. (0.76±0.20)×10 -3mm 2/s], and the difference was statistically significant ( t = 6.01, P < 0.001); after radiotherapy, the ADC value of the effective group was also higher than that of the ineffective group [(1.43±0.25)×10 -3mm 2/s vs. (1.11±0.23)×10 -3mm 2/s), and the difference was statistically significant ( t = 5.61, P < 0.001); the ADC values of both the effective and ineffective groups increased after radiotherapy compared to before radiotherapy (both P < 0.05). The ADC values of patients with different International Federation of Obstetrics and Gynecology (FIGO) stage, degree of pathological differentiation, depth of lesion infiltration, Ki-67 expression, lymph node metastasis, and distant metastasis were statistically significant (all P < 0.05). The results of multivariate logistic regression analysis showed that ≥FIGO stage Ⅲ, low differentiation, lymph node metastasis, lymphatic vessel infiltration, distant metastasis, and low ADC value before radiotherapy were independent risk factors for efficacy of radiotherapy in patients with advanced cervical squamous cell carcinoma (all P < 0.05). Conclusions:The ADC value before radiotherapy is a factor that affects the radiotherapy effect of patients with advanced cervical squamous cell carcinoma. The lower the ADC value before radiotherapy is, the worse the radiotherapy effect of patients will be.

Objective:A prospective, multicenter randomized controlled clinical research was conducted to explore the diagnostic value of the new optical staining technology for domestic endoscope, spectral focused imaging (SFI) and variable intelligent staining technology (VIST), for gastric precancerous lesions.Methods:Patients who intended to undergo gastroscopy between August 2020 and May 2021 were randomly divided into the white light group and the new optical staining group at the First Hospital of Hebei Medical University, Shanghai Tenth People's Hospital and the Second Affiliated Hospital of Soochow University. A sequential examination method was applied (white light to new optical staining or new optical staining to white light). The endoscopic diagnostic results and the detection results of Helicobacter pylori ( HP) of the two groups were recorded. At the same time, such five variables as gastric mucosal atrophy, intestinal metaplasia, fold enlargement, nodular gastritis and diffuse redness were evaluated for the risk of gastric cancer in the two groups. Results:A total of 419 cases were enrolled, including 208 cases in the white light group and 211 cases in the new optical staining group. Compared with pathological findings, the detection rates of gastric inflammation, atrophy, intestinal metaplasia, low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia and advanced cancer lesions in the white light group were 28.9%, 40.4%, 64.9%, 17.8%, 0.5% and 0.5% respectively; while those in the new optical staining group were 30.8%, 42.7%, 62.6%, 15.2%, 2.8% and 0.5%. There were no significant differences in the detection rates between the two groups ( P>0.05). Compared with pathology, the sensitivity, the specificity, the accuracy, the positive predictive value and the negative predictive value for gastric mucosal atrophy in the white light group were 92.9%, 61.3%, 74.0%, 61.9% and 92.7% respectively and those in the new optical staining group (SFI mode) were 94.4%, 64.5%, 77.3%, 66.4% and 94.0% respectively. The above 5 measures for gastric mucosal intestinal metaplasia were 68.1%, 72.6%, 69.7%, 82.1% and 55.2% in the white light group, and 87.1%, 89.9%, 88.2%, 93.5% and 80.7% in the new optical staining group (VIST mode), with significant difference between the two groups ( P<0.05). In terms of HP infection with 13C-urea breath test ( 13C-UBT) results as the gold standard, the above 5 measures were 90.2%, 84.3%, 87.4%, 86.8% and 88.2% in the white light group and 92.6%, 77.1%, 85.4%, 82.2% and 90.1% in the new optical staining group respectively. The proportion of high-risk gastric lesions in the new optical staining group was higher in cases of a gastric cancer risk score≥ 4 ( P<0.05). Conclusion:The new optical staining technology of domestic endoscopy has higher diagnostic value for gastric mucosal intestinal metaplasia. Gastroscopy is helpful for the detection of precancerous lesions with gastric cancer risk score as a tool. The new optical staining technology of domestic endoscopy is similar to imported endoscopy in diagnosing gastric precancerous lesions and HP infection, which is an effective means to detect gastric mucosal precancerous lesions.

Cadmium (Cd) is a common heavy metal in the environment. Cd²⁺ may penetrate the blood-brain barrier and produce neurotoxicity, thus inducing various neurodegenerative diseases. Celastrol is an effective component of Tripterygium wilfordii Hook. F., which has many pharmacological effects such as anti-cancer and anti-inflammatory. Here we explored the effect of celastrol on the corresponding neurotoxicity induced by Cd²⁺. Cell proliferation test, cell membrane integrity test, and cell morphology were observed to analyze the effect of Cd²⁺ on the viability of HMC3. The neurotoxicity of Cd²⁺ and the effect of celastrol on the corresponding neurotoxicity induced by Cd²⁺ were analyzed by nitric oxide (NO) test, lipid peroxidation (MDA) test, and Western blotting. When the concentration of Cd²⁺ reached 40 μmol/L, the inhibition rate of HMC3 cell proliferation was (57.17±8.23)% (P < 0.01, n=5), compared with the control group. The cell activity continued to reduce when the Cd²⁺ concentration further increased. When the concentration of Cd²⁺ was higher than 40 μmol/L, the cell membrane of HMC3 was significantly damaged, and the damage was dose-dependent. Upon increasing the Cd²⁺ concentration, the cell morphology began to change and the adhesion also became worse. Cd²⁺ significantly increased the amount of NO released by HMC3 cells, while celastrol effectively inhibited the NO release of HMC3 cells induced by Cd²⁺. Cd²⁺ greatly increased the release of MDA in HMC3 cells, and the level of MDA decreased rapidly upon the addition of 10^-7 mol/L celastrol. Cd²⁺ increased the expression of p-PI3K protein, and the levels of p-PI3K protein and p-AKT protein were inhibited by the addition of celastrol (10^‒7 mol/L, 10^‒6 mol/L), thus preventing cell apoptosis. In conclusion, celastrol inhibits Cd²⁺ induced microglial cytotoxicity and plays a neuroprotective role.
Anti-Inflammatory Agents/pharmacology* ; Apoptosis ; Cadmium/toxicity* ; Nitric Oxide/pharmacology* ; Pentacyclic Triterpenes ; Phosphatidylinositol 3-Kinases ; Proto-Oncogene Proteins c-akt/metabolism* ; Triterpenes/pharmacology*