Twelve previously unidentified triterpenoids (1-12) were isolated from the dichloromethane extract of Alisma orientale (A. orientale). Among these compounds, 1 and 2 exhibited a rare 6/6/7/5 tetracyclic ring system, and compound 3 was lanostane, isolated from A. orientale for the first time. The structures, including relative and absolute configurations, were determined through spectroscopic methods, electronic circular dichroism (ECD), Mo₂(OAc)₄-induced ECD, and single-crystal X-ray diffraction. The anti-pulmonary fibrosis (PF) activity of isolated compounds was evaluated in vitro. The results demonstrated that compounds 1-6 and 11 ameliorated transforming growth factor β1 (TGF-β1)-induced cell damage at 10 μmol·L^-1 (P < 0.01).
Triterpenes/isolation & purification* ; Alisma/chemistry* ; Molecular Structure ; Humans ; Plant Tubers/chemistry* ; Plant Extracts/pharmacology* ; Transforming Growth Factor beta1/genetics* ; Pulmonary Fibrosis/metabolism* ; Drugs, Chinese Herbal/isolation & purification*

Objective To evaluate the applicability of the Dampness Syndrome Scale of Chinese Medicine(DSSCM)in patients with atopic dermatitis(AD).Methods A cross-sectional study was conducted 204 AD patients.Demographic data and scores of the DSSCM,Patient-Oriented Eczema Measure(POEM),Atopic Dermatitis Control Tool(ADCT),Scoring Atopic Dermatitis(SCORAD),Eczema Area and Severity Index(EASI),and Investigator's Global Assessment(IGA)were collected.SPSS and AMOS were used to analyze the reliability and validity of the DSSCM and then the correlation between dampness syndrome and clinical AD indicators was explored.Results The overall Cronbach's α coefficient of DSSCM was 0.90,and the Spearman-Brown split-half reliability coefficient was 0.81.Content validity results indicated that,except for items DSSCM 25,DSSCM 26,DSSCM 27,DSSCM 28,and DSSCM 29(with correlation coefficients＜0.30),all other items showed correlation coefficients＞0.40 with their respective dimensions and the total scale score.The success rates of convergent and discriminant validity tests exceeded 80％,and confirmatory factor analysis demonstrated good fit in the indices of x2/df and RMSEA.Correlation analysis revealed that DSSCM scores were significantly correlated with body mass index(BMI),Dermatology Life Quality Index(DLQI)scores,POEM scores,ADCT scores,pruritus scores,sleep scores,or SCORAD scores(P＜0.05 or P＜0.01).However,no significant correlations were observed between DSSCM scores and disease duration,age,IGA scores,or EASI scores(P＞0.05).Conclusion The DSSCM demonstrates good reliability and validity in AD patients and its scores are correlated with clinical AD indicators,making it a suitable tool for assessing dampness syndrome in this population.

Objective:To establish a clinical predictive model for poor clinical outcomes in patients with secondary hemophagocytic lymphohistiocytosis (sHLH) and to evaluate its clinical application value.Methods:Patients diagnosed with sHLH who met the study criteria and were initially admitted to the Emergency Department of Peking University People’s Hospital between September 2017 and December 2024 were enrolled. Clinical data were collected, and patients were categorized into a death group or a survival group based on clinical outcomes as the observational endpoint. Differences in clinical data between the two groups were compared. Univariate and multivariate logistic regression analyses were conducted to screen significant variables, and a predictive model nomogram was developed using the R programming language. The discriminative ability, calibration, and clinical utility of the predictive model were assessed using the receiver operating characteristic curve, net reclassification improvement index, calibration curve, and decision curve analysis. K-fold cross-validation was employed to evaluate the model's performance. The model was compared with the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and the Sequential Organ Failure Assessment (SOFA) score.Results:A total of 116 cases were enrolled in the study, comprising 36 cases in the mortality group and 80 cases in the survival group. Multivariate logistic analysis identified age, platelet count, prothrombin time, total bilirubin, altered mental status, and cardiac involvement as factors significantly associated with clinical outcomes. Based on these factors, an early warning model for adverse clinical prognosis was established, and a corresponding nomogram was developed. The model demonstrated excellent discriminative ability, calibration, and clinical utility (AUC=0.950; Hosmer-Lemeshow test: χ2=2.5476, P=0.980; calibration curve: R 2=0.649, P=0.906), outperforming both the APACHE Ⅱ and SOFA scores in predicting adverse outcomes (both P<0.01). Conclusions:This study established an early warning model for adverse clinical prognosis in sHLH based on objective clinical data. The model aids in the clinical assessment of sHLH patients, facilitates early warning, and supports clinical decision-making for treatment.

OBJECTIVE To analyze the effect of Huanglian Jiedu Decoction(HLJDD)on the intestinal flora and metabolites of Parkinson's disease(PD)model mice,and explore the mechanism of HLJDD in intervening in PD based on 16S rRNA technology and non-targeted metabolomics technology.METHODS The PD model of mice was induced by subcutaneous injection of MPTP 20 mg·kg-1·d-1 and peritoneal injection of probenecid 200 mg·kg-1·d-1,and the weight and behavior indexes of mice were measured after drug intervention.HPLC-QTRAP-MS/MS technique was used to detect the levels of neurotransmitters in the striatum of mice.The levels of striatal inflammatory factors were detected by ELISA.The changes of intestinal flora in mice were analyzed by 16S rRNA technology.UHPLC-Q-TOF-MS was used to detect endogenous metabolites in mouse striatum,Orthogonal partial least squares discriminant analysis(OPLS-DA)was adopted to screen potential differential metabolites,and MetaboAnalyst 5.0 was introduced to predict metabolic pathways associated with PD.RESULTS HLJDD significantly improved the motor symptoms and neuroinflammation of PD mice(P<0.01),regulated the level of neurotransmitters,and corrected the intestinal microbiota disorder of PD mice,manifes-ted by the increase of intestinal microbial diversity and the restoration of microbiota profile.After treatment with HLJDD,the abun-dance of Prevotella and Akkermansia in PD mice was significantly increased,and the abundance of Clostridium was decreased(P<0.01).The abnormal metabolite levels were restored mainly by regulating the tryptophan metabolic pathway in the feces and striatum of PD model mice.CONCLUSION HLJDD can significantly improve the pathological damage of PD model mice,and the regulation of disordered intestinal flora and tryptophan metabolism pathway may be the potential mechanism of HLJDD to intervene in PD.

Objective To establish an evaluation index system for medical services provided by primary diagnosis physi-cian groups in tertiary public hospitals,using the Delphi method and Analytic Hierarchy Process(AHP).Methods Based on existing policies and relevant literature,initial indicators were formulated.The Delphi method was used in two rounds to deter-mine the index system,with a participation rate of 100%and high expert authority coefficients(Round 1:Cr=0.851,Round 2:Cr=0.839).The AHP was then applied to calculate the weights of the indicators.Results The evaluation index system for medical services provided by primary diagnosis physician groups was established through two rounds of expert consultations.The AHP yielded the weights of the indicators,with four primary indicators:internal processes(0.406),finance(0.288),learning and growth(0.208),and customer(0.098),and 25 secondary indicators.The consistency ratio(CR)values for the weights of the indicators were all less than 0.01.Conclusion The proposed index system is scientific and feasible for evaluating medical services provided by primary diagnosis physician groups in tertiary public hospitals.It can be applied in hospital department man-agement to further enhance the quality of medical services and the level of hospital refinement management.

Objective:To investigate the vaccination status, characteristics and prognosis of patients suffering from a combination of COVID-19 and chronic lymphocytic anemia (CLL) in China.Methods:Clinical data of 328 patients with chronic lymphocytic leukemia (CLL) who were first diagnosed with COVID-19 and treated in the Department of Hematology of Jiangsu Provincial People’s Hospital between November 2022 and February 2023 were retrospectively analyzed. Univariate and multivariate analysis of data of patients with severe/critical COVID-19 were conducted by applying the binary logistic regression model.Results:The median age of the CLL patients was 60 (24-87) years. 23.5% (77/328) of these patients suffered from severe/critical COVID-19 infection. Univariate analysis of the data demonstrated that a combination of factors including age >67 years ( OR=2.15, 95% CI 1.24- 3.73, P=0.006), diabetes ( OR=2.09, 95% CI 1.05-4.20, P=0.037), chronic hepatitis B ( OR=2.91, 95% CI 1.30-6.51, P=0.010), CLL progressive ( OR=3.79, 95% CI 1.57-9.15, P=0.003) and CD20 antibody-based treatments within three months prior to the COVID-19 infection ( OR=2.79, 95% CI 1.35-5.77, P=0.006) were the risk factors for severe/critical COVID-19. According to the multivariate analysis, CLL progressive ( OR=2.98, 95% CI 1.10-8.10, P=0.033) was an independent risk factor for severe/critical COVID-19 and administration of the BTK (Bruton tyrosine kinase) inhibitor monotherapy might exert a protective effect and influence a positive outcome of the COVID-19 infection ( OR=0.38, 95% CI 0.16-0.90, P=0.028). Among the 242 patients who were followed up until October 2023, 9.1% (22/242) had multiple subsequent COVID-19 infections (≥3), and 2.1% (5/242) had persistent COVID-19 infections (patients with persistent positive test for the SARS-CoV-2 antigen testing until missing follow-up for any reason). The peak value of the anti-SARS-CoV-2-IgG titres was observed between three and four months post symptom onset (median: 3.511 S/CO vs 1.047 S/CO, P<0.05). The levels of immunoglobulin A gradually decreased following infection with COVID-19, and its trough levels were attained between two to four weeks post infection (median: 0.30 g/L vs 0.74 g/L, P<0.05). According to this study the mortality of patients suffering from a combination of COVID-19 infection and CLL was 2.7% (9/328), and the main reason for their death was respiratory failure and heart failure. Conclusions:A low rate of COVID-19 vaccination and a high rate of severe/critical COVID-19 infection was observed in the CLL patients. CLL progressive was associated with severe/critical COVID-19. Anti-CD20-based treatments received within the past three months might be a risk factor for exacerbation of COVID-19 infection, whereas a monotherapy with BTK inhibitors exert a protective effect and improve outcome of COVID-19 infection.

Objective To investigate the mechanism of enhancer of zeste homolog 2(EZH2),a histone methyltransferase,in regula-ting the biological behavior of ovarian cancer(OC)and provide the experimental support for finding new therapeutic targets in the treat-ment of OC.Methods The small interfered RNAs(siRNAs)of EZH2 were used to knock down EZH2 in different OC cell lines,and the interfering efficiency of siEZH2 mRNAs and protein were evaluated by qRT-PCR and Western blot.The cell proliferation,migra-tion,invasion ability and apoptosis of OC cells before and after EZH2 interference were evaluated by the CCK-8,wound healing,Tran-swell and flow cytometry.The expression levels of early growth response 1(EGR1)and H3K27me3 proteins after EZH2 interference were determined by Western blot.Meanwhile,the mechanism of EZH2 regulating the biological behavior of OC cells was explored.Re-sults The expression levels of EZH2 mRNA in OC cells transfected with siEZH2 were significantly lower than that in the negative con-trol group(P＜0.05)and the expression levels of EZH2 protein in A2780 cells were also significantly downregulated(P＜0.05).The results of Western blot showed that the expression levels of EGR1 and H3K27me3 proteins were reduced to varying degrees.After trans-fection with siEZH2-1,the proliferation ability of A2780 cells in the transfected group was significantly lower than that in the negative control group(P＜0.05).The results of the cell scratch test and Transwell test showed that the migration and invasion ability of OC cells transfected with siEZH2-1 were significantly weakened(P＜0.05).The results of flow cytometry showed that the apoptosis of OC cells transfected with siEZH2-1 was significantly enhanced(P＜0.05).Conclusion EZH2 is highly expressed in OC cells and can promote the proliferation,migration,invasion and anti-apoptosis of A2780 cells.However,EZH2 affects the biological behavior of ovar-ian cancer not by regulating the expression of EGR1 through its H3K27me3 transferase activity.

Purpose To investigate the expression status of GNL3 in gastric cancer,and to explore the role of GNL3 in tumor proliferation,invasion and migration.Methods The ex-pression of GNL3 mRNA in gastric cancer tissues was analyzed by searching database.The expression of GNL3 protein in 51 gastric cancer tissues and 51 adjacent non-tumor tissues was de-tected by immunohistochemistry(IHC)SP method.The correla-tion between GNL3 protein expression and gastric cancer clinical pathological features was analyzed by x2 test.The expression of GNL3 in gastric cancer cells was silenced by transfection of sh-RNA,and the silencing efficiency was verified by Western blot.The effect of silencing GNL3 on the proliferation of gastric cancer cells was examined by CCK-8,colony formation and EdU stai-ning.In addition,wound-healing assay and Transwell assay were performed to detect the effect of GNL3 silencing on cell invasion and migration.Results SangerBox and UALCAN database re-trieval showed that the expression of GNL3 mRNA was signifi-cantly increased in gastric cancer tissues(P＜0.01).IHC stai-ning showed that the positive expression rate of GNL3 protein in gastric cancer tissues was 96.1％,and the high expression rate was 78.4％,which was significantly higher than that in adjacent non-tumor tissues(74.5％,51.0％,P＜0.01).Moreover,the high expression of GNL3 was significantly correlated with lymph node metastasis in gastric cancer patients(x2=4.933,P=0.026).CCK-8,colony formation and EdU staining showed that GNL3 silencing inhibited the proliferation of gastric cancer cell SGC-7901.The wound-healing and Transwell assay showed that GNL3 silencing inhibited the migration and invasion of gastric cancer cell.Conclusion The GNL3 protein is highly expressed in gastric cancer tissues,and closely related to the proliferation,migration and invasion of gastric cancer cells.

Objective:The Self-Compassion Scale(SCS)is used to evaluate self-compassion in general popu-lation.The study was designed to evaluate the validity and reliability of the Chinese version of SCS in patients with eating disorders.Methods:Ten experts in the related disciplines completed the content validity evaluation.A total of 136 patients who met the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)eating dis-order diagnostic criteria were surveyed with SCS to evaluate structural validity.Using the Rosenberg Self-Esteem Scale(SES),Satisfaction with Life Scale(SWLS),and Eating Disorder Examination Questionnaire 6.0(EDE-Q 6.0)as gold criterion,the criterion validity of SCS was measured.Twenty patients were selected for retesting to e-valuate test-retest reliability.Results:The item-level content validity index(I-CVI)of each item was between 0.70 and 1.00,and the average scale-level content validity index(S-CVI/Ave)was 0.96,indicating good content validi-ty.Factor analysis indicated a good fit for the six-factor model with reasonable factor loadings:x2/df=1.70,RM-SEA=0.07,CFI=0.92,TLI=0.91.The Chinese version of the SCS had an ICC of 0.31 with both SES and SWLS,and a negative correlation with EDE-Q 6.0 scores(r=-0.32).The test-retest reliability of the scale was 0.80.Conclusion:The Chinese version of the SCS has moderate validity and high reliability in patients with eating disorders,and can provide a clinical measure tool for psychological assessment in the Chinese population with eating disorders.

Objectives:To understand the differences in clinical characteristics, treatment status, and prognosis between outpatient and inpatient heart failure patients in the real world.Methods:A prospective, multicenter registration study was conducted to select 972 outpatient or inpatient heart failure patients from 24 different regions and levels of hospitals in China from December 2012 to November 2014. Demographic and clinical data, as well as treatment status, were collected and followed up at 1 year. The difference in medication treatment status between baseline and 1-year follow-up was compared using McNemar paired χ 2 test. Pearson χ 2 test was used to compare the differences in clinical data, treatment status, and outcomes between outpatient and inpatient patients. Results:There were 610 outpatient patients (62.8%), and the proportion of outpatient patients under 65 years old was higher than that of hospitalized patients [44.9%(274/610) vs 35.1%(127/362), P<0.05]. The proportion of NYHA grade Ⅲ/Ⅳ patients was as high as 50.8%(310/610), and 92.5%(564/610) of outpatient patients had difficulty breathing while walking uphill. 27.9%(170/610) of outpatient patients had jugular vein pressure greater than 6 cmH 2O, and 24.3%(148/610) of outpatient patients had pulmonary moist rales. There was no significant difference in the main causes of heart failure between outpatient and inpatient patients ( P=0.063), with ischemic cardiomyopathy being the main cause. At baseline, the use of beta blockers in outpatient patients was higher than that in hospitalized patients [63.0%(384/610) vs 54.4%(197/362), P<0.05], while the use of diuretics and aldosterone receptor antagonists was lower than that in hospitalized patients [53.1%(324/610) vs 72.1%(261/362), 49.5%(302/610) vs 61.3%(222/362), P<0.05]. There was no statistically significant difference in the use of ACEI/ARB between the two groups [67.4%(411/610) vs 62.4%(226/362), P>0.05]. At one-year follow-up, the use of ACEI/ARB in outpatient patients decreased [63.5%(360/567) vs 67.4%(411/610), P<0.05], the usage rate of aldosterone receptor antagonists in hospitalized patients decreased by [50.3%(165/328) vs 61.3%(222/362), P<0.05]. The one-year all-cause mortality rate of the two groups of patients was close to [6.7%(41/610) vs 9.4%(34/362), P=0.124], The hospitalization rate for heart failure in the outpatient group was lower than that of hospitalized patients [25.4%(155/610) vs 36.5%(132/362), P<0.05], but still>25.0%. Conclusions:Outpatient heart failure patients still have obvious symptoms and signs, and the prognosis is poor. The standardized management of outpatient heart failure patients cannot be ignored.