High-performance liquid chromatography(HPLC) was used to determine the content of three major components in Citri Reticulatae Semen(CRS), including limonin, nomilin, and obacunone. The chromaticity of the CRS sample during salt processing and stir-frying was measured using a color difference meter. Next, the relationship between the color and content of the salt-processed CRS sample was investigated through correlation analysis. By integrating the oil bath technique for processing simulation with HPLC, the changes in the relative content of nomilin and its transformation products were analyzed, with its structural transformation pattern during processing identified. Additionally, RAW264.7 cells were induced with lipopolysaccharides(LPSs) to establish an inflammatory model, and the anti-inflammatory activity of nomilin and its transformation product, namely obacunone was evaluated. The results indicated that as processing progressed, E~*ab and L~* values showed a downward trend; a~* values exhibited a slow increase over a certain period, followed by no significant changes, and b~* values remained stable with no significant changes over a certain period and then started to decrease. The limonin content remained barely unchanged; the nomilin content decreased, and the obacunone increased significantly. The changing trends in content and color parameters during salt-processing and stir-frying were basically consistent. The content of nomilin and obacunone was significantly correlated with the colorimetric values(L~*, a~*, b~*, and E~*ab), while limonin content showed no significant correlation with these values. By analyzing HPLC patterns of nomylin at different heating temperatures and time, it was found that under conditions of 200-250 ℃ for heating of 5-60 min, the content of nomilin significantly decreased, while the obacunone content increased pronouncedly. The in vitro anti-inflammatory activity results indicated that compared to the model group, the group with a high concentration of nomilin and the groups with varying concentrations of obacunone showed significantly reduced release of nitric oxide(NO)(P<0.01). When both were at the same concentration, obacunone showed better performance in inhibiting NO release. In this study, the obvious correlation between the color and content of major components during the processing of CRS samples was identified, and the dynamic patterns of quality change in CRS samples during processing were revealed. Additionally, the study revealed and confirmed the transformation of nomilin into obacunone during processing, with the in vitro anti-inflammatory activity of obacunone significantly greater than that of nomilin. These findings provided a scientific basis for CRS processing optimization, tablet quality control, and its clinical application.
Mice ; Animals ; Drugs, Chinese Herbal/pharmacology* ; RAW 264.7 Cells ; Limonins/chemistry* ; Chromatography, High Pressure Liquid ; Citrus/chemistry* ; Color ; Benzoxepins/chemistry* ; Anti-Inflammatory Agents/chemistry*

OBJECTIVE: To explore clinical efficacy of percutaneous endoscopic discectomy with a lateral approach and dual-channel method in treating highly free lumbar disc herniation(LDH). METHODS: A retrospective analysis was conducted on 54 patients with highly free LDH who were treated with spinal endoscopic techniques from January 2021 to December 2022. Twenty-seven patients were treated with lateral approach dual-channel(lateral approach dual-channel group), including 16 males and 11 females, with an average age of (54.6±10.5) years old. Twenty-seven patients were treated with unilateral biportal endoscopic (UBE group), including 17 males and 10 females, with an average age of (52.9±12.3) years old. The number of intraoperative fluoroscopy, operation time and hospital stay, as well as visual analogue scale (VAS) and Oswestry diability index (ODI) of low back and leg pain between two patients before operation, 1 day, 1, 3, and 12 months after operation, and the efficacy was evaluated by the modified MacNab criteria at 12 mohths after operation. RESULTS: All patients were successfully completed surgical and were followed up, the time raged from 12 to 22 months with an average of (13.57±4.12) months. There was no statistically significant difference in operation time between two groups (P>0.05). The hospital stay of lateral approach dual-channel group was (3.9±1.1) days, which was shorter than that of UBE group (6.5±1.4) days, the number of intraoperative fluoroscopy in lateral approach dual-channel group was (12.7±2.1) times, which was more than that in UBE group (6.6±1.3) times, the differences were statistically significant (t=5.197, -7.532;P<0.05). VAS and ODI for low back pain at 1 day and 1 month after operation, and VAS for leg pain at 1 day after operation of lateral approach dual-channel group were superior to those of UBE group, and the differences were statistically significant (P<0.05). However, there were no statistically significant differences in VAS and ODI for low back and leg pain between two groups before operation and 3 and 12 months after operation (P>0.05). VAS and ODI of low back and leg pain were significantly improved at each time point before and after operation in both groups, and the difference were statistically significant (P<0.05). At 12 months after operation, according to the modified MacNab criteria, the excellent and good rates of therapeutic effects between lateral approach dual-channel group and UBE group were 92.6% (25/27) and 88.9% (24/27), respectively, and the difference was not statistically significant (χ²=0.22, P>0.05). CONCLUSION For patients with highly free lumbar intervertebral disc protrusion, both of lateral approach dual-channel method and UBE endoscopic surgery are safe and effective. Endoscopic surgery with lateral approach and dual-channel method could be performed under local anesthesia, allowing for the removal of the nucleus pulposus under direct vision. It is simpler, more efficient.
Humans ; Male ; Female ; Intervertebral Disc Displacement/surgery* ; Middle Aged ; Diskectomy, Percutaneous/methods* ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Adult ; Retrospective Studies ; Aged

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It has a high prevalence and poor prognosis. The application of antiarrhythmic drugs and even surgery cannot completely treat the disease, and there are many sequelae. AF can be classified into the category of "palpitation" in Chinese medicine according to its symptoms. Acupuncture has a significant effect on AF. The authors find that an important mechanism of acupuncture in AF treatment is to regulate the cardiac vagus nerve. Therefore, this article intends to review the distribution and function of vagus nerve in the heart, the application and the regulatroy effect for the treatment of AF.
Atrial Fibrillation/physiopathology* ; Humans ; Acupuncture Therapy ; Vagus Nerve/physiology* ; Animals

T-cell acute lymphoblastic leukemia (T-ALL) is a highly aggressive hematologic malignancy with a poor prognosis, despite advancements in treatment. Many patients struggle with relapse or refractory disease. Investigating the role of the super-enhancer (SE) regulated gene ubiquitin-specific protease 20 (USP20) in T-ALL could enhance targeted therapies and improve clinical outcomes. Analysis of histone H3 lysine 27 acetylation (H3K27ac) chromatin immunoprecipitation sequencing (ChIP-seq) data from six T-ALL cell lines and seven pediatric samples identified USP20 as an SE-regulated driver gene. Utilizing the Cancer Cell Line Encyclopedia (CCLE) and BloodSpot databases, it was found that USP20 is specifically highly expressed in T-ALL. Knocking down USP20 with short hairpin RNA (shRNA) increased apoptosis and inhibited proliferation in T-ALL cells. In vivo studies showed that USP20 knockdown reduced tumor growth and improved survival. The USP20 inhibitor GSK2643943A demonstrated similar anti-tumor effects. Mass spectrometry, RNA-Seq, and immunoprecipitation revealed that USP20 interacted with hypoxia-inducible factor 1 subunit alpha (HIF1A) and stabilized it by deubiquitination. Cleavage under targets and tagmentation (CUT&Tag) results indicated that USP20 co-localized with HIF1A, jointly modulating target genes in T-ALL. This study identifies USP20 as a therapeutic target in T-ALL and suggests GSK2643943A as a potential treatment strategy.

Objective To explore the behavioral characteristics of using cognitive reappraisal(CR)and expressive suppression(ES)in high trait anxiety individuals under both explicit and implicit conditions.Methods A total of 57 non-psychology undergraduates and postgraduates were recruited in a military medical university from June to July in 2023.All the participants were surveyed with Trait Form of Spielberger's State-Trait Anxiety Inventory(STAI-T)and Emotion Regulation Questionnaire(ERQ)to investigate their level of anxiety and usage habits of CR and ES strategies.According to the STAI-T results,they were divided to a high trait anxiety(HTA)group(n=28)and a low trait anxiety(LTA)group(n=29).Then the implicit and explicit emotion regulation(ER)tasks were used to analyze and compare 2 strategies on improving negative emotional pleasure and arousal,and the differences in difficulty and success of using CR and ES under the explicit condition.Results ① Both the HTA and LTA individuals showed a higher use of CR and less use of ES[t(27)=3.94,P<0.001;t(28)=11.33,P<0.001],while the HTA individuals used more ES[t(55)=3.02,P<0.01]and less CR than the LTA individuals[t(55)=-2.20,P=0.02].②Compared with implicit neutral priming,both implicit CR(Pleasure:2.56±0.11 vs 2.73±0.12,P<0.01;Arousal:6.68±0.18 vs 6.51±0.20,P<0.05)and implicit ES priming(Pleasure:2.56±0.11 vs 2.86±0.11,P<0.001;Arousal:6.68±0.18 vs 6.30±0.20,P<0.001)improved the negative emotional experiences of both HTA and LTA groups,and ES showed better effect(Pleasure:P<0.001;Arousal:P<0.001).③ Explicit CR(Pleasure:2.92±0.12 vs 5.09±0.09,P<0.001;Arousal:6.43±0.20 vs 4.33±0.21,P<0.001)and explicit ES(Pleasure:2.92±0.12 vs 4.34±0.09,P<0.001;Arousal:6.43±0.20 vs 4.22±0.22,P<0.001)ameliorated the negative feelings in the HTA and LTA individuals,and the effect of explicit CR on improving pleasure was superior than that of explicit ES(P<0.001).For the HTA individuals,it is more difficult to implement CR and ES[CR:t(55)=2.16,P=0.02;ES:t(55)=2.92,P<0.01],and ES was less successful in emotion regulation when compared with the LTA individuals[t(55)=-1.88,P=0.03];the difficulty of using ES was significantly higher than that of CR[4.00±1.81 vs 5.00±1.80,t(27)=-2.78,P<0.01],and the success rate was also lower[7.04±1.00 vs 6.64±1.13,t(27)=2.09,P=0.02].④ Comparing the effects of emotion regulation under implicit and explicit conditions,it was presented that explicit CR and ES were better than implicit CR and ES for both HTA and LTA individuals(Pleasure:explicit CR vs implicit CR:5.09±0.09 vs 2.73±0.12,P<0.001;explicit ES vs implicit ES:4.34±0.09 vs 2.86±0.11,P<0.001;Arousal:explicit CR vs implicit CR:4.33±0.21 vs 6.51±0.20,P<0.001;explicit ES vs implicit ES:4.22±0.22 vs 6.30±0.20,P<0.001).Conclusion In terms of usage habits of ER strategies,HTA individuals tend to use ES more and CR less than LTA individuals.Under the implicit/explicit conditions,HTA individuals can both employ CR and ES to improve negative emotional experience,and the effect of explicit ER is significantly better than implicit condition.

Objective To comparatively analyze the clinical characteristics of primary bilateral macronodular adrenal hyperplasia(PBMAH)and adrenal cortisol-producing Adenoma(CPA),and enhance the understanding of two diseases.Methods The clinical data of 85 PBMAH patients(PBMAH group)and 195 CPA patients(CPA group)diagnosed at Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,from September 2014 to August 2024 were retrospectively analyzed.The demographic characteristics,comorbidities,biochemical indicators,adrenocorticotropic hormone-cortisol(ACTH-F)levels,and adrenal imaging features and treatment conditions were compared between the two groups.Results(1)General characteristics:Compared with CPA group,PBMAH group had older age at diagnosis and a higher proportion of male patients.(2)Clinical characteristics:Compared with CPA group,PBMAH group had a longer disease duration,a higher proportion of subclinical Cushing's syndrome(CS),and a higher proportion of hypertension,impaired glucose tolerance/diabetes,bone mass reduction or osteoporosis,with higher serum potassium levels,and the differences were statistically significant(P<0.01).(3)Hormone levels:Both PBMAH and CPA groups showed ACTH-F rhythm disorder,significantly increased cortisol levels and suppressed ACTH.Compared with PBMAH group,CPA group had stronger autonomous cortisol secretion ability,manifested by increased midnight serum cortisol(F0:00),16:00 serum cortisol(F16:00),24-hour urinary free cortisol(24 h UFC)levels and lower 8:00 serum ACTH(ACTH8:00)and 16:00 serum ACTH(ACTH16:00)(P<0.01).After low-dose dexamethasone suppression test(LDDST),CPA group showed lower suppression rates of ACTH and cortisol,and higher proportions of paradoxical elevation in serum cortisol and 24 h UFC compared with PBMAH(P<0.01).Conclusions PBMAH has a longer disease course and higher proportions of comorbid metabolic disorders than CPA,mostly manifested as subclinical Cushing's syndrome.CPA has stronger autonomous cortisol secretion ability,with cortisol less likely to be suppressed after LDDST and more obvious paradoxical elevation of cortisol and 24 h UFC.

Objective To compare the performances of 3D MERGE sequence and 3D SPACE STIR sequence in detecting lumbar disc herniation(LDH).Methods The clinical data and MRI data of 135 LDH patients admitted between January 2020 and November 2022 were analyzed retrospectively.All patients were examined using conventional MRI,3D MERGE sequence and 3D SPACE STIR sequence.The consistency of 3D MERGE sequence and 3D SPACE STIR sequence in measuring the diameter of nerve root was analyzed,and the image quality parameters[signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)]and image definition score of the two sequences were evaluated.Results There were no statistically significant differences in L3-S1 nerve root diameters measured by 3D MERGE sequence and 3D SPACE STIR sequence(P＞0.05),and the diameters of L3,L4,L5 and S1 measured by the two sequences showed high correlations(r=0.957,0.986,0.975,0.972,P＜0.05).Compared with 3D SPACE STIR sequence,3D MERGE sequence had higher SNR and CNR,scored better on image definition,and displayed nerve root more clearly(P＜0.05).Conclusion 3D MERGE sequence and 3D SPACE STIR sequence have high consistency in the measurement of LDH nerve root diameter.3D MERGE sequence can display the anatomical morphology of nerve root more clearly as compared with 3D SPACE STIR sequence,and the former one has higher image quality.

Objective:To construct an ensemble machine learning model for predicting the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy and evaluate its application value.Methods:This is a research on predictive model. Clinical data of 421 patients undergoing pancreaticoduodenectomy in the Department of Pancreatic Surgery,Union Hospital, Tongji Medical College,Huazhong University of Science and Technology from June 2020 to May 2023 were retrospectively collected. There were 241 males (57.2%) and 180 females (42.8%) with an age of (59.7±11.0)years (range: 12 to 85 years).The research objects were divided into training set (315 cases) and test set (106 cases) by stratified random sampling in the ratio of 3∶1. Recursive feature elimination is used to screen features,nine machine learning algorithms are used to model,three groups of models with better fitting ability are selected,and the ensemble model was constructed by Stacking algorithm for model fusion. The model performance was evaluated by various indexes,and the interpretability of the optimal model was analyzed by Shapley Additive Explanations(SHAP) method. The patients in the test set were divided into different risk groups according to the prediction probability (P) of the alternative pancreatic fistula risk score system (a-FRS). The a-FRS score was validated and the predictive efficacy of the model was compared.Results:Among 421 patients,CR-POPF occurred in 84 cases (20.0%). In the test set,the Stacking ensemble model performs best,with the area under the curve (AUC) of the subject′s work characteristic curve being 0.823,the accuracy being 0.83,the F1 score being 0.63,and the Brier score being 0.097. SHAP summary map showed that the top 9 factors affecting CR-POPF after pancreaticoduodenectomy were pancreatic duct diameter,CT value ratio,postoperative serum amylase,IL-6,body mass index,operative time,albumin difference before and after surgery,procalcitonin and IL-10. The effects of each feature on the occurrence of CR-POPF after pancreaticoduodenectomy showed a complex nonlinear relationship. The risk of CR-POPF increased when pancreatic duct diameter<3.5 mm,CT value ratio<0.95,postoperative serum amylase concentration>150 U/L,IL-6 level>280 ng/L,operative time>350 minutes,and albumin decreased by more than 10 g/L. The AUC of a-FRS in the test set was 0.668,and the prediction performance of a-FRS was lower than that of the Stacking ensemble machine learning model.Conclusion:The ensemble machine learning model constructed in this study can predict the occurrence of CR-POPF after pancreaticoduodenectomy,and has the potential to be a tool for personalized diagnosis and treatment after pancreaticoduodenectomy.

Objective To investigate the predictive value of serum soluble CD40 ligand(sCD40L)and an-giotensin Ⅱ receptor-like 1 endogenous ligand 13(Apelin-13)levels for the short-term prognosis in patients after traumatic brain injury surgery.Methods A total of 89 patients with traumatic brain injury who under-went treatment and surgery in Zhongwu Hospital of Suqian from June 2020 to December 2022 were collected as the research group.A total of 89 healthy individuals who came to Zhongwu Hospital of Suqian during the same period for physical examination were selected as the control group.The clinical data of the study subjects were collected and the expression levels of sCD40L and Apelin-13 in the serum were detected.Pearson method was applied to analyze the correlation between sCD40L and Apelin-13 in the serum of patients in the research group.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum sCD40L and Apelin-13 for the short-term prognosis in patients after traumatic brain injury surgery.Results Compared with the control group,the serum level of sCD40L in the research group was significantly increased,and the serum level of Apelin-13 was significantly decreased(P<0.05).There were no statistically significant differences in age and gender between the poor prognosis group and the good prognosis group(P>0.05).The proportions of patients with preoperative hospitalization time≥10 h,surgical duration≥4 h,intraoperative bleeding vol-ume≥400 mL,and permanent implants were higher than those in the good prognosis group,and the Glasgow Outcome Scale(GOS)score was lower than that in the good prognosis group(P<0.05).The serum sCD40L level in good prognosis group was lower than that in poor prognosis group,and the serum Apelin-13 level was higher than that in poor prognosis group(P<0.05).The area under the curve(AUC)of serum sCD40L and Apelin-13 levels for predicting the short-term prognosis in patients after traumatic brain injury surgery was 0.776 and 0.819,respectively,with sensitivity of 79.31%and 75.86%,specificity of 75.00%and 81.67%,respectively,and the AUC of the combination of the two was 0.909,with sensitivity of 89.66%and specificity of 75.00%,respectively.Conclusion The serum sCD40L level increases and the serum Apelin-13 level decrea-ses in patients with poor short-term prognosis after traumatic brain injury surgery.The combined detection of the two has high predictive value for the short-term prognosis in patients.

Objective To observe the efficacy and safety of Xiaoying Sanjie Granules(derived from the modified Sini San and Banxia Houpo Decoction)in the treatment of patients with benign thyroid nodules of qi stagnation and phlegm obstruction type.Methods A retrospective study was conducted.According to the treatment methods,60 patients with benign thyroid nodules of qi stagnation and phlegm obstruction type were divided into observation group and control group,30 cases in each group.The control group was given health training alone,and the observation group was given oral use of Xiaoying Sanjie Granules on the basis of treatment for the control group.The course of treatment covered 12 weeks.The changes of traditional Chinese medicine(TCM)syndrome scores,maximum cross-section diameter of the thyroid nodule and thyroid function indexes of thyroid stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)in the two groups before and after treatment were observed.After treatment,the clinical efficacy and adverse reactions were compared between the two groups.Results(1)After 12 weeks of treatment,the total effective rate of the observation group was 73.33%(22/30),and that of the control group was 10.00%(3/30).The intergroup comparison(tested by chi-square test)showed that the efficacy of the observation group was significantly superior to that of the control group(P＜0.01).(2)After treatment,the TCM syndrome scores of the observation group were significantly lower than those before treatment(P＜0.01),and the maximum cross-section diameter of the thyroid nodule was significantly smaller than that before treatment(P＜0.01).However,no obvious improvement of TCM syndromes and the maximum cross-section diameter of the thyroid nodule was presented in the control group(P＞0.05).The intergroup comparison showed that the decrease of TCM syndrome scores and the reduction of the maximum cross-section diameter of the thyroid nodule in the observation group were significantly superior to those in the control group(P＞0.05).(4)During the treatment,no obvious adverse reactions occurred in the two groups,indicating high safety.Conclusion Xiaoying Sanjie Granules exerts certain effects on patients with benign thyroid nodules of qi stagnation and phlegm obstruction type.The granuels are effective on significantly reduce the maximum cross-section diameter of the thyroid nodule,improve the clinical symptoms of patients,and has fewer adverse reactions,with high safety.