OBJECTIVE To optimize the water extraction technology for Kaixin granules. METHODS UPLC-MS/MS method was established for the simultaneous determination of ginsenoside Rg1， ginsenoside Re， ginsenoside Rb1， tenuifolin， polygalaxanthone Ⅲ and 3， 6′-disinapoyl-sucrose. An orthogonal test was designed with extraction times， extraction duration， and the volume of added water as factors. Using the contents of the aforementioned six indicator components and the extract yield as evaluation indexes， analytic hierarchy process-entropy weight method was employed to determine the combined weights of each indicator. Subsequently， process optimization and validation were conducted by integrating grey relational analysis （GRA） and back propagation （BP） neural network. RESULTS The water extraction technology optimized by the orthogonal test and GRA was 10- fold water for the first decoction and 8-fold water for the subsequent two， extracting 3 times，extracting for 1 h each time； the average comprehensive score of the validation experiment was 91.10 （RSD＝0.31%， n＝3）. The water extraction technology optimized by BP neural network was extracting 3 times with 10-fold water added each time， extracting for 1.5 h each time； the average comprehensive score of the validation experiment was 95.89 （RSD＝0.73%， n＝3）. Considering practical production requirements， the optimal water extraction technology was extraction performed three times， with 10-fold water for the first decoction and 8-fold water for the subsequent two extractions， with an extraction time of 1 h each. CONCLUSIONS The optimized water extraction technology for Kaixin granules is stable and feasible.

OBJECTIVE: To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. METHODS: Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. RESULTS: Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). CONCLUSION Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.
Humans ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Shoulder Fractures/surgery* ; Arthroplasty, Replacement, Shoulder/methods* ; Aged ; Bone Plates ; Open Fracture Reduction/methods* ; Range of Motion, Articular ; Treatment Outcome ; Shoulder Joint/physiopathology* ; Aged, 80 and over ; Operative Time ; Postoperative Complications/epidemiology* ; Length of Stay

Objective To analyze the influence of anxiety and depression on postoperative recovery of patients with acute coronary syndrome(ACS),and to analyze the relationship with neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR)and platelet-to-lymphocyte ratio(PLR).Methods A total of 108 ACS patients undergoing surgical treatment in Hainan Provincial Anning Hospital from March 2022 to March 2024 were retrospectively recruited.According to their scores of Hamilton anxiety scale and Hamilton depression scale,they were divided into an anxiety and depression group(34 cases)and a non-anxiety and depression group(74 cases).The quality of life at 1 month after surgery and serum levels of NLR,LMR and PLR at 3 d after surgery were compared between groups.Spearman correlation analysis was performed to analyze the correlation between serum NLR,LMR and PLR and anxiety as well as depression in the ACS patients.Binary logistic regression analysis was used to construct an evaluation model with NLR,LMR and PLR as variables.Receiver operating characteristic(ROC)curve was plotted to analyze the value of serum NLR,LMR and PLR in evaluating anxiety and depression.Results At 1 month after surgery,the scores of dimensions of Short-Form 36 Questionnaire(SF-36)were significantly lower in the anxiety and depression group than the non-anxiety and depression group(P＜0.01).The levels of serum NLR and PLR at 3 d post-operatively were obviously higher while that of LMR was notably lower in the anxiety and depression group than the non-anxiety and depression group(P＜0.01).Spearman correlation analysis indicated that serum NLR and PLR levels(r=0.500,P=0.000;r=0.215,P=0.026)were positively correlated,and LMR level(r=-0.474,P=0.000)was negatively correlated with co-occurrence of anxiety and depression in the ACS patients.Binary logistic regression analysis suggested that NLR,LMR and PLR were high risk factors for anxiety and depression in ACS patients(OR=6.867,95％CI:2.792-16.887,P=0.000;OR=0.180,95％CI:0.078-0.419,P=0.000;OR=1.285,95％CI:1.038-1.591,P=0.032).ROC curve analysis showed that the AUC value of the three indicators combined together in evaluating anxiety and depression in the ACS patients was 0.900(95％CI:0.827-0.949,P=0.000),with a sensitivity of 73.53％and a specificity of 95.95％.The efficiency of combined evalu-ation was superior to that of each indicator.Conclusion Anxiety and depression can affect the postoperative recovery and serum NLR,LMR and PLR in ACS patients.Early combined detection of the three indicators can provide certain value for whether ACS patients are complicated with anxiety and depression.

Objective To explore the current status of penile erection hardness and its influencing factors in patients with non-obstructive azoospermia.Methods From January to December 2024,450 patients with non-obstructive azoospermia were surveyed at the Reproductive Medicine Center of Hospital.A self-made general information questionnaire was used to collect their demographic data.The Erectile Hardness Scale(EHS)was employed to investigate the current status of their penile erection hardness,and a self-made questionnaire was utilized to explore the influencing factors.Results Among the 450 patients with non-obstructive azoospermia,during sexual intercourse,35.3%of the patients reported that their penile erection hardness could reach grade 4(normal state),54.5%reported that it only reached grade 3(sub-optimal state),9.3%reported that it only reached grade 2(slight penile erection),and 0.9%reported that it only reached grade 1(inability to achieve an erection).In the survey of satisfaction with sexual life quality,among the 450 patients,only 24.9%were very satisfied with their sexual life quality;57.3%were basically satisfied;9.6%considered it average;4.0%were dissatisfied;3.1%were very dissatisfied;and 1.1%had no sexual life.alcohol consumption(OR=2.393,95%CI:1.493～3.836),satisfaction with the quality of sexual life(OR=1.455,95%CI:1.118～1.894),educational attainment(OR=0.709,95%CI:0.549～0.917),and the sleep quality in the past month(OR=0.641,95%CI:0.452～0.907).Conclusions Clinical studies have shown that factors such as drinking habits,sexual life satisfaction,sleep quality,and educational attainment collectively influence the penile erection hardness in patients with non-obstructive azoospermia.Therefore,the medical team needs to customize personalized intervention plans and educational materials based on individual differences among patients.Through psychological counseling and lifestyle guidance,they can improve erectile function and the quality of sexual life,promote harmonious marital relationships,and enhance the overall life experience of the patients.

Objective To explore the current status of penile erection hardness and its influencing factors in patients with non-obstructive azoospermia.Methods From January to December 2024,450 patients with non-obstructive azoospermia were surveyed at the Reproductive Medicine Center of Hospital.A self-made general information questionnaire was used to collect their demographic data.The Erectile Hardness Scale(EHS)was employed to investigate the current status of their penile erection hardness,and a self-made questionnaire was utilized to explore the influencing factors.Results Among the 450 patients with non-obstructive azoospermia,during sexual intercourse,35.3%of the patients reported that their penile erection hardness could reach grade 4(normal state),54.5%reported that it only reached grade 3(sub-optimal state),9.3%reported that it only reached grade 2(slight penile erection),and 0.9%reported that it only reached grade 1(inability to achieve an erection).In the survey of satisfaction with sexual life quality,among the 450 patients,only 24.9%were very satisfied with their sexual life quality;57.3%were basically satisfied;9.6%considered it average;4.0%were dissatisfied;3.1%were very dissatisfied;and 1.1%had no sexual life.alcohol consumption(OR=2.393,95%CI:1.493～3.836),satisfaction with the quality of sexual life(OR=1.455,95%CI:1.118～1.894),educational attainment(OR=0.709,95%CI:0.549～0.917),and the sleep quality in the past month(OR=0.641,95%CI:0.452～0.907).Conclusions Clinical studies have shown that factors such as drinking habits,sexual life satisfaction,sleep quality,and educational attainment collectively influence the penile erection hardness in patients with non-obstructive azoospermia.Therefore,the medical team needs to customize personalized intervention plans and educational materials based on individual differences among patients.Through psychological counseling and lifestyle guidance,they can improve erectile function and the quality of sexual life,promote harmonious marital relationships,and enhance the overall life experience of the patients.

Based on the"brain-heart-kidney-seminal chamber"axis theory to understand the pathogenesis of coronary heart disease(CHD)complicated with erectile dysfunction(ED),it is considered that the dysfunction of the"brain-heart-kidney-seminal chamber"axis is closely related to the occurrence of CHD complicated with ED,in which kidney deficiency is the initial factor;heart brain disorder,loss of consciousness is the key to the pathogenesis;the loss of seminal chamber is an important link in the pathogenesis.Under the guidance of the concept of"brain-heart-kidney-seminal chamber"axis,Cistanches Herba-Rehmannize Radix et Praeparata-Cuscutae Semen were used to invigorate the kidney and regulate the essence of the brain,heart,kidney and seminal chamber;Salviea Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma-Schisandrae Chinensis Fructus can reach the heart and brain,calm the heart and calm the mind;Cyathulae Radix-Scolopendra-Spatholobi Caulis can adjust and restore the seminal chamber,moistening the tendons and vibrating the flaccidity.In clinical practice,the whole medication should be used to make the brain,heart and kidney in harmony with the seminal chamber at the same time,and the drugs should be flexibly added and subtracted according to the specific symptoms of patients to enhance the curative effect of CHD patients with ED.

Based on the"brain-heart-kidney-seminal chamber"axis theory to understand the pathogenesis of coronary heart disease(CHD)complicated with erectile dysfunction(ED),it is considered that the dysfunction of the"brain-heart-kidney-seminal chamber"axis is closely related to the occurrence of CHD complicated with ED,in which kidney deficiency is the initial factor;heart brain disorder,loss of consciousness is the key to the pathogenesis;the loss of seminal chamber is an important link in the pathogenesis.Under the guidance of the concept of"brain-heart-kidney-seminal chamber"axis,Cistanches Herba-Rehmannize Radix et Praeparata-Cuscutae Semen were used to invigorate the kidney and regulate the essence of the brain,heart,kidney and seminal chamber;Salviea Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma-Schisandrae Chinensis Fructus can reach the heart and brain,calm the heart and calm the mind;Cyathulae Radix-Scolopendra-Spatholobi Caulis can adjust and restore the seminal chamber,moistening the tendons and vibrating the flaccidity.In clinical practice,the whole medication should be used to make the brain,heart and kidney in harmony with the seminal chamber at the same time,and the drugs should be flexibly added and subtracted according to the specific symptoms of patients to enhance the curative effect of CHD patients with ED.

Objective To analyze the influence of anxiety and depression on postoperative recovery of patients with acute coronary syndrome(ACS),and to analyze the relationship with neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR)and platelet-to-lymphocyte ratio(PLR).Methods A total of 108 ACS patients undergoing surgical treatment in Hainan Provincial Anning Hospital from March 2022 to March 2024 were retrospectively recruited.According to their scores of Hamilton anxiety scale and Hamilton depression scale,they were divided into an anxiety and depression group(34 cases)and a non-anxiety and depression group(74 cases).The quality of life at 1 month after surgery and serum levels of NLR,LMR and PLR at 3 d after surgery were compared between groups.Spearman correlation analysis was performed to analyze the correlation between serum NLR,LMR and PLR and anxiety as well as depression in the ACS patients.Binary logistic regression analysis was used to construct an evaluation model with NLR,LMR and PLR as variables.Receiver operating characteristic(ROC)curve was plotted to analyze the value of serum NLR,LMR and PLR in evaluating anxiety and depression.Results At 1 month after surgery,the scores of dimensions of Short-Form 36 Questionnaire(SF-36)were significantly lower in the anxiety and depression group than the non-anxiety and depression group(P＜0.01).The levels of serum NLR and PLR at 3 d post-operatively were obviously higher while that of LMR was notably lower in the anxiety and depression group than the non-anxiety and depression group(P＜0.01).Spearman correlation analysis indicated that serum NLR and PLR levels(r=0.500,P=0.000;r=0.215,P=0.026)were positively correlated,and LMR level(r=-0.474,P=0.000)was negatively correlated with co-occurrence of anxiety and depression in the ACS patients.Binary logistic regression analysis suggested that NLR,LMR and PLR were high risk factors for anxiety and depression in ACS patients(OR=6.867,95％CI:2.792-16.887,P=0.000;OR=0.180,95％CI:0.078-0.419,P=0.000;OR=1.285,95％CI:1.038-1.591,P=0.032).ROC curve analysis showed that the AUC value of the three indicators combined together in evaluating anxiety and depression in the ACS patients was 0.900(95％CI:0.827-0.949,P=0.000),with a sensitivity of 73.53％and a specificity of 95.95％.The efficiency of combined evalu-ation was superior to that of each indicator.Conclusion Anxiety and depression can affect the postoperative recovery and serum NLR,LMR and PLR in ACS patients.Early combined detection of the three indicators can provide certain value for whether ACS patients are complicated with anxiety and depression.

Objective To construct recombinant human butyrylcholinesterase(rhBChE)knock-in goat fetal fibroblast cell lines(GFFs)by using clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated protein 9(Cas9)-mediated homology-directed repair mechanism for subsequent production of goat expressing rhBChE.Methods The efficient sgRNA sites targeting goat[3-casein(CSN2)gene were designed and screened,and the targeting efficiency of the sgRNA in goat mammary epithelial cells(GMECs)was confirmed by electro-transfection,flow sorting,and sequencing of PCR products.The red fluorescent reporter gene homology repair vector(P2A-mCherry)targeting the sgRNA was constructed,and then the integration and expression efficiency was detected by flow cytometry.The rhBChE homology repair vector(P2A-rhBChE)targeting the sgRNA of CSN2 gene was constructed in GFFs,the rhBChE positive cell clones were obtained via electro-transfection and flow sorting,and the rhBChE knock-in cell lines was identified by sequencing of PCR products.Results The sgRNA4 was identified as an efficient target of goat CSN2 gene,which could be also used for targeted integration of other genes.Three rhBChE knock-in cell lines were successfully constructed.Conclusion The rhBChE knock-in GFFs targeting goat CSN2 gene lays the foundation for the production of mammary bioreactors expressing rhBChE.

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.