ObjectiveTo investigate the effects of Xinjia Congrong Tusizi decoction （XJCTD） on ovarian functions in the rat model of premature ovarian insufficiency （POI） and decipher the mechanism of regulating the tumor suppressor protein （p53）/nuclear factor E₂-related factor 2 （Nrf2） pathway to attenuate granulosa cell ferroptosis. MethodForty-eight SPF-grade female SD rats were randomized into control， model， low-， medium-， and high-dose （1.1， 2.2， 4.4 g·kg^-1） XJCTD， and Western medicine （coenzyme Q₁₀， 0.002 7 g·kg^-1） groups， with eight rats in each group. The rat model of POI was established by gavage of triptolide （TP）， and after successful modeling， each group was administrated with the corresponding drugs by gavage for 14 d. The body weight and ovarian weight of each rat were weighed and the ovarian index was calculated. The morphology of the ovarian tissue was observed by hematoxylin-eosin staining， and the proportions of growing follicles and atretic follicles were calculated. The serum levels of anti-Müllerian hormone （AMM）， estradiol （E₂）， and follicle-stimulating hormone （FSH） were measured by enzyme-linked immunosorbent assay （ELISA）. The DCFH-DA fluorescent probe was used to measure the reactive oxygen species （ROS） content in granulosa cells. The content of cellular Ferrous ion （Fe²⁺）， lipid peroxide （LPO）， malondialdehyde （MDA）， glutathione （GSH）， and superoxide dismutase （SOD） was detected by colorimetry. The expression of the tumor suppressor protein p53，Nrf2， solute carrier family 7 member 11 （SLC7A11）， and glutathione peroxidase 4 （GPX4） was determined by immunohistochemistry and Western blot. ResultCompared with the control group， the model group showed decreased ovarian weight， body weight， and ovarian index （P<0.01）， reduced ovarian tissue volume and proportion of growing follicles （P<0.01）， increased proportion of atretic follicles （P<0.01）， lowered AMH and E₂ levels and elevated FSH level in the serum （P<0.01）， and elevated levels of Fe²⁺， ROS， LPO， and MDA （P<0.01） and lowered levels of GSH and SOD in granulosa cells （P<0.01）. Moreover， the modeling up-regulated the expression of p53 （P<0.01） and down-regulated the expression of Nrf2， SLC7A11， and GPX4 （P<0.05， P<0.01） in the ovarian tissue. Compared with the model group， XJCTD increased the body weight， ovarian weight， and ovarian index （P<0.01）， alleviated the pathological changes in the ovarian tissue， increased the proportion of growing follicles （P<0.01）， decreased the proportion of atretic follicles （P<0.01）， and reduced the content of ROS in granulosa cells （P<0.05， P<0.01）. In addition， medium- and high-dose XJCTD lowered the FSH level （P<0.01） and raised E₂ and AMH levels （P<0.01） in the serum， reduced the Fe²⁺ content （P<0.05， P<0.01）， and increased the SOD content （P<0.01） in granulosa cells. High-dose XJCTD reduced the LPO and MDA content （P<0.01） and increased the SOD content （P<0.01） in the granulosa cells， down-regulated the expression of p53 （P<0.05）， and up-regulated the expression of Nrf2， SLC7A11， and GPX4 in the ovarian tissue （P<0.05， P<0.01）. ConclusionXJCTD may protect the ovarian function in the rat model of POI by regulating the p53/Nrf2 signaling pathway to attenuate the ferroptosis of ovarian granulosa cells.

Objective To determine the effect of isopsoralen(ISO)on the healing of tibia fracture in mice and explore its underlying mechanism.Methods Fifty male C57BL/6 mice(2 month old,20±2 g)were randomly divided into model group and ISO treatment group,with 25 animals in each group.From the 3rd day after modeling,the mice from the ISO group were given an intragastric gavage of 40 mg/kg ISO,once per day for 28 consecutive days,while those of the model group was given same volume of normal saline in same way.On the 7th,14th,21st,and 28th day after gavage,the tibia on the surgical side was taken,and the fracture area was quantified by bone volume/total volume(BV/TV)after micro-CT scanning.The healing and shaping of the fracture end were observed through HE staining.ELISA was used to detect the serum contents of bone alkaline phosphatase(BALP)and procollagen type I N-terminal peptide(PINP)on the 14th day of gavage.Western blotting was employed to determine the expression levels of Collagen Ⅰ,Runx2,BMP2,OSX,and VEGF in the tibial callus tissue in 7 and 14 d after gavage.Vascular perfusion was applied to observe the callus microvessels in 28 d to quantitatively analyze the vascular volume fraction and vessel diameter.Immunohistochemical staining was conducted to observe the expression of VEGF in the callus in 14 d after gavage.Results HE staining displayed that the ISO group had faster healing process than the model group.Micro-CT quantification results showed that the ISO group had higher BV/TV ratio in 7 d after gavage though no statistical difference,significantly higher ratio in 14 d(P＜0.05),but obviously lower ratio in 21 and 28 d after gavage(both P＜0.05)when compared with the model group.The serum contents of BALP and PINP were also remarkably higher in the ISO group than the model group(P＜0.05).Western blotting results indicated that the expression levels of Collagen Ⅰ,Runx2,BMP2,OSX and VEGF in the ISO group were higher than those in the model group(P＜0.05).The results of angiography revealed that the vascular volume fraction and vessel diameter were notably increased in the ISO group than the model group(both P＜0.05).Immunohistochemical assay showed that the expression of VEGF was higher in the ISO group than the model group(P＜0.05).Conclusion ISO can improve the activity of osteoblasts,increase the expression of osteogenesis-related proteins,and accelerate the angiogenesis to promote fracture healing.

Objective To observe the effects of different concentration and intervention time of triptolide(TP)on ovarian oxidative stress and mitophagy in rats.Methods Fifty 3-month-old female Sprague-Dawley rats were observed for 2 consecutive estrus cycles,and 25 rats with normal estrus cycles were selected and divided into the blank control group,experiment group 1,experiment group 2,experiment group 3 and experiment group 4 according to random number table method,with 5 rats in each group.Rats in experiment group 1 were administered intragastrically 400 μg·kg-1 TP once a day for 30 d.Rats in experiment group 2 were given 400 μg·kg-1 TP once a day for 40 d.Rats in experiment group 3 were given 500 μg·kg-1 TP once a day for 30 d.Rats in the experiment group 4 were given 500 μg·kg-1 TP once a day for 40d.Rats in the blank control group were given 10 mL·kg-1 distilled water once a day for 40 d.Serum anti-mullerian hormone(AMH),estradiol(E2)and follicle-stimulating hormone(FSH)levels were detected by enzyme-linked immunosorbent assay;hematoxylin-eosin staining was used to observe the pathological changes of ovarian tissue;malondialdehyde(MDA)level and superoxide dismutase(SOD)activity in ovarian tissue were detected by microplate reader.The morphological and structural changes of mitochondria in ovarian granulosa cells of rats in each group were observed by transmission electron microscope,and the apoptosis rate of ovarian granulosa cells was detected by flow cytometer.Results Compared with the blank control group,the levels of AMH and E2 in serum and SOD activity in ovarian tissue of rats in the experiment groups 1,2,3 and 4 significantly decreased,while the levels of FSH in serum and MDA in ovarian tissue significantly increased(P＜0.05).Compared with the experiment group 1,the levels of AMH and E2 in serum and SOD activity in ovarian tissue of rats in experiment groups 2,3 and 4 significantly decreased,while the levels of FSH in serum and MDA in ovarian tissue significantly increased(P＜0.05).There was no significant difference in the levels of AMH,E2 and FSH in serum,SOD activity and MDA level in ovarian tissue of rats among experiment groups 2,3 and 4(P＞0.05).The apoptosis rate of ovarian granulosa cells in experiment groups 1,2,3 and 4 was significantly higher than that in the blank control group(P＜0.05);the apoptosis rate of ovarian granulosa cells in experiment groups 2,3 and 4 was significantly higher than that in experiment group 1(P＜0.05);the apoptosis rate of ovarian granulosa cells in experiment groups 3 and 4 was significantly higher than that in experiment group 2(P＜0.05);the apoptosis rate of ovarian granulosa cells in experiment group 4 was significantly higher than that in experiment group 3(P＜0.05).In the blank control group,the ovarian tissue capsule was intact,and the number and development of primordial,primary and secondary follicles in the cortex were normal,with rare atretic follicles and less corpus luteum.The fibrous connective tissue in the medullary area was closely arranged,and no obvious edema or necrosis was observed.In experiment groups 1,2,3 and 4,the number of follicles in ovarian tissue decreased,the number of atretic follicles increased,and necrosis and shedding of follicles in the granular layer and cystic dilatation of follicles were observed.The pathological changes of ovarian tissue in experiment group 1 were relatively light,with fewer atretic follicles and less cell necrosis in the granulosa cell layer.The degree of ovarian tissue lesions in experiment group 4 was the most severe,with more atretic follicles and cell necrosis and shedding in the granulosa cell layer.The degree of ovarian tissue lesions in experiment groups 2 and 3 was less than that in experiment group 4,with fewer atretic follicles,necrosis of granulosa cell layer and follicle cystic dilatation.In the blank control group,the ovarian granulosa cells were normal in morphology and structure,with irregular polygon nuclei,uniform distribution of chromatin,mainly euchromatin,clear and complete nuclear membrane,mitochondria and other organelles with complete and clear structure visible in the cytoplasm.Different degrees of mitophagy were observed in the cytoplasm of granulosa cells of rats in experiment groups 1,2,3 and 4;the mitophagy of rats in experiment groups 2,3 and 4 was more severe than that in experiment group 1;that in experiment groups 3 and 4 was more severe than experiment group 2;the mitophagy of rats in experiment group 3 was similar to that in experiment group 4.Under electron microscopy,more mitochondrial autophagosomes were found in the cytoplasm of ovarian granulosa cells in experiment groups 3 and 4.Most mitochondria were mildly swollen,some mitochondrial crista structures disappeared,and the rough endoplasmic reticulum showed cystic dilatation.Conclusion The ovarian dysfunc-tion model in rats can be successfully established by TP intragastric administration.The ovarian injury of rats is related to TP dose and intervention time.TP-induced ovarian oxidative stress may be an important factor triggering ovarian hypofunction,and it may work through oxidative stress affecting ovarian endocrine function and inducing granulosa cell apoptosis and other patho-physiological processes.With the aggravation of oxidative stress damage,the mitophagy increases.After reaching a certain de-gree,mitophagy will not continue to increase with the increase of TP intervention time.

Objective To explore the effects of Xin Jia Congrong Tusizi decoction on mitochondrial biosynthesis and mitochondrial function in ovarian granulosa cells.Methods We prepared the functional injury model of human ovarian granulosa cells KGN induced by triptolide.We divided the cells into control group,model group,Tiao jing Cuyun Pill group,Xin Jia Congrong Tusizi decoction group,SIRT1 inhibitor group and SIRT1 inhibitor+Xin Jia Congrong Tusizi decoction group.After 6 h incubation with triptolide to cause functional impairment of granulosa cells,SIRT1 inhibitor,blank serum and medicated serum were added for 48 h.Cell viability and apoptosis rate were assessed using CCK-8 and flow cytometry.Anti-Müllerian(AMH),follicle-stimulating hormone(FSH)and inhibin B(INHB)were detected by ELISA.ATP enzyme and MMP were used to detect by biochemical kit and JC-1 method.apoptosis rate and MMP were assessed using flow cytometry.The morphology,structure,quantity and activity changes of mitochondria were observed by electron microscope and fluorescence microscope.Western blot and PCR were used to detect the protein and mRNA expressions of SIRT1,p-SIRT1,PGC-1α,NRF1 and TFAM.Results Chinese patent medicine TiaojingCuyun Pill and bushen Yangxue Huoxue therapy compound Xin Jia Congrong Tusizi decoction augmented the activity of granulosa cells(P<0.05),decreased the apoptosis rate(P<0.05),increased ATP enzyme and MMP(P<0.05),improved mitochondrial morphological and structural damage,added the mtDNA level,the number and activity of mitochondria(P<0.01)and up-regulated and the protein and mRNA expressions of SIRT1,PGC-1α,NRF1,TFAM(P<0.05).Conclusion Xin Jia Congrong Tusizi decoction protected ovarian granulosa cells damage caused by triptolide.Its mechanism may related to improve mitochondrial dysfunction by regulating SIRT1/PGC-1α signaling pathway in order to promote the biosynthesis of new mitochondria.

Hypovarianism diseases mainly include diminished ovarian reserve， premature ovarian insufficiency， and premature ovarian failure， which decreased female reproductive capacity due to various causes. Mitochondrial dysfunction in ovarian cells can interfere with the pathway of mitochondrial energy supply to germ cells and affect follicular development and egg quality. Therefore， the role of mitochondrial homeostasis in the pathogenesis of such diseases has gradually received attention. Traditional Chinese medicine （TCM） believes that the pathogenesis of hypovarianism diseases is deficiency of kidney Qi， essence and blood as well as stasis caused by deficiency. Accordingly， tonifying kidney and nourishing and activating blood is established as the fundamental treatment. In TCM， Chinese herbal compounds for tonifying kidney， replenishing essence， and nourishing and activating blood were mostly used， which can improve the secretion of ovarian hormones and ovulatory function to enhance female reproductive capacity. These compounds have definite clinical efficacy and unique advantage of treating different diseases with same method. The effect of Chinese herbal compounds for tonifying kidney and nourishing and activating blood on "Qi and blood" is closely related to mitochondrial function， and thus more and more studies have been conducted to explore the experimental mechanism of these Chinese herbal compounds in regulating mitochondrial homeostasis and protecting ovarian function. On this basis， the paper summarized and elaborated the experimental studies on the dynamic regulation of mitochondrial homeostasis in the treatment of hypovarianism diseases by Chinese herbal compounds for tonifying kidney， replenishing essence and nourishing and activating blood. Moreover， the paper reviewed the related mechanism of regulating mitochondrial homeostasis in ovarian cells， promoting follicular development， and delaying ovarian aging by Chinese herbal compounds for tonifying kidney and nourishing and activating blood through improving mitochondrial function， resisting mitochondrial oxidative stress damage as well as regulating mitochondrial quality and quantity in multi-effect and multi-target way， in order to provide a new perspective for further research on improving female fertility with Chinese medicine.

Objective:To analyze the clinical effect of real-time virtual sonography (RVS) surgical navigation combined with indocyanine green fluorescence imaging technology in the anatomical liver segmentectomy for hepatocellular carcinoma (HCC).Methods:The clinical data of 35 patients who underwent anatomical liver segmentectomy using RVS surgical navigation combined with indocyanine green fluorescence imaging technology in the Department of Hepatobiliary Surgery of Peking University International Hospital from January 2020 to January 2022 were retrospectively analyzed. There were 22 males and 13 females, aged (60.0±10.0) years. RVS is real-time virtual sonography, which fuses real-time intraoperative ultrasound images with corresponding preoperative CT or MRI images to guide the surgical plane. Methods of operation, time of operation, intraoperative blood loss, operative margin, hospital stay and postoperative complications were analyzed. Postoperative complications were graded by Clavien-Dindo system. The 1-year overall survival and tumor-free survival rates of patients were followed up by outpatient or telephone review.Results:Anatomical liver segmentectomy was performed on 36 patients, including 1 patient (2.9%) of segment Ⅱ, 1 patient (2.9%) of segment Ⅲ, 5 patients (14.3%) of segment Ⅳ, 6 patients (17.1%) of segment Ⅴ, 10 patients (28.6%) of segment Ⅵ, 7 patients (20.0%) of segment Ⅶ, 4 patients (11.4%) of segment Ⅷ, and 1 patient (2.9%) of segments Ⅴ+ Ⅷ. The operation time of 35 patients was (310.2±81.6) min, with an intraoperative blood loss of [ M( Q1, Q3)] 390.0(250.0, 500.0) ml. The hospital stay was (11.6±2.1) d. There was no postoperative death. Postoperative complications occurred in 3 cases (8.6%), of which 2 cases (5.7%) were ascites, Clavien-Dindo grade Ⅰ; Postoperative hemorrhage occurred in 1 case (2.9%), Clavien-Dindo grade Ⅱ. HCC was confirmed by pathology in all cases, and the operative margins were negative. The median follow-up time was 14 months (12 to 20 months). The 1-year overall survival rate after surgery was 100.0%(35/35), three patients (8.6%) had tumor recurrence, and the 1-year tumor-free survival rate was 91.4% (32/35). Conclusion:RVS surgical navigation combined with indocyanine green fluorescence imaging technology could be feasible in anatomical segmental hepatectomy for HCC.

In recent years, there have been increasing studies on the role of microorganisms in pancreatic cancer which show that bacteria and fungi are closely associated with pancreatic cancer. In the past, the pancreas has usually been considered as a sterile organ. Recent studies, however, show that microbiome exists in the pancreas. Bacteria can migrate from the intestine to the pancreas. Changing the composition of the microbiome may have positive effects on treatment of pancreatic cancer. This article reviews the relationship between gastrointestinal microbiome and pancreatic cancer.

Objective:To study the effects of a simulated plateau environment on fracture healing in rats.Methods:A rat model of mid-femoral fracture was established by hacksaw truncation and intramedullary fixation with Kirschner wires in 60 male Wistar rats which were divide into 2 groups ( n=30) by the random number table method. The rats in the control group were raised in the animal experiment center of The 940 Hospital of Joint Logistic Support Force of Chinese PLA at an altitude of 1,400 m, while the rats in the plateau group were placed in an animal experimental cabin in a simulated plateau environment at a simulated altitude of 5,000 m. The body weight was weighed once a week and X-ray films were taken every 2 weeks. Blood samples were collected after 4 weeks for detection of biochemical indicators of bone metabolism. After 8 weeks, the femurs of the surgical side were taken for bone biomechanical detection and the bone mineral density of the healthy side was detected. After 4 and 8 weeks, the femurs of the surgical side were taken for in vitro Micro-CT scanning and angiography detection. After 1, 2, 4 and 8 weeks, the femurs of the surgical side were taken for bone histopathologic detection. Results:During the entire experiment, no rats in the control group died while the mortality rate of the rats in the plateau group was as high as 26.7% (8/30). In the plateau group, some organs were pathologically damaged in the rats, fracture union was delayed, and the callus differentiated and matured slowly with the chondrocytes still dominant at the 8th week. The bone mineral density and the maximum load of the femur in the plateau group were significantly lower than those in the control group ( P< 0.05). Angiography showed that the rats in the plateau group had microvascular proliferation which did not penetrate the fracture end at the 8th week. The bone formation indexes like osteocalcin, procollagen type Ⅰ N-terminal propeptide (PⅠNP), and osteoprotegerin of the rats in the plateau group were significantly lower than those in the control group at the 4th week ( P<0.05). The bone resorption indexes like tartrate resistant acid phosphatase 5b (TRACP-5b) and receptor activator for nuclear factor-κB ligand (RANKL) in the plateau group were significantly higher than those in the control group ( P<0.05). Conclusion:A simulated plateau environment at an altitude of 5,000 m may lead to delayed fracture healing in rats.

Gastric schwannoma is a tumor originating from mesenchymal tissue. The clinical incidence is relatively rare, accounting for 6.3% of all gastric stromal tumors. The tumor is more likely to occur in the body of the stomach and usually originates from the gastric submucosal nerve. Most gastric schwannomas do not have any clinical symptoms. Imaging examination can play a diagnostic role, but the diagnosis still requires pathological examination, especially S-100 protein which is the gold standard for the diagnosis of gastric schwannomas. Gastric schwannoma usually needs to be distinguished from gastrointestinal stromal tumors and gastrointestinal autonomic nerve tumors. In terms of treatment, complete surgical resection is the first choice.

Objective:To investigate the clinical features, treatment methods of metastatic liver leiomyosarcoma (MLL).Methods:The characteristics of 5 cases of MLL were reviewed and summarized. Among them, 4 cases were derived from retroperitoneal leiomyosarcoma and 1 case was derived from uterine leiomyosarcoma. In terms of metastasis time, 1 case was simultaneous liver metastasis and 4 cases were heterochronous liver metastases, all of which were more than 2 years away from the primary tumor resection.Results:One patient died within 2 years after the diagnosis of MLL, and this patient had not undergone surgical treatment for liver metastases. Of the 4 patients who had had the metastasis resection, 2 patients died within 3 years. Currently, 2 patients are alive, 1 patient after 36 months, and 1 patient after 29 months.Conclusion:MLL occurs mostly years after the primary tumor is removed. Currently, surgical treatment is considered to be the main treatment method for MLL, which can significantly prolong the patients survival.