ObjectiveUltra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS） was used to identify the metabolites of harmine in rats， in order to explore the differences in distribution of metabolites in rats after single dose（40 mg·kg^-1） intragastric administration of harmine， as well to speculate the metabolic pathways. MethodSD rats were given a single dose of harmine by intragastric administration. Plasma， bile， urine and feces samples were collected after administration， and the samples were processed for determination by UPLC-Q-TOF-MS. The separation was performed on an ACQUITY UPLC™ HSS T3 columu（2.1 mm×100 mm， 1.8 μm） with acetonitrile（A）-0.1% formic acid aqueous solution（B） as mobile phase for gradient elution（0-2 min， 5%A； 2-9 min， 5%-35%A； 9-9.5 min， 35%-100%A； 9.5-12 min， 100%A； 12-12.5 min， 100%-5%A； 12.5-14 min， 5%A）， the mass spectra were obtained in positive ion mode with electrospray ionization（ESI）， the scanning range was m/z 50-1 200. The metabolites of harmine were identified based on the information of the obtained compounds and the literature data， and the metabolic pathways were hypothesized. ResultA total of 42 compounds（harmine and its metabolites） were identified in rats， including 27 in plasma， 17 in bile， 26 in urine and 13 in feces. The metabolic pathways involved in these 42 metabolites included monohydroxylation， dihydroxylation， demethylation， glucuronidation and sulfation. ConclusionHarmine can undergo phase Ⅰ and phase Ⅱ metabolic reactions in rats， and the prototype drug is metabolized rapidly in vivo， and the metabolites are mainly excreted by the kidneys， which can provide a reference basis for the pharmacodynamics and material basis of harmine.

Objective:To investigate the short-term effect of Helicobacter pylori ( HP) eradication on intraoperative bleeding during endoscopic submucosal dissection (ESD) for early gastric cancer. Methods:Patients who underwent ESD for early gastric cancer in Shanghai East Hospital from September 2021 to September 2023 were retrospectively analyzed for endoscopic, pathological and clinical data. The patients with current HP infection were included in the current infection group, and those who underwent eradication therapy within 10 weeks and successfully eradicated were included in the short-term after eradication group. The occurrence of intraoperative bleeding was compared. Results:A total of 345 patients were analyzed, with 156 in the current infection group and 189 in the short-term after eradication group. Compared with the current infection group, short-term after eradication group was effective in reducing the intraoperative bleeding rate [6.3% (12/189) VS 12.8% (20/156), χ2 =4.253, P=0.039] and significantly reduced the duration of operation (29±9 min VS 38±14 min, t=2.667, P=0.008). Intraoperative bleeding was significantly reduced in short-term after eradication group in lesions of the upper 1/3 of the stomach [12.5% (5/40) VS 32.1% (9/28), χ2 =3.887, P=0.049], while there were no significant differences in intraoperative bleeding between the current infection group and the short-term after eradication group in lesions of the middle 1/3 [5.4% (2/37) VS 10.0% (3/30), χ2 =0.506, P=0.477] and lower 1/3 [4.5% (5/112) VS 8.2% (8/98), χ2 =1.231, P=0.267] of the stomach. Conclusion:HP eradication therapy can effectively reduce intraoperative bleeding in ESD and significantly reduce the duration of operation in a short-term. For individuals with early gastric cancer and HP infection, undergoing eradication therapy before ESD is recommended, particularly for lesions situated in the upper 1/3 of the stomach.

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

To investigate the effects of streptavidin and dimethylsilicone oil on the detection rate of microscopic lesions under gastroscopy, a total of 353 patients who underwent painless gastroscopy were categorized into the experimental group (given streptavidin combined with sodium bicarbonate, n=176) and the control group (given dimethylsilicone oil combined with sodium bicarbonate, n=177). Clinical indexes such as visual field clarity, examination duration, number of rinses, detection rate of micro lesions, early cancer detection rate and incidence of adverse reactions were recorded in the gastroscopy examination of the two groups. The experimental and control groups were compared in terms of visual field clarity (1.84±0.51 points VS 2.15±0.48 points, t=-5.900), fundus mucus properties (1.04±0.43 points VS 1.46±0.76 points, t=-6.347) and number of rinses (0.76±0.66 times VS 1.18±0.72 times, t=-5.628) with significant differences ( P<0.001). The examination time in the experimental group was slightly higher than that in the control group (10.01±4.40 min VS 8.98±4.22 min, t=2.239, P=0.026). The detection rate of microscopic lesions was significantly higher in the experimental group than that in the control group [97.73%(172/176) VS 91.53%(162/177), χ2=6.665, P=0.010]. There was no significant difference in the detection rate of inflammatory hyperplasia, polyps, precancerous lesions or cancer between the experimental group and the control group ( P>0.05). There was no preoperative drinking discomfort in either group, and 4 cases of intraoperative choking occurred in each of the experimental and the control group with no significant difference ( P>0.999). No postoperative adverse reaction occurred in either group. Taking streptavidin before operation could significantly improve visual field clarity and the detection rate of microscopic lesions, which helps to detect early lesions in stomach.

ObjectiveTo establish a more accurate and sensitive liquid chromatography-ultraviolet (LC-UV) method for the determination of uric acid in rat serum, and compare the results with those of commercial kits, providing a new method for the accurate determination of uric acid in the rat hyperuricemia model induced by potassium oxonate.Methods A hyperuricemia model was established by intraperitoneal injection of potassium oxonate (300 mg/kg) into SPF-grade male SD rats, and the control group was administered an equal amount of 0.5% sodium carboxymethylcellulose solution. Blood samples were collected from the posterior orbital venous plexus and centrifuged to obtain serum samples. After precipitation with 0.1% trifluoroacetic acid-acetonitrile (containing the internal standard 3,4-dihydroxybenzylamine hydrobromide), the supernatant was injected for analysis. Uric acid was separated on a Waters XBridge HILIC column (150 mm×4.6 mm, 3.5 μm) using acetonitrile (containing 0.5% formic acid and 2 mmol/mL ammonium formate) as the organic phase and methanol solution (methanol∶water=1∶1, containing 0.5% formic acid with 2 mmol/L ammonium formate) as the aqueous phase for isocratic elution and detection at 290 nm. Serum samples treated with activated carbon were used as substitute matrices for the methodological verification. Serum uric acid levels in rats with potassium oxonate-induced hyperuricemia were measured using the established LC-UV method and commercially available kits (uricase and phosphotungstic acid methods), and the accuracies of the three methods were compared.Results Serum uric acid showed a good linear relationship (R>0.999) at mass concentration of 10–200 μg/mL in rats, the lower limit of quantification was 10 μg/mL, the accuracy ranged from -2.17% to 2.21%, the intra-batch precision ranged from 0.52% to 1.95%, the inter-batch precision ranged from 3.04% to 4.90%, and the extraction recovery ranged from 83.12% to 89.91%. In the rat model, the results obtained using the commercially available phosphotungstic acid method kit were significantly higher than those of the LC-UV method, and those obtained using the commercially available uricase method kit were significantly lower than those of the LC-UV method, but the LC-UV method showed the best recovery of the spiked sample (95.90%–99.96%).ConclusionThe LC-UV method developed in this study can determine the concentration of uric acid in rat serum with higher accuracy than commercially available kits and is recommended for the determination of serum uric acid in the rat model of hyperuricemia induced by potassium oxonate.

Lateral ankle avulsion fracture is a common sports injury that can lead to chronic lateral ankle instability and substantial deterioration of the joint function. Currently, problems such as misdiagnosis, inappropriate treatment, disparate outcomes and lack of standardization are usually met in the diagnosis and treatment of lateral ankle avulsion fracture. The Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians thus organized a working group of experts in the field of sports medicine and ankle surgery from China to develop "An evidence-based clinical guideline for the diagnosis and treatment of lateral ankle avulsion fractures (2022 version)" in accordance with the principle of evidence-based medicine and scientificity and practicability. The guideline covered the topics of imaging diagnosis, indications and methods of non-operative and operative treatment as well as postoperative rehabilitation, in order to provide guidance for the diagnosis and treatment of lateral ankle avulsion fracture.

Objective To explore the predictive values of the initial model for end-stage liver disease (MELD) score, MELD combined with serum sodium (MELD-Na) score and MELD combined with serum lactic acid (MELD-Lac) score for early survival rate after liver transplantation in patients with liver failure. Methods Clinical data of 135 recipients undergoing liver transplantation for liver failure were retrospectively analyzed. All patients were divided into the early survival group (n=110) and early death group (n=25) according to the survival at postoperative 28 d. Clinical data were compared between two groups. The optimal cut-off values of MELD, MELD-Na and MELD-Lac scores for predicting early survival rate after liver transplantation in patients with liver failure were determined by the receiver operating characteristic (ROC) curve. The predictive values of different scores for early survival rate after liver transplantation in patients with liver failure were evaluated. Results Significant differences were observed in the initial MELD, MELD-Na and MELD-Lac scores after liver transplantation between two groups (all P < 0.05). For the initial MELD, MELD-Na and MELD-Lac scores in predicting early survival rate after liver transplantation in patients with liver failure, the AUC were 0.653 [95% confidence interval (CI) 0.515-0.792], 0.648 (95%CI 0.514-0.781) and 0.809 (95%CI 0.718-0.900), the optimal cut-off values were 18.09, 18.09 and 19.97, Youden's indexes were 0.398, 0.380 and 0.525, the sensitivity was 0.680, 0.680 and 0.840, and the specificity was 0.720, 0.700 and 0.690, respectively. The AUC of MELD-Lac score was higher than those of MELD and MELD-Na scores, and the differences were statistically significant (both P < 0.05). Conclusions Compared with the initial MELD and MELD-Na scores after liver transplantation, the initial MELD-Lac score is a more reliable index for predicting early survival rate after liver transplantation in patients with liver failure.

Duchene muscular dystrophy (DMD) is a serious progressive muscular dystrophy.Reports in recent years about abnormal lipid in DMD patients have increased, yet little attention has been paid to liver lipid.This study aimed to explore the effect of dystrophin gene defect on liver lipid synthesis.7-week-old mdx male mice were used as DMD model.The conditions of liver function, liver lipid accumulation and liver lipid synthesis were determined through liver tissue morphological examination, blood biochemical examination, and detection of hepatic gene and protein expression.The results showed that lipid droplets in liver of mdx mice increased significantly.The contents of total cholesterol and triglyceride in liver, aspartate aminotransferase and alanine aminotransferase in serum increased.The gene and protein expression of hepatic lipid synthesis-related enzymes such as fatty acid synthase, acetyl CoA carboxylase, and sterol regulatory element binding protein 1-c were up-regulated.These results showed accumulation of liver lipid in 7-week-old mdx male mice.

Objective To analyze the use of antidepressants and its influencing factors in patients with depressive disorders in Haikou City,and to provide some reference for clinical rational drug use.Methods 310 patients with depressive disorder in Haikou were selected.All patients were assessed with the selfdesigned General Situation and Drug Use Questionnaire,General Self-efficacy Scale (GSES),Quality of Life Questionnaire for Psychiatric Patients (QOL-P) and Hamilton Depression Scale (HAMD-17).Results (1)The usage rate of serotonin reuptake inhibitors (SSRIs) was 53.22％,30.32％ for tricyclic antidepressants (TCAs) and 16.45％ for other new antidepressants.(2)Patients'self-efficacy (β=-0.473,OR=0.713,P=0.030),social function (β=0.371,OR=1.437,P=0.036),family income (β=-1.242,OR=0.423,P=0.001) were the factors influencing patients' choice of TCAs;family income (β=-1.762,OR=0.234,P=0.001),payment method (β =0.248,OR =1.157,P =0.030) were the factors influencing the choice of SSRIs drugs;self-efficacy (β=0.563,OR=1.913,P=0.041) and depression (β=0.543,OR=2.225,P=0.026) were the factors influencing the choice of other new antidepressants.Conclusion Traditional antidepressants such as serotonin reuptake inhibitors and tricyclic antidepressants are still widely used in patients with depressive disorders.Self-efficacy,social function,income,and payment methods can influence the drug selection of depressive patients.

Objective To evaluate the clinical outcomes of endoscopic and microsurgical treatments in patients with hypertensive basal ganglia hemorrhage (HBGH).Methods A retrospective analysis of clinical features of 37 patients received microsurgical treatment via transsylvian-transinsular approach or 32 patients received endoscopic treatment for evacuation of HBGH in our hospital from January 2011 to January 2015 was performed.The operation time,hematoma clearance rate,re-bleeding rate and prognoses of the patients were investigated.Results As compared with patients accepted microsurgical treatment,patients accepted endoscopic treatment had significantly shorter operation time,smaller peroperative bleeding volume,and shorter hemostatic time (P＜0.05).The preoperative Glasgow coma scale (GCS) scores in patients accepted endoscopic treatment and microsurgical treatment were 8.63±1.24 and 8.67±1.31,without significant difference (P＞0.05);24 h after operation,GCS scores in patients accepted endoscopic treatment increased to 12.79±1.20,which had significant difference as compared with those in patients accepted microsurgical treatment (11.23±1.29,P＜0.05).The cerebral edema volume in patients accepted endoscopic treatment and microsurgical treatment was (11.83±4.08) mL and (18.76±7.92) mL,with significant difference (t=6.460,P=0.000).The hematoma clearance and prognosis in patients accepted endoscopic treatment were better than those in patients accepted microsurgical treatment.Conclusion Endoscopic evacuation ofhematoma for HBGH is efficient and safe,enjoying better efficacy than microsurgery.