Objective:To explore the assessment value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and tumor markers in assessing the curative effect of neoadjuvant chemotherapy for breast cancer.Methods:A total of 75 patients with breast cancer who received neoadjuvant chemotherapy combined with surgical intervention in Jining No.1 People's Hospital from May 2019 to May 2022 were selected,and they were divided into effective group(54 cases)and ineffective group(21 cases)according to the Response Evaluation Criteria In Solid Tumour(RECIST).The Ve,Kep and Ktrans of DCE-MRI quantitative parameters and CEA,CA125 and CA15-3 levels of tumor markers between two groups were compared before and after chemotherapy,and the receiver operating characteristics(ROC)curve was adopted to analyze the predictive efficiency of each diagnostic method.Results:After chemotherapy,the differences of the Ve,Kep and Ktrans of quantitative parameters between the two groups were significant(t=7.237,51.695,16.879,P<0.05),respectively.The differences of the CEA,CA125 and CA15-3 of tumor markers between two groups were significant(t=44.201,6.736,6.885,P<0.05),respectively.The AUC value of combined prediction of 6 indicators included Ve,Kep,Ktrans,CEA,CA125 and CA15-3 was 0.979 in predicting the curative effect of neoadjuvant chemotherapy for breast cancer,which was significantly higher than the AUC value of each alone indicator,and the differences of them were statistically significant(Z=2.993,2.679,2.510,2.731,3.215,3.071,P<0.05),respectively.Conclusion:The combination of tumor markers and DCE-MRI quantitative parameters can better predict the curative effect of neoadjuvant chemotherapy for breast cancer,which can indirectly assess the prognosis.

Objective:To assess the clinical efficacy and infection control outcomes of two-stage revision in managing periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) utilizing either a low or high constrained prosthesis.Methods:A retrospective analysis was performed on 40 patients who underwent revision TKA in the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from February 2019 to February 2022. According to the type of prosthesis selected in primary TKA, they were divided into low constrained prosthesis group and high constrained prosthesis group. There were 28 patients (28 knees) in the low constrained group, including 12 males and 16 females, aged 69.0(63.0, 74.0) years, with a body mass index of 25.18±0.55 kg/m 2. And there were 12 patients (12 knees) in the high-constrained group, including 5 males and 7 females, aged 66.5(65.0, 71.5) years, with a body mass index of 23.94±0.51 kg/m 2. All patients underwent two-stage revision surgery, with RHK used in 1 case and LCCK in 27 cases in the low-constrained prosthesis group. In the high-constrained prosthesis group, 3 patients were treated with RHK, 1 patient with PFC Sigma MBT, and 8 patients with LCCK. The preoperative and postoperative range of motion (ROM), Knee Society score (KSS), and postoperative infection control rate were compared between the two groups. Results:All patients were followed up. The follow-up time was 22.79±8.02 months in the low-constrained prosthesis group and 23.92±7.04 months in the high-constrained prosthesis group, with no significant difference between the two groups ( t=0.426, P=0.680). At the last follow-up, the KSS and ROM in the low-constrained prosthesis group were 77.96±9.74 and 93.48°±7.45°, respectively, significantly higher than 38.93±8.01 and 68.89°±9.44° before the operation ( P<0.05). The KSS score and ROM in the high-constrained prosthesis group were 67.83±8.31 and 80.08°±5.89° at the last follow-up, which were also significantly higher than those before operation (34.25±6.31 and 66.50°±10.48°, P<0.05). There was no significant difference in KSS and ROM between the two groups before operation ( P>0.05), but the KSS score and ROM in the low-constrained prosthesis group were significantly higher than those in the high-constrained prosthesis group at the last follow-up ( P<0.05). Bacterial culture results revealed that the primary infectious agents were coagulase-negative Staphylococcus and Staphylococcus aureus, with an overall infection control rate of 80% (32/40). The infection control rate was 89% (25/28) in the low-constrained prosthesis group and 58% (7/12) in the high-constrained prosthesis group, but the difference between the two groups was not statistically significant (χ 2=3.283, P=0.070). Conclusion:Two-stage revision effectively controls PJI, and the clinical outcomes of two-stage revision for PJI after primary TKA with a high-constrained prosthesis are inferior to those with a low-constrained prosthesis. Further exploration is needed to enhance efficacy.

Polygoni multiflori radix praeparata is a processed product of Polygoni multiflori radix(Polygonum multiflorum Thunb.),and its main components include stilbene glycosides,anthraquinones,flavonoids,alkaloids,phenolic acids,etc.It has antioxidant,antianemic,anti-tumor,hypoglycemic,anti-inflammatory effects,etc,and is widely used in clinical practice.The processing technology is mainly stewinging with black bean juice,steaming,processing for 9 times and braising and simmering.After processing,the color deepens and the content of composition changes.By consulting domestic and foreign literature,the research on Polygoni multiflori radix praeparata is not comprehensive enough compared with Polygoni multiflori radix.Therefore,this paper mainly summarizes the processing technology,chemical composition and pharmacological activity of Polygoni multiflori radix preparata reported in the past 20 years,and provides a reference for further development of Polygoni multiflori radix preparata.

Objective To carry out a proficiency testing of content determination of geniposide in Gardeniae fructus,evaluate the content determination ability of index components in traditional Chinese medicine in the laboratory of inspection and detection in drug-related fields,and improve the quality control ability of content determination of related laboratories.Methods The laboratory's capability-verification activities were conducted based on the CNAS-RL02 Rules for Proficiency Testing and ISO/IEC 17043 Conformity Assessment-General Requirements for Proficiency Testing.After preparing the sample,the results of homogeneity and stability tests were analyzed according to CNAS-GL003 Guidance on Evaluating the Homogeneity and Stability of Samples Used for Proficiency Testing.After the test results were qualified,they were used as proficiency testing samples and randomly distributed to participants.The results were collected,and the robust statistical method and the Z scores were used to analyze the results of these laboratories'reports.Results 403 laboratories in this proficiency testing program reported the results,of which 367 results were acceptable,accounting for 91.07％,17(4.22％)laboratories obtained suspicious results,and 19 laboratories gave unsatisfactory results,with the dissatisfaction rate of 4.71％.Conclusion The majority of the 403 participant laboratories have the ability to determine the content of geniposide in Gardeniae fructus by HPLC and the laboratory testing ability and quality management level of the drug monitoring system are high.This proficiency testing provides a basis for understanding the technical reserve capacity and management level of China's pharmaceutical inspection and testing laboratories,and provides technical support for future government supervision.

Background::Adamantinomatous craniopharyngioma (ACP) is the commonest pediatric sellar tumor. No effective drug is available and interpatient heterogeneity is prominent. This study aimed to identify distinct molecular subgroups of ACP based on the multi-omics profiles, imaging findings, and histological features, in order to predict the response to anti-inflammatory treatment and immunotherapies.Methods::Totally 142 Chinese cases diagnosed with craniopharyngiomas were profiled, including 119 ACPs and 23 papillary craniopharyngiomas. Whole-exome sequencing (151 tumors, including recurrent ones), RNA sequencing (84 tumors), and DNA methylome profiling (95 tumors) were performed. Consensus clustering and non-negative matrix factorization were used for subgrouping, and Cox regression were utilized for prognostic evaluation, respectively.Results::Three distinct molecular subgroups were identified: WNT, ImA, and ImB. The WNT subgroup showed higher Wnt/β-catenin pathway activity, with a greater number of epithelial cells and more predominantly solid tumors. The ImA and ImB subgroups had activated inflammatory and interferon response pathways, with enhanced immune cell infiltration and more predominantly cystic tumors. Mitogen-activated protein kinases (MEK/MAPK) signaling was activated only in ImA samples, while IL-6 and epithelial-mesenchymal transition biomarkers were highly expressed in the ImB group, mostly consisting of children. The degree of astrogliosis was significantly elevated in the ImA group, with severe finger-like protrusions at the invasive front of the tumor. The molecular subgrouping was an independent prognostic factor, with the WNT group having longer event-free survival than ImB (Cox, P = 0.04). ImA/ImB cases were more likely to respond to immune checkpoint blockade (ICB) therapy than the WNT group ( P <0.01). In the preliminary screening of subtyping markers, CD38 was significantly downregulated in WNT compared with ImA and ImB ( P = 0.01). Conclusions::ACP comprises three molecular subtypes with distinct imaging and histological features. The prognosis of the WNT type is better than that of the ImB group, which is more likely to benefit from the ICB treatment.

Objective:To analyze the factors affecting the relative height change of the patella after primary robotic-assisted total knee arthroplasty (R-TKA).Methods:The data of 97 patients with osteoarthritis of the knee treated with R-TKA admitted from June 2021 to March 2022 were retrospectively analyzed, including 15 males and 82 females, aged 70.0±5.4 years (range, 58-80 years). The bone resection parameters of the robotic system were recorded intraoperatively, including the bone resection amount of the medial and lateral distal femur, medial and lateral posterior femoral condyle and medial and lateral tibial plateau. The Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI) were used to measure the preoperative and postoperative relative patellar height on lateral radiographs, as well as the posterior tibial slope (PTS) and the change in patellar ligament length before and after surgery. The relationship between the change in relative patellar height and the variables of interest was analyzed using partial correlation and multiple linear regression.Results:The mean postoperative CDI was lower than preoperatively (0.79±0.15 vs. 0.91±0.13, t=9.69, P<0.001), and the percentage of patients with postoperative CDI<0.6 was higher than preoperatively (9.3% vs. 0; χ 2=12.92, P<0.001); the differences in mean postoperative BPI and percentage of patients with postoperative BPI<0.45 were not statistically significant compared to preoperatively (0.69±0.13 vs. 0.71±0.17, t=1.35, P=0.182; 11.3% vs. 17.5%, χ 2=1.50, P=0.220). The mean patellar ligament length on the first postoperative day was 2.29 mm shorter than preoperatively, there was a statistically significant difference ( t=5.90, P<0.001). Partial correlation analysis showed that the amount of patellar ligament length change was positively correlated with the amount of BPI and CDI change ( r=0.84, P<0.001; r=0.70, P<0.001), and the amount of PTS change and the mean distal femoral bone resection were negatively correlated with the amount of BPI ( r= -0.41, P<0.001; r=-0.32, P=0.002) and CDI ( r=-0.23, P=0.029; r=-0.25, P=0.017) change. In contrast, the amount of posterior femoral condyle bone resection and tibial plateau bone resection did not correlate with the change of BPI and CDI. Multiple linear regression analysis showed that the amount of patellar ligament length change, PTS change and the distal femoral bone resection were factors influencing the change of BPI ( β=0.03, P<0.001; β=-0.01, P<0.001; β=-0.02, P=0.021) and CDI ( β=0.02, P<0.001; β=-0.01, P=0.001; β=-0.02, P=0.008). Conclusion:Amount of patellar ligament length change, PTS change and the distal femoral bone resection are factors affecting the BPI. In order to obtain a better relative patellar height in the primary R-TKA, attention should be paid to the adjustment of the distal femoral bone resection and PTS, while taking the necessary measures to reduce the postoperative patellar ligament length changes.

Digital orthopedic technologies are increasingly being applied to the clinical practice of joint surgery. These technologies include artificial intelligence, virtual/augmented/mixed reality, 3D printing, computer navigation, robotic-assisted joint replacement surgery, and other digital orthopedic technologies. Digital orthopedic technologies continue to empower joint surgeons, simplify complex operations, achieve precision in simple operations, and to make precise operations more individualized. Thus, they are becoming important development directions for joint surgery in the future. With the help of advances in computer-aided design and additive manufacturing technology, customized joint prostheses and bone tissue repair materials provide great convenience for reconstruction of complex bone defects during revision surgery. Various types of computer-assisted navigation technologies and robot-assisted surgery technologies can help doctors improve the accuracy of osteotomy and prosthesis implantation significantly. However, to fundamentally improve patients' satisfaction after joint replacements, we need to use digital orthopedics technologies to explore the ideal target value of arthroplasty. Further, we use personalized preoperative planning with objective and accurate assessment technology of soft tissue balance, precise intraoperative operations, and the use of customized prostheses to achieve individualized and precise joint arthroplasty. Various digital orthopedic technologies have their own advantages and disadvantages. Joint surgeons should have an in-depth understanding of these technologies and make full and reasonable use of these technologies to benefit the majority of patients.

Objective To investigate the role of enteral nutrition (EN) support in the treatment of patients with chronic heart failure. Methods Ninety patients with chronic heart failure (conform to the New York Heart Association (NYHA) cardiac function class Ⅲ-Ⅳ) admitted to Intensive Care Unit (ICU), Cardiology Care Unit (CCU) and Emergency ICU (EICU) of Taizhou First People's Hospital from January 2015 to September 2017 were enrolled, and according to different nutritional methods, they were divided into a control group (rational autonomous diet group) and an observation group (Ruineng enteral nutritional emulsion for EN group), each group 45 cases. Based on the calculation (Harris-Benedict) of individual total energy consumption the control group had a reasonable autonomous diet and Ruineng EN emulsion for EN group. The chang of various nutrition indexes [including body mass index (BMI), serum total protein (TP), albumin (Alb), hemoglobin (Hb), vitamin B12, folic acid, serum iron], inflammatory factors [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)], and the level of cardiac function index (LVEF) before and after treatment were observed. Results ① Before treatment, vitamin B12 in the observation group was significantly higher than that in the control group (ng/L: 153.3±54.6 vs. 113.4±80.2, P < 0.05), there were no statistical significant differences in other indicators between the two groups (all P > 0.05). ② After treatment, compared with those before treatment, the nutritional indicators and LVEF of both groups were higher, and inflammatory factors were lower, there were statistical significant differences in the other indicators before and after treatment except Hb and IL-6 in the control group and serum iron in the observation group [the control group: BMI (kg/m2) was 20.9±1.8 vs. 19.9±1.2, TP (g/L) was 66.0±2.4 vs. 63.7±1.6, Alb (g/L) was 34.4±3.5 vs. 31.1±2.3, vitamin B12 (ng/L) was 149.5±79.2 vs. 113.4±80.2, folic acid (nmol/L) was 10.0±1.7 vs. 4.6±3.2, serum iron (μmol/L) was 16.5±13.7 vs. 10.4±7.5, TNF-α (ng/L) was 23.8±10.0 vs. 28.3±8.6, LVEF was 0.35±0.14 vs 0.32±0.04; observation group: BMI (kg/m2) was 21.5±1.4 vs. 20.2±1.4, TP (g/L) was 66.5±2.8 vs. 64.3±2.2, Alb (g/L) was 35.8±3.1 vs. 33.3±1.9, Hb (g/L) was 121.4±13.8 vs. 112.9±12.0, vitamin B12 (ng/L) was 201.1±98.6 vs. 153.3±54.6, folic acid (nmol/L) was 15.7±14.4 vs. 8.8±2.8, TNF-α (ng/L) was 20.5±6.3 vs. 25.8±3.0, IL-6 (ng/L) was 209.4±6.5 vs. 220.9±16.9, LVEF was 0.38±0.07 vs. 0.33±0.02, all P < 0.05]. ③ Before and after treatment, the changes of BMI, Hb, vitamin B12, folic acid and IL-6 in the observation group were more significant than those in the control group [BMI (kg/m2): 1.4±0.9 vs. 1.1±0.3, Hb (g/L): 8.6±1.2 vs. 2.7±0.9, vitamin B12 (ng/L): 47.1±1.0 vs. 36.2±0.9, folic acid (nmol/L): 6.8±1.8 vs. 5.5±1.8, IL-6 (ng/L):-10.8±2.3 vs. -1.6±1.0, all P < 0.05]. After treatment, the degree of increase of serum iron in the control group was more significant than that in the observation group (μmol/L: 6.2±0.8 vs. 1.4±0.9, P <0.05), there were no significant differences in the degrees of improvement in TP, Alb and TNF-α between the two groups (all P > 0.05). ④ The difference value of each indicator before and after treatment of the two groups of patients with cardiac grade Ⅲ was more significant than that in the patients with cardiac grade Ⅳ, among the indicators in the control group, Hb, serum iron and IL-6 showed statistical significant differences [Hb (g/L): 3.05±0.42 vs. 2.47±0.84, serum iron (μmol/L): 6.81±0.91 vs. 5.95±1.82, IL-6 (ng/L): -3.87±0.45 vs. -0.53±0.28, all P < 0.05], while in the observation group of patients with cardiac grade Ⅲ and Ⅳ, Alb, Hb, serum iron, IL-6 appeared statistical significant differences [Alb (g/L): 3.41±0.38 vs. 2.27±0.91, Hb (g/L): 9.83±1.44 vs. 8.10±0.98, serum iron (μmol/L): 2.23±0.34 vs. 1.04±0.88, IL-6 (ng/L):-14.11±0.42 vs. -9.45±1.01, all P < 0.05]. Conclusion In the treatment of patients with chronic cardiac failure, simultaneously EN support is given energetically, that can improve the nutrition status of organism, reduce inflammatory reaction and enhance cardiac function; the therapeutic effect of Ruineng EN support is remarkably better than that of the autonomous diet support.

Objective To observe the intervention effect of immune-enhancing enteral nutrition (EN) emulsion on immune function of critically ill patients with mechanical ventilation (MV). Methods One hundred and twenty critically ill patients with MV admitted to the Department of Emergency Intensive Care Unit (EICU) of Taizhou First People's Hospital from July 2015 to June 2017 were enrolled, and they were divided into immune-enhancing EN group and standard EN group by random numbers generated by a computer. Ultimately, 76 cases were enrolled in the study, among them, 36 cases were in the immune-enhancing nutrition group and 40 cases were in the standard nutrition group. The differences of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), the sequential organ function evaluation (SOFA) score on 1, 3, 7 days and immunity indexes (secretory immuno-globulins IgA, IgG, IgM), lymphocyte subpopulation (CD4 and CD8), duration of MV and the length of ICU stay on the 1, 7 days after EN were compared. Results Comparisons between the immune-enhancing EN group and standard EN group showed: APACHE Ⅱ score had no statistically significant difference between the two groups at each time point, SOFA score on 7 days after EN treatment was significantly decreased in the immune-enhancing EN group (2.56±1.38 vs. 3.68±2.96, P < 0.05); IgA, IgG, IgM were obviously higher in the immune-enhancing EN group than those in standard EN group on 7 days after treatment [IgA (mg/L): 2 967.6±635.6 vs. 2 525.0±592.7, IgG (mg/L): 14 982.5±2 899.7 vs. 12 996.4±2 875.9, IgM (mg/L): 1 206.8±233.3 vs. 1 093.2±165.1, all P < 0.05], CD4 (0.45±0.06 vs 0.37± 0.10) and CD8 (0.20±0.03 vs. 0.18±0.04) were significantly higher than those in standard EN group (both P < 0.05). The MV time (hours): 122.33±63.91 vs. 155.69±77.06) and ICU stay time (hours): 197.57±70.60 vs. 239.61±84.83) of the immuno-enhancing EN group were markedly shorter than those of the standard EN group (both P < 0.05). Conclusion Compared with standard EN, the immune-enhancing EN emulsion can improve the immune function of critically ill patients with MV, and shorten the duration of MV support and the length of ICU stay.

As one of the major causes of disability in the elderly population,knee osteoarthritis is a common degenerative joint disease.The general treatment approaches for knee osteoarthritis include physical therapy,nonsteroidal anti-inflammatory drugs (NSAIDs),intra-articular injection of steroid hormones,viscosupplementation and surgery,etc.Hyaluronic acid (HA) is a kind of macromolecule which plays pivotal roles in the articular physiology as a key component of synovial fluid and cartilage.Intra -articular injection of hyaluronic acid (IA-HA) is established as a local therapy to restore the viscoelasticity of synovial fluid and achieve physiological stability.Numerous clinical trials have demonstrated that IA-HA is effective in relieving pain and reducing structural damage in patients with knee osteoarthritis.Generally,the pain-relieving activity of IA-HA is comparable to or higher than that of NSAIDs,intra-articular corticosteroids,and physical therapy.In addition,IA-HA treatment is tolerated and is associated with less adverse events in comparison with NSAIDs,which elicits gastrointestinal bleedings and is associated with increased mortality.Studies in the mechanisms of action also revealed that HA could specifically bind to the membrane receptor (such as CD44) and adhesion molecules (ICAM-1) in cells.The connection may stimulate functional activities,including cell migration and proliferation.However,debates on whether hyaluronic acid produces significant clinical benefits still exist in the literature and different clinical practice guidelines.The variability in pharmaceutical property of different HA products,the severity of knee osteoarthritis,treatment protocol and injection technique can potentially have impacts on the outcomes of treatment of knee osteoarthritis with IA-HA.