ObjectiveTo investigate the transformation mechanism and content variation of saponins from Polygalae Radix before and after being boiled with licorice juice and water. MethodSimulated licorice juice boiled products and simulated water boiled products of onjisaponin B， onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ were prepared by simulated processing technology， and analyzed by ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Exactive Orbitrap/MS）. Then the contents of onjisaponin B， onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ and tenuifolin in Polygalae Radix， licorice-boiled Polygalae Radix and water-boiled Polygalae Radix were determined by UPLC-triple quadrupole tandem mass spectrometry（UPLC-QQQ-MS/MS）. ResultDuring the boiling process with licorice juice and water， onjisaponin B could be hydrolyzed to produce 4-methoxycinnamic acid， desacylsenegin Ⅲ， polygalasaponin ⅩⅩⅧ and tenuifolin， onjisaponin Z could be hydrolyzed to produce 3，4，5-trimethoxycinnamic acid， onjisaponin TF， polygalasaponin ⅩⅩⅧ and tenuifolin， onjisaponin F could be hydrolyzed to produce 3，4，5-trimethoxycinnamic acid， onjisaponin G， polygalasaponin ⅩⅩⅧ and tenuifolin， and polygalasaponin ⅩⅩⅧ was hydrolyzed to produce tenuifolin. After being boiled with licorice juice or water， the content of onjisaponin B decreased significantly（P<0.05， P<0.01）， but the contents of onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ and tenuifolin increased significantly（P<0.05， P<0.01） in Polygalae Radix. Compared with the water-boiled products， the contents of onjisaponin Z and tenuifolin increased significantly（P<0.05， P<0.01）， and the change of tenuifolin content was the most significant in the licorice-boiled products.However， there was no significant difference in the content of onjisaponin B， onjisaponin F and polygalasaponin ⅩⅩⅧ between the water-boiled products and the licorice-boiled products. ConclusionBeing boiled with licorice juice or water can hydrolyze onjisaponin B， onjisaponin Z， onjisaponin F and polygalasaponin ⅩⅩⅧ， and generate secondary glycosides and aglycones（organic acids） through deglycosylation， which leads to obvious changes in the contents of onjisaponins after Polygalae Radix being processed.It is inferred that licorice juice can promote the hydrolysis of some onjisaponins in Polygalae Radix to onjisaponin Z and tenuifolin.This study provides an experimental basis for revealing processing mechanism of Polygalae Radix.

Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China. Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose. Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week⁻¹, 1-4 servings·week⁻¹, and ≥5 servings·week⁻¹. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d⁻¹ increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose. Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week⁻¹, 1-4 servings·week⁻¹, and ≥5 servings·week⁻¹ were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week⁻¹ group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week⁻¹ group compared to the <1 serving·week⁻¹ SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (P_interaction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L⁻¹ and 0.18 mmol·L⁻¹, respectively (P<0.05), and no significant increase in fasting plasma glucose was found (P>0.05). Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.

AIM To determine the contents of arillanin A,tenuifoliside A and tenuifoliside C in raw Polygalae Radix (root barks),Polygalae Radix duramen,Glycyrrhizae Radix et Rhizoma-processed Polygalae Radix,waterboiling Polygalae Radix and honey-processed Polygalae Radix.METHODS The analyses of 50％ methanol extracts from samples were performed on a 30 ℃ thermostatic Kromasil C18 column (250 mm ×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1％ formic acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 330 nm.RESULTS The contents of three oligosaccharide esters were the highest in raw Polygalae Radix,followed by those in honey-processed Polygalae Radix,and those in water-boiling Polygalae Radix were the lowest.These constituents also existed in Polygalae Radix duramen,but their contents were lower than those in root barks.CONCLUSION The ester bonds of oligosaccharide esters in Polygalae Radix may be hydrolyzed during processing,followed by the generation of small molecular organic acids.The medication of whole Polygalae Radix (root barks and duramen) can be taken into consideration in clinical practice to reduce toxicity and enhance efficacy.

ObjectiveTo assess the effect of hemodialysis(HD),hemodiafiltration(HDF) and hemodialysis(HD) and hemoperfusion(HDP) on the quality of life,cognitive function and nutritional status in chronic renal failure(CRF) patients.MethodsAll patients were randomly divided into HD,HDF and HDP group.Mini-mental state examination(MMSE),Wisconsin card sorting test (WCST),SF-36 were measured for cognitive function,quality of life and nutrition indicators test.ResultsAfter 3,6 months treatment,MMSE ( respectively ( 22.62 ±3.85),(25.10 ±2.26),(25.35 ±2.44)and (23.87 ±4.19),(25.10 ±2.26),(27.19 ±2.23)),WCST indicators were statistically significant in the three groups (P ＜ 0.05 ) ;after 1,3,6 months treatment,the PF,RP,BP,GH,SF and nutrition indicators were significant difference too(P＜0.05 ) ; HDP and HDF,HD groups were statistically significant(P＜ 0.05 ).ConclusionHDF and HDP obviously influence on long-term cognitive function,physical health domains and nutritional status in CRF patients,and superior to HD.

Objective To analyze the clinical features of the hospitalized children with laboratory-confirmed influenza in Suzhou. Methods The demographic information, laboratory test results, clinical features, treatments and outcomes of the hospitalized children with laboratoryconfirmed influenza were collected retrospectively. The data were analyzed using chi square test,Cochran-Armitage trend test. Results Four hundred and eighty hospitalized children were diagnosed with laboratory-confirmed influenza during the period of 2005 to 2009. Among these cases, 414 were subtype A and 66 were subtype B. The positive rate was 2.66%. Four hundred and nineteen cases (87.29 %) were ≤ 5 years old. Most of the cases developed during winter (from December to April the next year) and summer (from July to August). The age and sex distribution didn't vary from year to year (x2=9. 7768,x2 = 8. 7573; both P＞0.05). The mean disease course was (16.22± 9.41)days, and the mean hospitalization duration was (7.89 ±2.97) days. The percentages of patients with symptoms of fever, dyspnea and diarrhea or requiring oxygen treatment decreased with age (Z =4. 9430, Z=2. 1021, Z=3. 2073 and Z=2. 3277, respectively; all P＜0.05). The percentages of cases with concomitant pneumonia and upper respiratory infection also decreased with age (Z =-3. 8762 and Z=-3. 5095, respectively; both P＜0.01). Fifteen point five percent (60/387 cases)of the cases were co-infected with pneumococcus and 15. 0% (72/480 cases) were co-infected with respiratory syncytial virus (RSV). The level of C-reactive protein was significantly higher in cases with bacterial co-infection than those with viral co-infection (Z= -3.1290, P ＜ 0. 01 ).Conclusions Hospitalized children with influenza are more common in winter and summer in Shuzhou.Many patients are co-infected with pneumococcus or RSV. The symptoms are more severe in younger children.

Objective To improve the recognition of pituitary hyperplasia secondary to primary hypothyroidism by analyzing clinical and imaging data. Methods The clinical features, hormone data,imaging findings, and treatment were reviewed in 32 patients with pituitary hyperplasia secondary to primary hypothyroidism in Huashan Hospital from 1999 to 2008. Results Thirty-two patients, most juvenile,presented clinical and imaging features suggestive of functional primary pituitary adenoma. The dose of levothyroxine was increased to maintain the thyrotropin concentration at normal values. Following adequate thyroxine replacement, pituitary hyperplasia regressed on average within 6 months. Conclusions Pituitary hyperplasia secondary to primary hypothyroidism seems to be quite prevalent in children and adolescents.Complete regression will be achieved with thyroxine replacement therapy.

OBJECTIVETo explore the species, distributing and resource of Paris genus plants in Xishuangbanna area of Yunnan province.

METHODTwo steps, talking with the folk doctors and field survey, were employed to explore the resource status of Paris plants. Twenty six villages and towns, which are at an elevation of 500 m to 2000 m, were investigated.

RESULTA total of 214 specimens were collected and identified according to morphological characteristics. All investigated spots had Paris genus resources distribution but there always had a small Paris population less than 20. The Paris genus is an understory plants which lives always in a specific environment beside creek in hill valley and with many commensal plants such as bamboo and broadleaf. Three species of Paris, P. polyphylla var. yunnanensis, P. polyphylla var. chinensis, and P. vietnamensis were collected and identified.

CONCLUSIONParis genus resources declined rapidly in recent year, particular the P. polyphylla var. yunnanensis. Developing the breeding and cultivation technologies and enhancing the resources protection are needed urgently.

AIM:To establish the quality standard of Biling Weitong Granules (Rhizoma Corydalis, Radix et Rhizoma Rhei, Rhizoma Coptidis, etc.). METHODS: Rhizoma Corydalis, Radix et Rhizoma Rhei, Rhizoma Coptidis, Fructus Evodiae, Fructus Litseae were identified by TLC. The content of berberine hydrochloride was determined by RP-HPLC C_ 18 column(ODS, 250 mm?4.6 mm, 5 ?m) was used as chromatographic column. The acetonitrile-0.02 mol/L potassium dihydrogen phosphate (Adjust with phosphoric acid to a pH of 3.0) (25∶75) was used as mobile phase. The detection wavelength was at 347 nm. The flow rate was kept to 1.0 mL/min. RESULTS: The TLC sports developed were fairly clear, and the blank test showed no interference. The linearity of berberine hydrochloride was good in the range of 0.041 32-0.619 8 ?g(r= 0.999 9 ). The average recovery of berberine hydrochloride was 101.93%, RSD=0.60%(n=6). CONCLUSION: The method is simple, reliable, accurate and can be applied as the quantity control method of Biling Weitong Granules.