The n-butanol fraction of Alpinia oxyphylla Fructus 70% ethanol extract was separated and purified using column chromatography with MCI Gel CHP-20, Sephadex LH-20, ODS, and silica gel, combined with semi preparative liquid phase and TLC separation methods. One new halogenated 4,5-seco-eudesmane sesquiterpenoid and two new eremophilane sesquiterpenoids were isolated and purified from the n-butanol fraction of Alpinia oxyphylla Fructus. The structures of the isolated compounds were identified using modern spectroscopic methods (1D, 2D NMR, UV, IR, MS, etc.), and the absolute configuration of the new compounds were determined using the methods of calculated ECD and induced ECD.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective To investigate the significance of alkaline phosphatase to albumin ratio(APAR)in the diagnosis and prognosis evaluation of trauma sepsis in patients with multiple trauma.Methods A total of 130 patients with multiple trauma treated in this hospital from January 2021 to October 2023 were selected as subjects.According to the presence or absence of trauma sepsis,they were divided into sepsis group(82 cases)and non-sepsis group(48 cases).The patients with traumatic sepsis were followed up for 28 d and divided into survival group(67 cases)and death group(15 cases)according to the prognosis.The levels of alkaline phos-phatase and albumin in peripheral blood were detected by automatic biochemical analyzer,and APAR was cal-culated.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of alkaline phosphatase,albumin,and APAR for trauma sepsis in patients with multiple trauma.Multivariate Logistic re-gression analysis was used to explore the influencing factors of the prognosis of trauma sepsis in patients with multiple trauma.Results The levels of alkaline phosphatase and APAR in sepsis group were higher than those in non-sepsis group,and the level of albumin was lower than that in non-sepsis group(P＜0.05).The area under the curve(95％CI)of alkaline phosphatase,albumin,and APAR for predicting traumatic sepsis in patients with multiple trauma were 0.753(0.702-0.801),0.849(0.798-0.900),and 0.901(0.850-0.952),respectively.The cut-off values were 142.12 U/L,27.89 g/L and 5.24,the specificity were 55.24％,66.16％and 85.43％,and the sensitivity were 91.67％,91.67％and 84.12％,respectively.The levels of alka-line phosphatase and APAR in the death group were higher than those in the survival group,and the level of albumin was lower than that in the survival group(P＜0.05).Compared with the survival group,the death group had significantly higher proportion of patients aged ≥ 60 years,sequential organ failure score,acute physiology and chronic health evaluation Ⅰ(APACHEⅡ)score,and levels of C-reactive protein,blood lactic acid,and serum creatinine(P＜0.05).Multivariate Logistic regression analysis showed that old age(OR=2.330,95％CI 1.568-3.462),high APACHE Ⅱ score(OR=2.056,95％CI 1.448-2.921),high expression of alkaline phosphatase(OR=2.479,95％CI 1.652-3.720),low expression of albumin(OR=2.525,95％CI 1.543-3.288),and high APAR(OR=2.849,95％CI 1.848-4.394)were the influencing factors of the prog-nosis of trauma sepsis in patients with multiple trauma(P＜0.05).Conclusion APAR can be used as a bio-logical index to predict trauma sepsis in patients with multiple trauma,and the abnormal increase of APAR is associated with the prognosis of trauma sepsis.

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disease caused by abnormal expression of glycosylphosphatidylinositol (GPI) on the cell membrane due to mutations in the phosphatidylinositol glycan class A(PIGA) gene. It is commonly characterized by intravascular hemolysis, repeated thrombosis, and bone marrow failure, as well as multiple systemic involvement symptoms such as renal dysfunction, pulmonary hypertension, swallowing difficulties, chest pain, abdominal pain, and erectile dysfunction. Due to the rarity of PNH and its strong heterogeneity in clinical manifestations, multidisciplinary collaboration is often required for diagnosis and treatment. Peking Union Medical College Hospital, relying on the rare disease diagnosis and treatment platform, has invited multidisciplinary clinical experts to form a unified opinion on the diagnosis and treatment of PNH, and formulated the Expert Consensus of Multidisciplinary Diagnosis and Treatment for Paroxysmal Nocturnal Hemoglobinuria (2024), with the hope of promoting the standardization of PNH diagnosis and treatment.

Objective:To evaluate the role of the sodium leak channel (NALCN) in the hippocampal dentate gyrus (DG) in the social behavior of mice.Methods:Thirty-nine male wild-type C57BL/6 mice, aged 6-8 weeks, weighing 18-22 g, were used in this study. Three mice were sacrificed to verify the expression and co-expression of NALCN with neuronal nuclear antigen (NeuN) in the hippocampal DG using the immunofluorescent staining. The remaining 36 mice were divided into 2 groups ( n=18 each) by the random number table method: control group (group C) and NALCN gene knockdown group (group KO). NALCN-shRNA virus was injected in group KO, and scrambled-shRNA virus was injected in group C. The three box social test and open field test were performed at 3 weeks after the virus injection. Mice were sacrificed under anesthesia after the behavioral test, hippocampal tissues were collected, and the injection location of the virus was verified with a fluorescence microscope, and the NALCN protein and mRNA expression in the hippocampal DG was detected by Western blot and real-time polymerase chain reaction, respectively. Results:NALCN and NeuN co-expressed a lot on the same neuron in the hippocampal DG of mice, indicating that NALCN was widely expressed on the neurons in the hippocampal DG. Compared with group C, the expression of NALCN and mRNA in the hippocampal DG was significantly down-regulated, and the social novelty preference disappeared ( P<0.05), and no significant change was found in the social ability and each parameter in the open field test in group KO ( P>0.05). Conclusions:NALCN in the hippocampal DG is involved in the regulation of social memory in mice, and the down-regulated expression of NALCN can lead to the loss of social novelty preference in mice.

Objective    To construct a prognostic model of esophageal squamous cell carcinoma (ESCC) based on immune checkpoint-related genes and explore the potential relationship between these genes and the tumor microenvironment (TME). Methods     The transcriptome sequencing data and clinical information of immune checkpoint genes of samples from GSE53625 in GEO database were collected. The difference of gene expression between ESCC and normal paracancerous tissues was evaluated, and the drug sensitivity of differentially expressed genes in ESCC was analyzed. We then constructed a risk model based on survival-related genes and explored the prognostic characteristics, enriched pathway, immune checkpoints, immune score, immune cell infiltration, and potentially sensitive drugs of different risk groups. Results    A total of 358 samples from 179 patients were enrolled, including 179 ESCC samples and 179 corresponding paracancerous tissues. There were 33 males and 146 females, including 80 patients≤60 years and 99 patients>60 years. 39 immune checkpoint genes were differentially expressed in ESCC, including 14 low expression genes and 25 high expression genes. Drug sensitivity analysis of 8 highly expressed genes (TNFRSF8, CTLA4, TNFRSF4, CD276, TNFSF4, IDO1, CD80, TNFRSF18) showed that many compounds were sensitive to these immunotherapy targets. A risk model based on three prognostic genes (NRP1, ICOSLG, HHLA2) was constructed by the least absolute shrinkage and selection operator analysis. It was found that the overall survival time of the high-risk group was significantly lower than that of the low-risk group (P<0.001). Similar results were obtained in different ESCC subtypes. The risk score based on the immune checkpoint gene was identified as an independent prognostic factor for ESCC. Different risk groups had unique enriched pathways, immune cell infiltration, TME, and sensitive drugs. Conclusion     A prognostic model based on immune checkpoint gene is established, which can accurately stratify ESCC and provide potential sensitive drugs for ESCC with different risks, thus providing a possibility for personalized treatment of ESCC.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective: To investigate the associations between neutrophil-to-lymphocyte ratio (NLR) and estimated glomerular filtration rate (eGFR) in patients with primary aldosteronism (PA). Methods: This study was a cross-sectional study. Consecutive patients diagnosed with PA and admitted to the Second Affiliated Hospital of Nanchang University from October 2017 to April 2022 were enrolled. General information, blood routine, renal function, and other clinical data of the patients were collected. Based on the median NLR of the enrolled patients, NLR-1·1.73 m^-2. Multiple linear regression and multivariate logistic regression models, smooth curve fitting and threshold effect exploration were used to analyze the relationship between NLR and eGFR in PA patients, and stratified analysis and interaction tests were used to evaluate potential variables that may affect the correlation between NLR and eGFR. Results: This study finally included 743 PA patients, aged (50.3±10.4) years, 42.9% (319/743) were female, and the median NLR was 2.3. After adjusting for sex, age, body mass index (BMI) and other factors, multiple linear regression analysis showed that high NLR was negatively correlated with eGFR (β=-4.9, P=0.008), and multivariate logistic regression analysis showed that high NLR was associated with low eGFR (OR=3.1, P=0.002). In the corrected smooth curve, NLR is U-shaped correlation with eGFR, and the inflection point is at NLR=3.5. When the NLR was<3.5, the eGFR decreased with the increase of NLR (corrected β=-4.7, P<0.001); When the NLR was≥3.5, the eGFR increased with the increase of NLR (corrected β=5.8, P=0.031). The results of stratified analysis showed that there was an interaction between the association of NLR and eGFR with the presence or absence of hyperlipidemia (P interaction=0.017), and the correlation between NLR and eGFR was stronger in PA patients with hyperlipidemia. Conclusion: In the PA patients, there is a U-shaped relationship between NLR and eGFR, and higher NLR is associated with lower eGFR. PA patients with elevated NLR should undergo additional screening for chronic kidney disease and receive related preventive interventions.
Humans ; Female ; Male ; Neutrophils ; Glomerular Filtration Rate ; Cross-Sectional Studies ; Lymphocytes ; Hyperaldosteronism/diagnosis* ; Hyperlipidemias

Objective: To investigate the associations between neutrophil-to-lymphocyte ratio (NLR) and estimated glomerular filtration rate (eGFR) in patients with primary aldosteronism (PA). Methods: This study was a cross-sectional study. Consecutive patients diagnosed with PA and admitted to the Second Affiliated Hospital of Nanchang University from October 2017 to April 2022 were enrolled. General information, blood routine, renal function, and other clinical data of the patients were collected. Based on the median NLR of the enrolled patients, NLR-1·1.73 m^-2. Multiple linear regression and multivariate logistic regression models, smooth curve fitting and threshold effect exploration were used to analyze the relationship between NLR and eGFR in PA patients, and stratified analysis and interaction tests were used to evaluate potential variables that may affect the correlation between NLR and eGFR. Results: This study finally included 743 PA patients, aged (50.3±10.4) years, 42.9% (319/743) were female, and the median NLR was 2.3. After adjusting for sex, age, body mass index (BMI) and other factors, multiple linear regression analysis showed that high NLR was negatively correlated with eGFR (β=-4.9, P=0.008), and multivariate logistic regression analysis showed that high NLR was associated with low eGFR (OR=3.1, P=0.002). In the corrected smooth curve, NLR is U-shaped correlation with eGFR, and the inflection point is at NLR=3.5. When the NLR was<3.5, the eGFR decreased with the increase of NLR (corrected β=-4.7, P<0.001); When the NLR was≥3.5, the eGFR increased with the increase of NLR (corrected β=5.8, P=0.031). The results of stratified analysis showed that there was an interaction between the association of NLR and eGFR with the presence or absence of hyperlipidemia (P interaction=0.017), and the correlation between NLR and eGFR was stronger in PA patients with hyperlipidemia. Conclusion: In the PA patients, there is a U-shaped relationship between NLR and eGFR, and higher NLR is associated with lower eGFR. PA patients with elevated NLR should undergo additional screening for chronic kidney disease and receive related preventive interventions.
Humans ; Female ; Male ; Neutrophils ; Glomerular Filtration Rate ; Cross-Sectional Studies ; Lymphocytes ; Hyperaldosteronism/diagnosis* ; Hyperlipidemias

Although herbal medicines(HMs)are widely used in the prevention and treatment of obesity and obesity-associated disorders,the key constituents exhibiting anti-obesity activity and their molecular mechanisms are poorly understood.Recently,we assessed the inhibitory potentials of several HMs against human pancreatic lipase(hPL,a key therapeutic target for human obesity),among which the root-extract of Rhodiola crenulata(ERC)showed the most potent anti-hPL activity.In this study,we adopted an integrated strategy,involving bioactivity-guided fractionation techniques,chemical profiling,and biochemical assays,to identify the key anti-hPL constituents in ERC.Nine ERC fractions(retention time=12.5-35 min),obtained using reverse-phase liquid chromatography,showed strong anti-hPL activity,while the major constituents in these bioactive fractions were subsequently identified using liquid chromatography-quadrupole time-of-flight mass spectrometry(LC-Q-TOF-MS/MS).Among the identified ERC constituents,1,2,3,4,6-penta-O-galloyl-β-D-glucopyranose(PGG)and catechin gallate(CG)showed the most potent anti-hPL activity,with pIC50 values of 7.59±0.03 and 7.68±0.23,respectively.Further investigations revealed that PGG and CG potently inhibited hPL in a non-competitive manner,with inhibition constant(Ki)values of 0.012 and 0.082 μM,respectively.Collectively,our integrative analyses enabled us to efficiently identify and characterize the key anti-obesity constituents in ERC,as well as to elucidate their anti-hPL mechanisms.These findings provide convincing evidence in support of the anti-obesity and lipid-lowering properties of ERC.