OBJECTIVE To compare the changes of chemical components of Morus alba leaves， screen differential markers， and determine their contents， so as to provide reference for quality control of M. alba leaves before and after baked with honey. METHODS The fingerprints of M. alba leaves before and after baked with honey were established by high-performance liquid chromatography （HPLC）. The common peaks of the fingerprints were identified and the similarity was evaluated. The differential markers of M. alba leaves before and after baked with honey were screened by principal component analysis （PCA） and orthogonal partial least squares-discriminant analysis （OPLS-DA） using common peak are of raw material and product baked with honey of M. alba leaves as index. The quantitative analysis was carried out. RESULTS Twenty-three and twenty-four common peaks were identified from the HPLC fingerprint spectra of ten batches of raw material and ten batches of product baked with honey of M. alba leaves， respectively. The similarities of HPLC fingerprints for raw material and product baked with honey of M. alba leaves were all greater than 0.97. The results of PCA showed that raw material and product baked with honey of M. alba leaves could be divided into two categories. The results of OPLS-DA showed that the variable importance in projection of peak 2， peak H （5- hydroxymethylfurfural）， peak 1， peak 17 （isochlorogenic acid C） and peak 16 were all greater than 1. The average contents of differential marker of isochlorogenic acid C in raw material and product baked with honey of M. alba leaves were 0.093 6 and 0.127 8 mg/g， respectively； there was statistical significance （P＜0.05）. CONCLUSIONS Five differential markers such as isochlorogenic acid C are obtained. The content of isochlorogenic acid C in M. alba leaves is significantly increased after baked with honey.

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

OBJECTIVE To optimite the purification technology of total triterpenoid extracts from Inonotus obliquus ，and to investigate the anti -tumor activity of its purified products . METHODS Using inotodiol as control ，the method was established for the content determination of total triterpenoid in I. obliquus. The type of macroporous adsorption resin ，sample volume ，sample concentration，sample flow rate ，eluent volume ，eluent dosage and elution flow rate were selected by single factor experiments . The purification technology of the crude extract was determined and verified . The effects of total triterpenoid purified from I. obliquus on the proliferation ，migration and apoptosis of human cervical cancer HeLa cells were detected by cell proliferation test ， migration test ，flow cytometry and AO/EB kit . RESULTS The best purification technology of total triterpenoid crude extracts from I. obliquus was as follows ：AB-8 macroporous adsorption resin was used ；mass concentration of the sample solution was 2.0 mg/mL；sample volume was 140 mL，and the flow rate was 1.0 mL/min；the impurity was removed with 50% ethanol 40 mL， then eluted with 95% ethanol 160 mL，at the elution flow rate of 3.0 mL/min. After purification ，mass concentration of total triterpenoid from I. obliquus increased from 34.36% to 73.39%. The total triterpenoid of I. obliquus could inhibit the proliferation of HeLa cells ，and the 50% inhibitory concentration was 184.20 μg/mL. Compared with control group ，the purified products could significantly inhibit the migratio n and promote the apoptosis of HeLa cells （P＜0.05 or P＜0.01）. CONCLUSIONS The purification technology of total triterpenoids extracts from I. obliquus is successfully optimited . The purified product could inhibit the proliferation and migration of HeLa cells and induce their apoptosis.

Objective:To investigate the effect of O-arm navigation assisted posterior pedicle screw reduction and internal fixation of atlantoaxial fractures.Methods:A retrospective case-control study was conducted to analyze 37 patients with atlantoaxial fractures admitted to Third Hospital of Hebei Medical University from January 2016 to June 2018, including 22 males and 15 females, aged from 29 to 68 years [(50.9±9.8)years]. The posterior pedicle screw reduction and internal fixation was performed under O-arm navigation system (navigation group, n=24), and using free-hand technique (free-hand group, n=13). The operation time and blood loss were compared between the two groups. The Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) were used to evaluate the clinical efficacy before operation, 7 days operation and at the last follow-up. The complications were detected. A total of 86 screws were placed in navigation group (Neo grade 0: 83 screws, grade 1: 2 screws, grade 2: 1 screw ), and 44 screws were inserted in free-hand group (Neo grade 0: 36 screws, grade 1: 5 screws, grade 2: 2 screws, grade 3: 1 screw)( P<0.05). Classification of screw positions proposed by Neo et al was used to evaluate the position relationship between the screw and the bone cortex and the incidence of screw penetration. Results:All patients were followed up 24-38 months [(27.7±4.0)months]. The operation time in navigation group was (189.8±35.4)minutes, significantly shorter than (221.5±48.6)minutes in free-hand group ( P<0.05). The bleeding volume in navigation group was 300.0 (250.0, 537.5)ml , significantly less than 500.0 (425.0, 625.0)ml in free-hand group ( P<0.05). Both groups showed significantly enhanced JOA and decreased NDI after operation and at last follow-up, compared with those before operation ( P<0.05). However, there was no significant difference in JOA and NDI between the two groups ( P>0.05). No severe complications such as neurovascular injury occurred during operation. The incidence of cortical penetration was 3% (3/86) in navigation group and 18% (8/44) in free-hand group ( P<0.05). Conclusions:In the process of posterior atlantoaxial pedicle screw placement, the application of O-arm navigation can significantly reduce the operation time and amount of bleeding, and enhance the accuracy of pedicle screw implantation.

Objective:To investigate the prevalence and associated risk factors of pre-hypertension and hypertension in young and middle-aged population in Nanjing.Methods:Subjects of the study were those who underwent physical examination in the physical examination center of Nanjing Drum Tower Hospital from 2009 to 2016. The prevalence and risk factors of pre-hypertension and hypertension in young (aged 18-44 years old) and middle-aged people (aged 45-59 years old) were analyzed.Results:A total of 142 857 participants aged 18-59 years old were analyzed. Among them, 64 220 cases in the pre-hypertension group and 13 912 cases in the hypertension group. The prevalence of hypertension was 9.74% (12.51% in males and 5.82% in females). The prevalence of pre-hypertension was 44.95% (53.31% in males and 33.15% in females). In the middle-aged group, the prevalence of pre-hypertension and hypertension were 51.68% and 15.13%, respectively, which was higher than that in the young group (37.95% and 4.13%, respectively). The prevalence of pre-hypertension and hypertension in 2013-2016 was 45.37% and 10.65%, respectively, which was higher than that in 2009-2012(44.52% and 8.78%). In addition, the prevalence of abnormal blood glucose metabolism, abnormal blood lipid metabolism and abnormal glucose and lipid metabolism in the pre-hypertension group was higher than that in the normal blood pressure group, but lower than that in the hypertension group ( P<0.001). A logistic regression analysis indicated that age, overweight or obesity, hyperglycemia, hypertriglyceridemia and hypercholesterolemia were risk factors of pre-hypertension in male. Age, overweight or obesity, hyperglycemia, hypertriglyceridemia, hypercholesterolemia and hyper-low density cholesterolemia were associated with hypertension in male and with pre-hypertension and hypertension in female. Conclusions:Middle age, overweight/obesity, elevated fasting plasma glucose, elevated triglyceride and elevated total cholesterol were risk factors of pre-hypertension and hypertension in both men and women. Intervention on the related risk factors should be conducted as early as possible.

Oblique lateral interbody fusion (OLIF) was minimally invasiveprocedure for lumbar interbody fusion (LIF) through the space between anterior margin of retroperitoneal psoas major muscle and the vessels (ATP). Although OLIF had many advantages over other approaches, there were also various kinds of surgical complications, the incidence of which was 3.69%-81.82%. Most of the complications were relieved by conservative or symptomatic treatment. Only a small number of complications were difficult to recover, if so, revision surgery was needed and might remain persistent symptoms. OLIF complications included intraoperative and postoperative complications. Major vascular injury was a dangerous complication during operation, which requires immediate compression or suture to prevent bleeding. The incidence of nerve injury could be reduced by avoiding violent traction and tissue separation and reducing the operation time. When injury of thorax and peritoneum occurs, suture should be done as soon as possible. Transient hip flexion weakness and transient thigh/groin sensory disturbance was the most common post-operative complication, most of which would disappear after several months. Intestinal obstruction is caused by the pulling of peritoneum during operation, most of which was incomplete and would be relieved after some time. Postoperative infection was mostly superficial and would be cured by dressing change and antibiotic application. Subsidence of cage and collapse of intervertebral space were the most common complications related to instrumentations which might not lead to related clinical symptoms; however the severe cases need to be repaired. The incidence of pseudarthrosis is relatively low and a few patients with clinical symptoms need revision surgery. The sample size of most studies was small and follow-up period was short. In the future, large samples and multi-center studies are needed to improve our understanding of OLIF complications in the future.

Objective To investigate the management of Graves' disease in Jiangsu province. Methods According to the 2011 management of GD survey from American Thyroid Association and the 2013 survey from European Thyroid Association, a questionnaire was designed for this survey to acquire the diagnosis, treatment, and follow-up of Graves' disease among endocrinologists from 35 tertiary hospitals in Jiangsu province. Results A total of 476 valid questionnaires were collected. For patients with symptoms of hyperthyroidism, a large majority of respondents monitored serum FT3 , FT4 , TSH, thyroid peroxidase antibody, thyroglobulin antibody, TSH receptor antibody, and finding of thyroid ultrasound, accounted for 95. 6％, 95. 0％, 95. 4％, 95. 8％, 90. 3％, 90. 5％, and 93. 9％physicians, respectively. 91.2％ of physicians preferred anti-thyroid drugs as the first-line treatment, and 92. 6％ of them gave priority to the use of methimazole. For the duration of anti-thyroid drugs therapy, 41.2％of endocrinologists chose 24 months, while 20％ chose 18 months. When patients have moderate and active ophthalmopathy, most respondents with medium or senior professional titles preferred anti-thyroid drugs, while most resident physicians chose radioactive iodine plus corticosteroids. When pregnancy was confirmed in the patients of Graves' disease, 88％ of respondents preferred propylthiouracil during the first trimester of pregnancy, and 58. 4％ of them would continue propylthiouracil into the second trimester. Conclusions The mastering of basic perception of Graves' disease knowledge is satisfactory among the endocrinologists. But by comparing to the American and European survey results and related guidelines, there are still some differences in diagnosis and treatment. Therefore, physicians should notice those differences and make improvement on standardized treatment for patients to raise the response ratio while reducing the recurrent events.

Objective To compare the clinical efficacy of pedicle subtraction osteotomy(PSO)and posterior unilateral vertebral column resection(PUVCR)for old thoracolumbar compressive fracture accompanied with kyphotic deformity.Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with old thoracolumbar fracture accompanied with kyphotic deformity admitted to the Third Hospital of Hebei Medical University from January 2010 to January 2016.There were 29 males and 22 females,aged 46-69 years,with an average age of 54.9 years.In terms of the injured segments,there were 11 patients with T11,10 with T12,17 with L1,and 13 with L2.A total of 22 patients were treated with traditional PSO(PSO group),and 29 patients PUVCR(PUVCR group).The operation time,intraoperative blood loss,hospital stay,Cobb angle improvement 2 weeks after operation and postoperative 1 year,visual analogue scale(VAS) 1 year after operation and Japanese Orthopedic Association(JOA)scores were compared between the two groups.Intraoperative and postoperative complications were recorded.Results All patients were followed up for 3-18 months,with an average of 13.5 months.There were no significant differences between PSO group and PUVCR group in hospital stay[(13.8±1.1)days vs.(14.1±1.2)days],thoracolumbar Cobb angle 2 weeks after operation[(8.3±1.5)°vs.(9.1±2.0).]and JOA scores[(26.2±1.2)points vs(25.5±1.5)points](P＞0.05).Significant differences were found between PUVCR group and PSO group in operation time[(184.9±22.9)minutes vs.(219.9±17.1)minutes],intraoperative blood loss[(911.5±70.2)ml vs.(1136.1±92.0)ml],Cobb angle 1 year after operation[(10.0±1.6)°vs.(12.7±1.9)°],and VAS 1 year after operation[(2.3±0.5)points vs.(2.9±0_ 7)points](P＜0.05).No serious complications occurred during operation and follow-up.Conclusions For old thoracolumbar compressive fracture accompanied with kyphotic deformity,PSO and PUVCR can both effectively improve kyphosis and relieve dysfunction.But PUVCR has the advantages of shorter operation time,less intraoperative blood loss,better-improved kyphosis,and lower incidence of spinal nerve injury.

Cytokines are small secreted proteins that play an important role in physiological and pathological processes. In the field of pharmacological development, cytokine drugs have achieved great suc-cess. In 2017, five of the world′s top ten best-selling drugs were inhibitors of cytokines or their receptors. The most innovative and challenging work in cytokine research is the discovery of novel cytokines with impor-tant functions and potential druggable prospects. In the post-genome era, a number of novel cytokines have been internationally discovered using reverse biology techniques, and from which, several cytokine drugs have been approved for marketing. This review highlights 10 novel cytokines found in the human genome by the author′s laboratory, including CTRP4, CCDC134, PSMP, VSTM1-v2, FAM3D, TMEM98, CSBF/C10orf99, FAM19A4, FAM19A5 and FAM19A1. Some of them have been shown to have important physio-logical and pathological functions. Identification of functional receptors, clinical specimen analysis or in vivo animal experiment has been carried out for them, which lays the foundation for further research in their clini-cal applications.

Objective To explore the hotspots and developing direction of splenic surgery in China.Methods The biliometric analysis was adopted.Database including Chinese Database of Literature on Biomedicine were searched with “脾,外科,移植”.The time for retrieving was from January 1984 to December 2013.Chinese articles on splenic surgery which were published by academic journals were retrieved,and data were analyzed and evaluated by 2 independent researchers,including published year,distribution of journals,key words,authors and publication type.The P-value was calculated according to P =2Ln(eE × Y),and Euler's number =0.577 2 and Y was maximum amount of published articles in each journal.Results (1) Published year:1 977 articles were retrieved.There were 168 articles from 1984 to 1993,and number of articles in every year was less than 30.There were 562 articles from 1994 to 2003 and increasing number of articles in every year,with a maximum number of 88.There were 1 247 articles from 2004 to 2013,and average number of articles in every year was 125,with a maximum number of 165 in 2009.(2) Distribution of journals:all the articles have been published in 489 journals,including 9 surgical journals in the core journal such as Chinese Journal of Hepatobiliary Surgery and 7 journals from Chinese Science Citation Database.The maximum number of published articles of each journal was 54,and literature number in the core journals P≈9.(3) Distribution of key words:occurrence frequencies of “脾破裂”and“脾切除术”were very high in 3 periods (from 1984 to 1993,from 1994 to 2003,from 2004 to 2013) and percentages of occurrence frequencies were respectively 9.524％,24.911％,51.163％ and 12.500％,19.217％,38.813％,showing an increasing trend.Occurrence frequencies of“回顾性研究”“手术后期间”“胰腺切除术”and“脾动脉”reached the top 20 of key words from 1994 to 2003 and then continued to increase from 2004 to 2013,and occurrence frequency of“回顾性研究”was significantly increased witha growth rate of 23.742％.The percentages of occurrence frequencies of“回顾性研究”“手术后期间”“胰腺切除术”and“脾动脉”were respectively 3.203％,8.185％,4.448％,3.559％ from 1994 to 2003 and 26.945％,16.279％,7.939％,6.496％ from 2004 to 2013.“创伤和损伤”and“腹腔镜”first appeared on the top 20 of key words from 2004 to 2013,with percentages of occurrence frequencies of 15.958％ and 11.307％.Occurrence frequencies of“胰腺”and“肝”were gradually increased in 3 periods,with the percentages of 2.976％,3.915％,10.906％ and l.786％,4.804％,6.496％.The percentage of occurrence frequency of“移植,自体”in 3 periods was respectively 15.476％,20.107％,8.821％.Conclusions The Chinese articles of splenic surgery are rising obviously in the past 30 years.The splenic injury and splenectomy have always been research hotspots in splenic surgery.The preservation of spleen function and minimal invasive surgery are the developing direction of splenic surgery.