Objective The contents of 11 nucleosides and base components in 10 batches of samples from 5 provinces(cities)including Chongqing,Yunnan and Shaanxi were determined,and the differences in nucleosides and base components in Fritillaria taipaiensis were compared by chemometric analysis,and the quality was comprehensively evaluated,so as to provide a reference for the cultivation of excellent varieties and the selection of medicinal materials.Methods Nucleoside and base components were extracted from Fritillaria taipaiensis by ultrasonication in aqueous solutions,and the content of each component was determined by HPLC-DAD method.The origin was classified by principal component analysis(PCA)and hierarchical cluster analysis(HCA).Partial least squares discriminant analysis(PLS-DA)was used to determine the differentiated index components in Fritillaria taipaiensis.Then the differences in the contents of the index components among samples from different origins were compared.Results It was found that 11 nucleoside and base components differed significantly among different origins of Fritillaria taipaiensis.Principal component analysis and hierarchical cluster analysis indicated that all samples could be clustered into 4 categories.Five characteristic components,including uracil,cytosine,uridine,inosine,and adenosine,were identified by PLS-DA.The nucleosides and bases in samples from Chongqing and Hubei were relatively high,and the quality of the samples was comparatively superior.Conclusion This method is simple,reproducible,accurate and reliable.It has screened out the index nucleoside and base components in the identification of Fritillaria taipaiensis of different origins,which can be used to initially elucidate the differences of samples between different origins.Additionally,it can better reflect the quality of Fritillaria taipaiensis,and can provide reference for the selection of procurement origin and the quality control for Fritillaria taipaiensis.

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery.Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients,and is widely recommended as a first-line clinical treatment.But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices.To address this issue,this consensus,based on a comprehensive literature review and clinical experiences of experts,systematically summarizes the indications,target patients,and contraindications of minimally invasive tooth extraction,the overall workflow of this procedure(preoperative preparation,surgical steps,postoperative management,postoperative instructions,medications,and follow-up),and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery.Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients,and is widely recommended as a first-line clinical treatment.But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices.To address this issue,this consensus,based on a comprehensive literature review and clinical experiences of experts,systematically summarizes the indications,target patients,and contraindications of minimally invasive tooth extraction,the overall workflow of this procedure(preoperative preparation,surgical steps,postoperative management,postoperative instructions,medications,and follow-up),and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Objective To investigate the effects of Anmian Dan on neurotransmitters in the brain of model rats,which were sleep deprived by multi-platform water environment.Methods Fifty SD rats were randomly and evenly divided into 5 groups with 10 rats in each group,which were blank control group(Control group),Model group(Model group),Estazolam group(Estazolam group),low dose group(AMD-L group)and high dose group(AMD-H group).The rats were subjected to sleep deprivation in a multi-platform water environment for 20 hours per day for 21 days.The movement distance and movement time of rats at different time points were recorded by autonomous activity analyzer to evaluate the changes of autonomous activity.The contents of glutamic acid(Glu)and gamma-aminobutyric acid(GABA)were detected by ELISA,and the mRNA expression levels of NDRG2,GLT-1,GAD65 and GAD67 were detected by Real-time PCR.Western blot was used to detect the expressions of NDRG2,p-PI3K,p-Akt,GLT-1,GAD65 and GAD67.Results The Model group was more active than the Control group,and the concentration of GABA in the cortex of the Model group was decreased and the concentration of Glu was increased.The mrna and protein expression levels of NDRG2 in Model group were higher than those in Control group(P<0.01),but the mrna and protein expression levels of GLT-1,GAD65 and GAD67 in model group were lower than those in Control group(P<0.01).The protein expression levels of P-PI3K and P-AKT in the cortex of model group were significantly decreased(P<0.01).Compared with Model group,Anmeidan could reduce the autonomic activity of sleep deprived rats,increase the concentration of GABA,decrease the concentration of Glu in cortex(P<0.05),and increase the mrna relative expression levels and protein expression levels of GLT-1,GAD65 and GAD67(P<0.05).The expression levels of P-PI3K and P-Akt were increased(P<0.01),and mrna and protein expression levels of NDRG2 were decreased(P<0.01).Conclusion Anmian Dan may regulate the activity of astrocytes and affect the levels of neurotransmitters GABA and GLU in the brain through the PI3K/AKT signaling pathway,thus playing a role in improving the circadian rhythm disturbance in sleep-deprived rats.

Objective:To investigate the correlation between plasma total α-synuclein (α-syn), phosphorylated α-synuclein (p-α-syn), neurofilament light chain(NfL) and subtypes of Parkinson disease(PD).Methods:A total of 62 PD patients admitted to the Department of Neurology, the Affiliated Huai 'an No. 1 People 's Hospital of Nanjing Medical University from September 2021 to January 2023 were selected and scored on the Hoehn-Yahr stage(H-Y), unified Parkinson's disease rating scale Ⅲ(UPDRS-Ⅲ), levodopa equivalent daily dosage(LEDD), mini-mental state examination(MMSE), Parkinson disease quality of life questionnaire(PDQ-39) and activities of daily living(ADL). During the same period, 25 healthy individuals matched in age and sex were enrolled as the control group (HC). Clinical characteristics and blood samples were collected. The plasma levels of α-syn, p-α-syn and NfL were detected by enzyme-linked immunosorbent assay(ELISA). PD patients were divided into tremor dominant type (TD, n=27) and akinetic-rigid dominant type (AR, n=35) based on UPDRS-Ⅲ scores. Multifactorial Logistic regression analysis was performed by SPSS 25.0 software to determine the influencing factors of subtypes of Parkinson disease. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point of plasma NfL between the AR type and the TD type. Results:Plasma α-syn, p-α-syn, NfL levels in the PD group were significantly higher than those of the HC group ( Z=-2.537, -6.580, -7.101, all P<0.05). There were statistically significant differences between the AR type and the TD type in disease duration, H-Y stage, UPDRS-Ⅲ scores, LEDD and MMSE scores ( Z=-2.503, -3.021, -2.025, -2.086, -2.409, all P<0.05). While no significant difference was found in plasma α-syn and p-α-syn levels between the AR type and TD type ( Z=-0.341, -0.085, both P>0.05), the plasma NfL levels were notably higher in the AR type(92.79(16.84, 117.53) pg/mL) compared to the TD type (12.10(6.99, 100.17) pg/mL)( Z=-2.236, P<0.05). Plasma NfL levels were correlated with rigidity scores ( r=0.438, P<0.001), UPDRS-Ⅲ scores ( r=0.337, P<0.05) and motor subtypes ( r=0.286, P<0.05) in PD patients. Multivariate Logistic regression analysis showed that NfL was risk factor for AR( B=0.002, OR=1.002, 95% CI=1.001-1.003, P=0.017). The ROC curve analysis indicated that plasma NfL levels could predict different subtypes of PD with an AUC=0.667, optimal cutoff =26.527. Conclusion:There is a correlation between elevated plasma NfL levels and the occurrence of AR type of PD, suggesting that nerve injury is probably involved in the occurrence and progression of various motor subtypes of PD.

ObjectiveTo explore the effect of Anmeidan on the sleep quality and serum levels of brain-derived neurotrophic factor （BDNF）， glial fibrillary acidic protein （GFAP）， and irisin in the patients with chronic insomnia. MethodA multicenter， randomized， double-blind， placebo-controlled clinical study was carried out， including 480 patients with chronic insomnia （deficiency syndrome） in Wuhan （Hubei）， Guangzhou （Guangdong）， and Lanzhou （Gansu）. They were randomized into an observation group and a control group at a ratio of 1∶1. The observation group was orally administered with Anmeidan granules at a dose of 11 g， 3 times per day， and the control group with Anmeidan simulant at a dose of 11 g， 3 times per day， Both groups of patients received sleep education after enrollment. After 4 weeks of medication， the Athens insomnia scale （AIS） scores， Spiegel scale scores， and serum levels of BDNF， GFAP， and irisin were compared between the two groups as well as between before and after treatment. ResultA total of 480 adult patients with chronic insomnia were enrolled in this study， with 64 patients falled off. Finally， the 415 patients were included in the analysis， including 213 patients in the observation group and 202 patients in the control group. There was no difference in age or sex between the two groups of patients. Compared with before treatment， the treatment in both groups decreased the AIS and Spiegel scores （P<0.01）. After treatment， the observation group had lower AIS and Spiegel scores than the control group （P<0.01）. The treatment in the observation group slightly lowered the level of BDNF， elevated the level of irisin （P<0.05）， and lowered the level of GFAP （P<0.05） in the serum. After treatment， the observation group showed higher level of irisin （P<0.05） and lower levels of BDNF and GFAP in the serum than the control group. ConclusionAnmeidan may improve the sleep quality of patients with chronic insomnia by elevating the irisin level and lowering the GFAP level in the serum.

OBJECTIVE To study the moderation effect of water extract of Farfarae Flos on blood lipid and glucose regulation in obese mice. METHODS Chemical method was used to identify the components of the water extract of Farfarae Flos. The contents of total terpenes in the water extract of the Farfarae Flos were determined by UV-VIS spectrophotometry. The mice were randomly divided into blank group, model group, orlistat group, and low-dose, medium-dose, and high-dose groups of water extract of Farfarae Flos. The blank group was fed with ordinary diet, while the other groups were fed with high-fat and high-sugar diet to establish an obese animal model, and they were administration while molding for 45 d. At the end of the experiment, the contents of serum triglyceride(TG), cholesterol(CHO), high-density lipoprotein-C(HDL-C), low-density lipoprotein-C(LDL-C), glucose(GLU), and glycosylated serum protein(GSP) were detected. Hematoxylin-eosin(HE) and oil red O staining were used to observe the morphological changes and lipid droplet distribution of liver tissue in mice. RESULTS There were flavonoids and terpenoids in the water extract of the flower. Compared with the blank group, the levels of TG, CHO, LDL-C, GLU and GSP in the model group were significantly increased(P<0.05 or P<0.01), HDL-C was significantly decreased(P<0.05), and the area of lipid droplets in the liver was significantly increased(P<0.01). Compared with the model group, TG, LDL-C, CHO, GLU and GSP levels in the Farfarae Flos water extract groups were significantly decreased, HDL-C was increased, and lipid droplet accumulation were reduced. Compared with the model group, the blood lipid and blood glucose levels in the treatment groups were significantly decreased, among them, the high-dose group of the water extract of Farfarae Flos had the best effect. CONCLUSION The water extract of farfara can improve glucose and lipid metabolism in obese mice by reducing blood lipids, CHO, and improving the pathological morphology of liver tissue.

Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.

Objective:To compare the safety apnea time during endotracheal intubation in the patients from different altitudes using oxygen reserve index (ORI).Methods:Sixty American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 18-70 yr, undergoing elective surgery requiring tracheal intubation under general anesthesia and requiring catheterization via arterial puncture, were included.Among the patients, 30 cases who had long lived at an altitude of 1 500-3 000 m in Qinghai Province People′s Hospital (Xining, 2 200 m above sea level) served as middle-altitude group, and 30 Tibetan patients who had long lived at an altitude >3 000-meter area in Yushu People′s Hospital (Yushu, 3 600 m above sea level) served as high-altitude group.The patients were preoxygenated for 5 min before induction of anesthesia, and then endotracheal intubation was performed with a video laryngoscope.Before induction (T 0), at 3 min of pre-oxygenation (T 1), and at 5 min of pre-oxygenation (T 2), arterial blood was collected for blood gas analysis, and PaO 2 was recorded, ORI and SpO 2 were simultaneously recorded.The time from the beginning of intubation to the time when ORI was decreased to 0 and the time from the beginning of intubation to the time when SpO 2 was decreased to 98% were recorded. Results:Compared with middle-altitude group, the time from the beginning of intubation to the time when ORI was decreased to 0 and the time from the beginning of intubation to the time when SpO 2 was decreased to 98% were significantly prolonged ( P<0.05), and no significant change was found in SpO 2, ORI and PaO 2 at each time point in high-altitude group ( P>0.05). Conclusions:The safety apnea time during endotracheal intubation is longer in the patients at high altitudes (altitude > 3000 m) than those at the moderate altitudes (altitude 1500-3000 m).

【Objective】 To investigate the effects of tranexamic acid(TXA) on intraoperative blood transfusion(volume) and postoperative coagulation function in patients with partial hepatectomy for hepatic hydatid disease in high altitude area(altitude ≥2 500 m). 【Methods】 Forty-four patients [(39.09±14.70) years old, 19 males and 25 females] underwent elective partial hepatectomy for hydatid after general anesthesia from October 2018 to December 2019 in the Department of Hydatid of Qinghai Provincial People's Hospital, with ASA gradeⅠ~Ⅲ, Child Pugh grade A~B, and normal preoperative coagulation function. They were randomly divided into TXA injection group, who received intravenous injection of TXA 10 mg/(kg·person)(30 min before surgery), and control group, given a placebo needed the equal amounts of injected 0.9% sodium chloride(30 min before surgery). 3 mL of arterial blood was extracted from each patient before intravenous injection and at the end of operation for TEG detection. The intraoperative blood loss and transfusion volume as well as Plt, Hb and TEG parameters before and after surgery were compared between the two groups, and statistical analysis was performed with SPSS22.0 statistical software. 【Results】 The volume of intraoperative blood loss(mL) in TXA group and control group was 300(200, 1 000) vs 1 400(1 000, 2 100), respectively; the units of plasma transfusion(mL) 0(0, 0) vs 380(0, 575); the units of RBC suspension transfusion(mL) 0(0, 400) vs 1 200(800, 600). Preoperative TEG parameters of two groups were similar to each other(P>0.05). The postoperative R, K and Angle(°) of two groups was 8.32±2.24 vs 10.78±2.67, 2.80(2.10, 3.30) vs 3.70(3.20, 4.80) and 54.76±9.48 vs 43.70±9.02, respectively(P<0.05). 【Conclusion】 TXA can significantly improve coagulation functions, as well as effectively reduce intraoperative blood loss and intraoperative blood transfusion in patients with partial hepatic resection of hydatid hepatica in high altitude area.