Three 2,3-diketoquinoxaline alkaloids were isolated from Heterosmilax yunnanensis Gagnep. Their structures were determined through 1D and 2D NMR, HR-ESI-MS, UV, and IR as 1-[5′-(3″-hydroxy-3″-methyl) glutaryl] ribityl-2,3-diketo-1,2,3,4-tetrahydro-6,7-dimethylquinoxaline (1), 1-[2′-(3″-hydroxy-3″-methyl) glutaryl]ribityl-2,3-diketo-1,2,3,4-tetrahydro-6,7-dimethylquinoxaline (2), and 1-ribityl-2,3-diketo-1,2,3,4-tetrahydro-6,7-dimethylquinoxaline (3). Compounds 1 and 2 are novel compounds, and 3 was isolated from H. yunnanensis for the first time. The hepatoprotective activity of these three compounds was evaluated, with compound 3 showing promising hepatoprotective activity.

Purpose: Oligometastatic non–small cell lung cancer (NSCLC) patients have been increasingly regarded as a distinct group that could benefit from local treatment to achieve a better clinical outcome. However, current definitions of oligometastasis are solely numerical, which are imprecise because of ignoring the biological heterogeneity caused by genomic characteristics. Our study aimed to profile the molecular alterations of oligometastatic NSCLC and elucidate its potential difference from polymetastasis. Materials and Methods: We performed next-generation sequencing to analyze tumors and paired peripheral blood from 77 oligometastatic and 21 polymetastatic NSCLC patients to reveal their genomic characteristics and assess the genetic heterogeneity. Results: We found ERBB2, ALK, MLL4, PIK3CB, and TOP2A were mutated at a significantly lower frequency in oligometastasis compared with polymetastasis. EGFR and KEAP1 alterations were mutually exclusive in oligometastatic group. More importantly, oligometastasis has a unique significant enrichment of apoptosis signaling pathway. In contrast to polymetastasis, a highly enriched COSMIC signature 4 and a special mutational process, COSMIC signature 14, were observed in the oligometastatic cohort. According to OncoKB database, 74.03% of oligometastatic NSCLC patients harbored at least one actionable alteration. The median tumor mutation burden of oligometastasis was 5.00 mutations/Mb, which was significantly associated with smoking, DNA damage repair genes, TP53 mutation, SMARCA4 mutation, LRP1B mutation, ABL1 mutation. Conclusion Our results shall help redefine oligometastasis beyond simple lesion enumeration that will ultimately improve the selection of patients with real oligometastatic state and optimize personalized cancer therapy for oligometastatic NSCLC.

Objective:To evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD).Methods:A prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10± 0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. Results:At 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes.Conclusion:Amniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.

AIM: To make a contribution to the work for myopia prevention and control by analyzing the date of 52 226 axial length characteristics statistically form multiple dimensionalities.

METHODS: A retrospective study with large sample was conducted. Sex, age and eye axial length of children and adolescent aged 4 to 22 with refractive errors who visited Dongguan Guangming Ophthalmological Hospital from 2009 to 2018 were collected. A total of 26 113 patients(52 226 eyes)were enrolled. Axial length data were analyzed statistically in three dimensions, including gender, laterality and age.

RESULTS: Among the children and adolescent aged 4 to 22 with refractive errors in Dongguan Area, axial length of female group was shorter than male group(t=34.297, P<0.001). The shorter axial length of left eye was observed in the group aged 10 to 22(t=5.362, P<0.001). There were two peaks in the growth rate of axial length: 7-8 years old and 18 years old respectively. A linear regression formula was derived: axial length in male group(mm)=21.97+0.224×age(F=14352.9, P<0.001 adjusted R2=0.332), axial length in female group(mm)=21.40+0.234 ×age(F=12491.9, P<0.001 adjusted R2=0.349).

CONCLUSION: Among the children and adolescent aged 4 to 22 in Dongguan, the average axial length of female is shorter than male. The increase of axial length were observed in the right eye compared to the left eye starting from the age of 10, the growth rate of axial length is faster in two age groups: 7 to 8 years old and 18 years old.

Objective: To observe the effect of Prunellae Spica extracts (PS) on the lipid metabolism in Zuker Diabetes Fatty (ZDF) rats based on AMP-activated protein kinase/acetyl CoA carboxylase (AMPK/ACC) signaling pathway.Method: The 32 male ZDF (fa/fa) type 2 diabetic rats were randomly divided into model group,metformin group (180 mg·kg^-1·d^-1),and low and high-dose PS groups (12.25,24.5 mg·kg^-1·d^-1),with 8 in each group.8 male Zuker Lean (ZL) rats were selected as normal group.Body weight and fasting blood glucose were monitored at the 0^th,4^th and 8^th weeks after administration.After 8 weeks,abdominal aorta blood was collected,serum was frozen at-20℃ by centrifugation,liver tissue was frozen at-80℃,fixed with 4% paraformaldehyde and embedded in paraffin.Serum triglyceride (TG),cholesterol (CHO),low density lipoprotein cholesterol (LDL-C) and free fatty acid (FFA) levels were measured by radioimmunoassay.Fat droplets in hepatocytes were measured by oil red O staining.Gene expressions of AMP-activated protein kinase-alpha 2(AMPKα₂),Acetyl CoA carboxylase (ACC) in liver were detected by real-time polymerase chain reaction (Real-time PCR).Protein expressions of p-AMPKα were observed by immuno-histochemical (IHC) method.Result: Compared with the normal group,the T2DM model group showed significant increases in serum levels of TG,CHO,LDL-C,FFA and lipid droplets in hepatocytes.AMPKα₂ mRNA expression was decreased,while ACC1 and ACC2 mRNA expressions were increased significantly.p-AMPKα protein expression in liver was decreased significantly (P<0.05,P<0.01).Compared with the model group,low and high-dose Ps groups showed significant decreases in serum levels of TG,CHO,LDL-C,FFA and lipid droplets in hepatocytes in ZDF rats,up-regulation in mRNA expression of AMPKα₂,down-regulation in mRNA expressions of ACC1 and ACC2,and up-regulation in protein expression of p-AMPKα(P<0.05,P<0.01).Conclusion:PS can effectively improve liver lipid metabolism in ZDF rats.Its mechanism may be related to the regulation of AMPK/ACC signaling pathway in liver.

Objective To investigate the anatomy characteristics of saphenous artery(SA) and its perforator vessels in mini pig,and to provide a new perforator flap animal model.Methods Between May,2018 and August,2018,6 7-months-old mini pigs weight 25 kilograms were sacrificed by blooding under general anesthesia.The bilateral external iliac arteries were injected with a mixture of latex-lead oxide mixture and underwent CT-scanning to provide 3-dimensional reconstruction.The origin,diameter,courses and distribution of the SA and perforators of both hind limbs were observed.Results One of the hind limbs was abandoned due to the leakage of perfusion fluid.The other 11 hind limbs were available.The femoral artery passed through the medial femoral muscle and sartorius muscle in the middle of thigh,and run between the medial femoral muscle and gracilis muscle above the knee.Below the knee,it run on the surface of the medial leg muscles.A number of small branches were distributed in the tarsal joint and calcaneus at the medial malleolus,and there were abundant communicating branches with the posterior tibial artery.The average length of SA was (14.86±0.76) mm.The outer diameters of SA at initiative,medial tibial condyle and medial malleolus were(1.73±0.15) mm,(1.50±0.12) mm and (1.30±0.13) mm,respectively.There were a total of 79 perforators which were identified,with a mean of (7.09±1.16) perforators per hind limbs.And the average outer diameter was 0.10-0.78 (0.40±0.13) mm.Conclusion The SA constantly exist with good outer diameter.The number of perforator is abundant.SA can be used as a reliable animal model for studying and training of perforator flap.

Objective To investigate positive picobirnaviruses(PVBs)infection and its association with unex-plained diarrhea in children. Methods From January to December 2015,the Clinical Microbiology Testing Center of Xuzhou Central Hospital as the sampling location,7 PVB reverse transcription - polymerase chain reaction(RT - PCR)- positive fecal samples with diarrhea were collected from children under 6 years old and 4 samples from healthy chil-dren were obtained and all the samples were analyzed by viral metagenomics to investigate the relationship between PVBs and diarrhea in children. Phylogenetic analysis of RdRp in the isolated PVB sequences was carried out to clarify the relationship between PVB classification and diarrhea. Results All the 7 diarrhea feces contained high titers of PVB sequences,while 3 of the controls were negative,and 1 with low titers of PVB. RdRp analysis was carried out on the iso-lated PVB sequences,which displayed that 7 RdRp sequences caming from 7 fecal samples separately,so named ChXz- 1 to ChXz - 7 respectively. Phylogenetic analysis based on the predicted amino acid sequences of RdRp from this study and whole RdRp sequences available in the GenBank database indicated that the 7 RdRp sequences belonged to 3 genogroups,in which ChXz - 1,ChXz - 2,ChXz - 3 belonging to genogroup Ⅰ,ChXz - 4,ChXz - 5,ChXz - 7 belong-ing to genogroup Ⅱ,and ChXz - 6 belonging to genogroup Ⅲ. Conclusions PVBs might be the cause of diarrhea in children in this study,and all the 3 different PVBs may lead to diarrhea.

Objective To analyze prevalence and determinants of medical adhesive-related skin injury (MARSI) in peripherally inserted central catheter implanted patients with lung cancer,to create evidence for improved clinical care.Methods A cross-sectional observational study design was adopted.Skin pictures and electronic medical records of 200 lung cancer patients who visited Shanghai Chest Hospital for PICC between June 2017 and September 2017 were analyzed to calculate prevalence of MARSI and identify related factors.Results The prevalence of MARSI was 31.5％ (63/200),and mechanical trauma accounted for 50.8％ of all cases (32/63).Age,diabetes and anaphylaxis were significantly related to MARSI.Conclusion Analysis of MARSI in PICC implanted patients with lung cancer provided evidence for improved clinical care of such patients.

Objective:To investigate the application value of serum procalcitonin in patients with viral infection,bacterial infection and severe bacterial infection.Methods:Selected60 cases of patients with infection who were treated in our hospital from June 2014toDecember 2016,divided into three groupsaccording to the severity of the infection,viral infection (group A) 15 cases,general bacterial infection (group B) 22 cases,and severe bacterial infection (group C) 23 cases.Three groups of patients were treated with symptomatic treatment,and after admission,the serum procalciton in levels were detected in 1,3,5,7 d,and compared with the serum procalcitonin levels before and after treatment in the three groups.Results:The serum procalcitonin ≥ 0.5 μg/L number of B group and C group had no significant difference (P＞0.05),the serum procalcitonin ≥ 0.5 μg/L number of A group was significantly lower than that of B group and C group (P＜0.05);the survival rate of severe bacterial infection patients whose serum procalcitonin was higher than than 0.5 μg/L was significantly higher than those who with serum procalcitonin lower than 0.5 μg/L (P＜0.05).Conclusion:Serumprocalcitonin level had a good application value in the clinical diagnosis prognostic prediction of patients with severe infection.