Eight compounds were isolated and purified from the ethyl acetate part of 70% acetone extract of Rehmannia glutinosa by various chromatographic techniques such as silica gel, MCI gel CHP-20, ODS, Toyopearl HW-40C, combined with TLC and semi-preparative HPLC. Their structures were elucidated by modern spectroscopy techniques (NMR, MS, UV, IR), and identified as neomartynoside A (1), osmanthuside B₆ (2), martynoside (3), isomartynoside (4), (E)-p-hydroxycinnamic acid (5), caffeic acid (6), ferulic acid (7), and methyl caffeate (8). Compound 1 is a new phenylethanol glycoside, which was identified as neomartynoside A. Compound 2 was isolated from Rehmannia glutinosa for the first time. In addition, compounds 2, 6 and 7 significantly increased relative glucose consumption, showing potential hypoglycemic activity.

BACKGROUND:Autophagy may be involved in the pathological process of steroid-induced necrosis of the femoral head(SINFH).Some studies have confirmed that circular RNAs(circRNAs)have a regulatory mechanism in SINFH;however,whether circCDR1as affects autophagy in SINFH has not been investigated. OBJECTIVE:To explore the level of autophagy and the regulatory mechanism of circCDR1as in SINFH. METHODS:Gene expression profiles of SINFH and control rats were extracted from the GSE26316 dataset and differential expression analysis was performed.Subsequently,the biological functions of differentially expressed genes were analyzed.Then,the target miRNAs of circCDR1as and the target genes of target miRNAs were predicted.Further,the target genes were compared with the differentially expressed genes to construct the regulatory network of circCDR1as.In addition,femoral head samples from patients with SINFH and healthy control individuals were collected.Bone marrow mesenchymal stem cells were also applied for cellular experiments and randomly divided into bone marrow mesenchymal stem cell group,model group(methylprednisolone-treated),model+si-NC group,and model+si-CDR1as group.RT-qPCR was used to detect the expression of circCDR1as and target genes in cells and tissue samples.Western blot was used to examine the expression of autophagy proteins.The luciferase reporter gene vectors,pmirGLO-CDR1as(WT),pmirGLO-RAF1(WT),pmirGLO-CDR1as(MUT),and pmirGLO-RAF1(MUT),were constructed and transfected into the cells.miR-7-5p mimic and mimic NC groups were established.The target-regulatory relationship of the circCDR1as network was detected. RESULTS AND CONCLUSION:A total of 1 283 differentially expressed genes were identified between the SINFH and control groups,which were mainly involved in apoptotic and autophagic signaling pathways.Prediction analysis revealed that circCDR1as targeted 6 miRNAs,which in turn regulated 305 target genes.Among these target genes,31 showed differential expression in SINFH.Among the differentially expressed target genes,RAF1,involved in autophagy,was selected as a key gene,leading to the construction of the circCDR1as/miR-7-5p/RAF1 regulatory network.Compared with the control group,circCDR1as,RAF1,and autophagy levels were upregulated in patients with SINFH and in hormone-induced bone marrow mesenchymal stem cells(P<0.05),while miR-7-5p expression was downregulated(P<0.05).Knockdown of circCDR1as significantly decreased cellular autophagy levels(P<0.05).Dual-luciferase reporter assays confirmed the targeting relationships between circCDR1as and miR-7-5p,as well as between miR-7-5p and RAF1.To conclude,the CircCDR1as/miR-7-5p/RAF1 may potentially promote SINFH through autophagy.Targeting circCDR1as is a potential strategy for partial autophagic repair in the treatment of SINFH.

ObjectiveTo present the exploration and application of a prospective follow-up research method for acute infectious disease surveillance based on natural community populations， using COVID-19 infection as an example， and to provide a reference for improving the infectious disease surveillance and early warning system. MethodsA multi-stage probability proportional sampling method was employed to sample residents from all communities of 16 administrative districts in Shanghai， with households as the units. A cohort for acute infectious diseases based on natural community populations was established. The baseline survey was conducted for all cohort subjects， and COVID-19 antigen test kits were distributed. From December 21， 2022 to September 30， 2023， prospective follow-up monitoring of COVID-19 antigen and nucleic acid was carried out on the study subjects on a weekly basis. The baseline characteristics and follow-up information of the cohort subjects were described. ResultsThe cohort for acute infectious diseases included a total of 12 881 subjects， comprising 6 098 males （47.3%） and 6 783 females （52.7%）. The baseline survey revealed that 35.2% （4 540/12 881） of the subjects had a history of COVID-19 infection. During the follow-up period from December 21， 2022 to September 30， 2023， the average incidence density in the cohort was 0.61/person-year， with a higher incidence density in females （0.63/person-year） compared to males （0.59/person-year）. Individuals aged 60 and above （0.64/person-year） and those with underlying health conditions （0.67/person-year） had a higher incidence density. Healthcare workers showed a notably higher incidence density （0.84/person-year） than that in other occupational groups. As of September 30， 2023， a total of 340 subjects in the cohort experienced secondary infections， with a median interval of 170 days between the first and second infections. ConclusionThis study applies cohort study method to acute infectious disease surveillance， providing crucial data support for estimating infection rates and forecasting alerts for acute infectious diseases in the community. This method can be promoted and applied as a new approach for acute infectious disease surveillance.

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective To investigate the disease spectrum and pathogenic genes of inherited metabolic disorder(IMD)among neonates in Gansu Province of China.Methods A retrospective analysis was conducted on the tandem mass spectrometry data of 286 682 neonates who received IMD screening in Gansu Provincial Maternal and Child Health Hospital from January 2018 to December 2021.A genetic analysis was conducted on the neonates with positive results in tandem mass spectrometry during primary screening and reexamination.Results A total of 23 types of IMD caused by 28 pathogenic genes were found in the 286 682 neonates,and the overall prevalence rate of IMD was 0.63‰(1/1 593),among which phenylketonuria showed the highest prevalence rate of 0.32‰(1/3 083),followed by methylmalonic acidemia(0.11‰,1/8 959)and tetrahydrobiopterin deficiency(0.06‰,1/15 927).In this study,166 variants were identified in the 28 pathogenic genes,with 13 novel variants found in 9 genes.According to American College of Medical Genetics and Genomics guidelines,5 novel variants were classified as pathogenic variants,7 were classified as likely pathogenic variants,and 1 was classified as the variant of uncertain significance.Conclusions This study enriches the database of pathogenic gene variants for IMD and provides basic data for establishing an accurate screening and diagnosis system for IMD in this region.

Objective To observe the clinical efficacy and safety of montelukast sodium chewable tablets combined with desloratadine citrate disodium tablets in the treatment of patients with chronic urticaria.Methods Patients with chronic urticaria were divided into control group and treatment group according to cohort method.Control group was treated with montelukast sodium chewable tablets 10 mg per night,orally chewed.On the basis of control group,the treatment group was treated with desloratadine citrate disodium tablets 8.8 mg each time,qd,orally.Two groups of patients were treated for 4 weeks.The clinical efficacy,serum levels of immunoglobulin E(IgE),interleukin-4(IL-4)and interferon-γ(INF-γ),and adverse drug reactions were compared between two groups.Results The treatment group and control group were enrolled with 68 and 66 cases,respectively.After treatment,the total effective rates of treatment and control groups were 95.59％(65 cases/68 cases)and 83.33％(55 cases/66 cases)with significant difference(P＜0.05).After treatment,the IgE levels of treatment and control groups were(70.55±8.50)and(92.57±9.65)U·mL-1;the IL-4 levels were(6.87±1.35)and(8.49±1.23)pg·mL-1;the INF-γ levels were(23.24±6.87)and(19.83±6.75)pg·mL-1;the differences were statistically significant(all P＜0.05).The adverse drug reactions of treatment group were drowsiness and fatigue,while those in the control group were drowsiness and fatigue.The total incidences of adverse drug reactions in the treatment and control groups were 8.82％and 4.55％without significant difference(P＞0.05).Conclusion Montelukast sodium chewable tablets combined with desloratadine citrate disodium tablets have a definitive clinical efficacy in the treatment of patients with chronic urticaria,which can effectively regulate the serum levels of IgE,IL-4 and INF-γ,without increasing the incidence of adverse reactions.

Objective:To understand the epidemiological characteristics of diarrheagenic Escherichia ( E. ) coli infection in infectious diarrhea outpatients aged 15 years and older in Shanghai and provide evidence for the development of disease control strategies .Methods:Based on multistage systematic sampling, diarrhea surveillance was conducted in 22 sentinel hospitals in Shanghai, the information about cases' demographic, clinical, and epidemiological characteristics were collected. Stool samples were collected for the detection and typing of diarrheagenic E. coli by local centers for disease control and prevention. The positive rate of diarrheagenic E. coli in different populations and seasons from 2014 to 2021 were analyzed. Statistical analysis was conducted by using χ2 test. Results:In 15 185 diarrhea cases, 8.05% (1 222/15 185) were positive for diarrheagenic E. coli. The positive rate was higher in men (8.74%, 684/7 824) than in women (7.31%, 538/7 361). The positive rate was highest in age group 15-29 years (9.14%, 335/3 665) and the annual positive rate was highest in 2021 (10.21%, 83/813), the differences were all significant ( P<0.05). In the 1 264 strains of diarrheagenic E. coli analyzed through PCR, enterotoxingenic E. coli was the most frequently identified pathogen (50.24%, 635/1 264), followed by enteroadhesive E. coli (27.93%, 353/1 264), and enteropathogenic E. coli (21.36%, 270/1 264). The positive rate of diarrheagenic E. coli showed obvious seasonality with peak in summer (13.92%, 774/5 562) ( χ2=495.73, P<0.001). Conclusions:Diarrheagenic E. coli has become a prominent pathogen in infectious diarrhea cases in Shanghai, the disease can occur all the year round with incidence peak during summer and autumn. Predominant subtypes included enterotoxingenic E. coli, enteroadhesive E. coli and enteropathogenic E. coli. Targeted prevention and control strategies are needed for diarrheagenic E. coli-induced infectious diarrhea in different age groups, seasons and for different types of infections.

Objective: To retrospectively analyze the epidemic characteristics and spatial distribution of vomiting and diarrhea outbreaks in schools and kindergartens in Shanghai from 2015 to 2019, so as to provide the scientific evidence for optimizing prevention and control of vomiting and diarrhea outbreaks in schools and kindergartens. Methods: Data collection and analysis were carried out on the vomiting and diarrhea outbreaks reported to Shanghai Municipal Center for Disease Control and Prevention from 2015 to 2019. Epidemiological characteristics were analyzed and compared. The proportion and incidence of outbreaks in schools and kindergartens were calculated, and the influencing factors of outbreaks were analyzed by multivariate Logistic regression. The index of Moran s I was used for the global and local spatial auto correlation analysis. Results: Among the 344 vomiting and diarrhea outbreaks, 98.26% occurred in kindergartens, primary schools, middle schools and other educational institutions. The median number of cases per outbreak was 15. The number of suspected outbreaks and the percentage of cases involved peaked in 2015 ( 60.00% , 84.35%) and then decreased year by year to 16.00% and 38.80% in 2019. About 86.98% of the outbreaks were transmitted by human to human contact. Among the 329 outbreaks with samples collected from cases and/or environments, the main pathogen detected was norovirus ( n =280), and sapovirus was detected in outbreak for the first time in 2016. The outbreaks showed obvious seasonality, with two peaks (November, March) and one trough (July), and the majority of outbreaks occurred in primary schools (44.38%) and kindergartens (32.84%). Compared with kindergartens, the probabilities of suspected epidemic outbreaks in primary schools, combined schools, middle schools and other educational institutions were higher (adjusted OR =6.40, 9.16, 12.64 , 5.58, P <0.01). The proportion and incidence of outbreaks in educational institutions in different districts showed no high-high aggregation areas. Conclusions Primary schools and kindergartens are key places for the prevention and control of vomiting and diarrhea outbreaks. Targeted prevention and control measures should be strengthened at the beginning of each semester and before the peak of the epidemic each year. Timely reporting of symptoms, suspension of school admissions after symptoms appear and standardized disposal of vomit are effective measures to reduce interpersonal transmission and control the scale of an outbreak.

Macroporous adsorption resin, MCI, Toyopearl HW-40C and silica gel column chromatography combined with the semi-preparative HPLC were used to isolate and purify the water extract of Cornus officinalis. And the structures of compounds were identified by HRESIMS, NMR, IR, UV and ECD. A total of twelve compounds were isolated from the fruits of Cornus officinalis. They were identified as neolignan B (1), 2,3-dihydro-7-methoxy-2-(4′-hydroxy-3′-methoxyphenyl)-3a-O-β-D-xylopyranosyloxymethyl-5-benzofuranpropanol (2), cornucadinoside A (3), 3,4-dihydroxyacetophenone (4), n-butyl gallate (5), 3-hydroxybenzoic acid (6), n-butyl quininate (7), 5-hydroxymaltol (8), 2-furolic acid (9), 5-hydroxymethylfurfural (10), 5-(methoxycarbonyl)-2-pyrrolidone (11), and dimethyl malate (12). Compound 1 is a new biphenyl lignan, named as neolignan B. Compounds 2, 4, 5, 7-9 and 11 were isolated from Cornus officinalis for the first time.

Eleven compounds were isolated from Eucommia ulmoides by silica gel, Sephadex LH-20, HW-40C column chromatography and semi-preparative HPLC. Their structures were identified by modern spectroscopic methods as neoeucommiate A (1), (7S,8R)-dihydrodehydrodiconiferyl alcohol (2), urolignoside (3), ficusal (4), tiruneesiin (5), glochidioboside (6), forsythialansides B (7), ecdysanol B (8), (+)-syringaresinol-4-O-β-D-glucopyranoside (9), (+)-pinoresinol 4-O-[6ʹʹ-O-vanilloyl]-β-D-glucopyranoside (10), samsesquinoside (11). Compound 1 is a new compound, compounds 3-7, 10 and 11 were isolated from Eucommia ulmoides for the first time.