OBJECTIVE To optimize the water extraction technology for Kaixin granules. METHODS UPLC-MS/MS method was established for the simultaneous determination of ginsenoside Rg1， ginsenoside Re， ginsenoside Rb1， tenuifolin， polygalaxanthone Ⅲ and 3， 6′-disinapoyl-sucrose. An orthogonal test was designed with extraction times， extraction duration， and the volume of added water as factors. Using the contents of the aforementioned six indicator components and the extract yield as evaluation indexes， analytic hierarchy process-entropy weight method was employed to determine the combined weights of each indicator. Subsequently， process optimization and validation were conducted by integrating grey relational analysis （GRA） and back propagation （BP） neural network. RESULTS The water extraction technology optimized by the orthogonal test and GRA was 10- fold water for the first decoction and 8-fold water for the subsequent two， extracting 3 times，extracting for 1 h each time； the average comprehensive score of the validation experiment was 91.10 （RSD＝0.31%， n＝3）. The water extraction technology optimized by BP neural network was extracting 3 times with 10-fold water added each time， extracting for 1.5 h each time； the average comprehensive score of the validation experiment was 95.89 （RSD＝0.73%， n＝3）. Considering practical production requirements， the optimal water extraction technology was extraction performed three times， with 10-fold water for the first decoction and 8-fold water for the subsequent two extractions， with an extraction time of 1 h each. CONCLUSIONS The optimized water extraction technology for Kaixin granules is stable and feasible.

Objective : To characterize MMP12 as a pan-cancer marker and assess its screening value as a tumor serum marker. Methods : Bioinformatics tools such as GEPIA2,GSCA,cBioPortal,and GeneMANIA were used to analyze the pan-cancer features of MMP12 in TCGA datasets,including encompassing differential gene expression analysis,prognostic analysis,DNA methylation analysis,gene structural variation analysis and immune microenvironment analysis.Furthermore,serum samples we collected from patients with lung adenocarcinoma,breast invasive carcinoma,esophageal squamous cell carcinoma,stomach adenocarcinoma,liver hepatocellular carcinoma,and healthy individuals.ELISA was used to detect MMP12 expression in serum,and the screening performance was evaluated using the area under the ROC curve.Additionally,we followed up 28 ESCC patients and compared serum MMP12 levels between 19 patients with disease progression and 9 patients with stable disease. Results: The pancancer feature analysis revealed a significant negative correlation between MMP12 mRNA expression and its promoter DNA methylation(P<0.05),as well as a positive correlation with gene copy number variations(P<0.05).MMP12 mRNA expression was up-regulated in 14 cancer tissues compared to normal tissues next to cancer(P<0.05) and was associated with poor prognosis of cancer patients(P<0.05).Immunocorrelation analysis showed that MMP12 was significantly associated with immunity,infiltration of stromal cells,tumor mutational burden(TMB) and microsatellite instability(MSI)(P<0.05).ROC curve analysis indicated that MMP12 could serve as a potential biomarker for screening lung adenocarcinoma,breast invasive carcinoma,esophageal squamous cell carcinoma,stomach adenocarcinoma,and liver hepatocellular carcinoma.In a 30-month follow-up study of esophageal squamous cell carcinoma patients,the expression of MMP12 was higher in the disease progression group than that in the stable group. Conclusion MMP12 serves as a potential prognostic and screening marker of pan-cancer.

Objective To investigate the effect of diosmine on semen quality and sex hormone concentra-tion in patients with spermatovenous ligation.Methods Clinical data were retrospectively collected from January 2019 to January 2022 on patients with varicocele admitted to Department of Urology,General Hospital of Southern Theater Command,divided into a control group and a study group based on whether they had a history of Diosmine use after surgery.Clinical data from both groups were matched using propensity score matching.Sperm quality and sex hormone tests were then compared before surgery,three months after surgery and six months after surgery.Results There were 73 in the control group and 73 in the study group.Both groups were balanced in terms of age,BMI,seminal fluid volume and testosterone(P＞0.05).Sperm motility,forward motility and testosterone were all increased 3 and 6 months after surgery,and sperm malformations,sperm DNA fragment index,follicle stimulating hormone and luteinizing hormone were all reduced significantly(P＜0.05).The results were also better than those in the control group for total sperm motility,forward motility,testosterone,sperm DNA fragment index,follicle stimulating hormone and luteinizing hormone(P＜0.05).Conclusions Diosmine can help to restore semen quality and improve sex hormone concentration in patients with varicocele after Laparoscopic varicocelectomy.

Purpose Hydrogen proton magnetic resonance imaging was used to study the brain metabolism of menstrual-related migraine(MRM)in different states,and to investigate its correlation with clinical features and estrogen and progesterone.Materials and Methods We recruited 36 patients with MRM diagnosed by neurology outpatient experts of the First Affiliated Hospital of Henan University of Science and Technology from April 2019 to August 2022,and also recruited 29 normal women with age-and education-matched.Proton magnetic resonance spectroscopy was used to assess neurochemical brain changes during interictal period(late follicular phase)and ictal period(perimenstrual phase)in them.The point resolved spectroscopic sequence was used to focus on the bilateral medial prefrontal cortex(mPFC)and bilateral thalamus.Sex hormone levels were collected on the same day of MRI acquisition.The ratios of NAA/Cr,GABA/Cr,Glx/Cr and Cho/Cr were observed.Metabolite changes and hormone levels were investigated among two groups.Furthermore,metabolite changes were investigated in a longitudinal design during the interictal period and ictal period.Results There were no significant differences in the levels of estrogen and progesterone both in the late follicular and perimenstrual periods.There were no significant differences in decline rate of them in perimenstrual periods between patients and normal people(P>0.05).During interictal period,the ratio of Cho/Cr in the region of left mPFC was lower significantly in the MRM group than that of control group(U=-2.957,P=0.003)and showed a significant negative correlation with attack frequency(r=-0.398,P=0.018).During ictal period,the women with MRM had significantly lower the ratio of GABA/Cr in the left mPFC and higher the ratio of Glx/Cr in the left thalamus compared to those of controls(U=-2.015,P=0.044;t=2.213,P=0.033).We found no significant correlations between these results and magraine characteristics(P>0.05).In addition,we found the ratio of GABA/Cr did not change(P>0.05),the ratio of Glx/Cr and Cho/Cr in right thalamus increased from interictal towards the ictal state for MRM patients(t=-2.181,P=0.038;Z=-2.414,P=0.016).Conclusion The present study suggests the existence of distinct cerebral metabolism states between MRM and control,and there are dynamic changes in cerebral metabolism with headache attacks.However,there is no significant difference in estrogen and progesterone from normal women,and its neural mechanism still needs to be further studied.

Objective:This study aims to explore the application value of the "liftoff" modular method in robot-assisted laparoscopic surgery for complex adrenal tumors.Methods:We retrospectively analyzed the clinical data of 15 patients with complex adrenal tumors treated at the General Hospital of Southern Theater Command from May 2022 to June 2023. The cohort comprised 5 males and 10 females with an average age of (47.6±7.8) years and a body mass index (BMI) of 26.5 (23.8-27.9) kg/m 2. Among the patients, 3 had a BMI ≥28 kg/m 2, 2 had diabetes, 6 had hypertension, and 1 had coronary heart disease. Preoperative endocrine hormone examination revealed abnormal blood catecholamines in 5 cases and abnormal blood cortisol in 2 cases. Ultrasound and CT scans indicated that 9 tumors were located on the left side and 6 on the right, with 4 cases showing tumor compression on adjacent large blood vessels or organs. The average tumor diameter was (7.61±2.79) cm, with 10 cases having a diameter ≥ 6 cm. All patients underwent laparoscopic adrenalectomy assisted by robots through the transperitoneal approach. The surgeries were performed in a lateral position under general anesthesia. The "liftoff" modular method was utilized to separate the treatment of adrenal tumors into lateral, medial, dorsal, cephalic, and adrenal renal plane sides. Tumors were appropriately manipulated during the operations to achieve a "liftoff" shape. Different modular dissociation steps were adopted based on the size and location of the left and right adrenal tumors. The left adrenal gland was dissected in the order of medial and dorsal, adrenal renal plane side, and lateral and cephalic sides, while the right adrenal gland was dissected in the order of lateral and dorsal, adrenal renal plane side, and medial and cephalic sides. Postoperative related indicators and follow-up status of patients were recorded and analyzed. Results:All 15 surgeries were successfully completed without any conversions to open adrenalectomy, with an average operation time of 118 (102-130) minutes and an average intraoperative blood loss of 102 (69-163) ml. The postoperative drainage time was 4 (3-5) days, and the postoperative hospital stay was 6 (4-7) days. The postoperative pathological diagnoses included 5 cases of pheochromocytoma, 3 cases of macronodular adrenal hyperplasia, 6 cases of adrenocortical adenoma, and 1 case of myelolipoma. Follow-up for 6-12 months after surgery showed good recovery and no recurrence.Conclusions:The application of the "liftoff" modular method in robot-assisted laparoscopic surgery for complex adrenal tumors is safe and feasible. It efficiently aids in tumor removal and holds significant clinical application value.

ObjectiveTo investigate the characteristics of traditional Chinese medicine syndrome and the evolution of pathogenesis in different stages of atherosclerotic thrombotic cerebral infarction （ATCI）. MethodsClinical data of 3088 ATCI patients from 8 hospitals in 6 provinces and cities were collected from the hospital information system during January 1， 2015 to December 31， 2019. After staging and counting clinical symptoms， common factors were extracted using the principal component analysis method in factor analysis. Cluster analysis was then carried out on the basis of the factor analysis. The results of the combination of the evidence element identification， cluster analysis and expert discussion were used to discuss the evidence of the different disease stages of atherosclerotic cerebral infarction. ResultsOf the 3088 ATCI patients included， 2290 cases were in the acute phase and 798 in the non-acute phase. Excluding the main symptoms of ischaemic stroke， such as numbness and weakness of limbs， unfavourable movement， unfavourable speech and dizziness， we identified 84 indicators with a frequency ≥5% of the four diagnostic information variables. Of these， 36 indicators were observed in the acute phase and 35 in the non-acute phase. Factor analysis extracted 14 common factors from each phase. We selected factors with a loading coefficient ＞0.3 for evidence determination. These 14 groups of common factors were used as variables for clustering. After clustering， the acute， non-acute phase were each divided into 5 categories. Based on a combination of clinical practice and expert opinion， the symptoms identified in the acute period were syndrome of deficiency of both qi and yin， syndrome of blockade of wind-phlegm-static blood （36.07%）， syndrome of qi deficiency and blood stasis （20.74%）， syndrome of upward disturbance of wind-fire （15.15%）， syndrome of stirring wind due to yin deficiency （9.43%）， and syndrome of spleen deficiency and liver hyperactivity （3.80%）. In the non-acute phase， the symptoms were qi and yin deficiency with syndrome of qi stagnation and blood stasis （45.49%）， syndrome of deficiency of both qi and yin （20.05%）， syndrome of qi stagnation and blood stasis （16.42%）， spleen-kidney deficiency syndrome （8.52%）， and syndrome of hyperactivity of liver yang （4.89%）. ConclusionThe acute phase of AICI is mainly characterized by blood stasis， fire， internal wind， hyperactivity of yang， qi deficiency and yin deficiency， while the non-acute phase is characterized by yin deficiency， qi deficiency， blood stasis and qi stagnation. The main pathomechanism of ATCI involves deficiency of qi and yin， as well as obstruction of the channels by phlegm and blood stasis， and the fundamental pathomechanism is deficiency of qi and yin.

Ischemic stroke(IS)is a multifactorial and heterogeneous disease.Despite years of studies,effective strategies for the diagnosis,management and treatment of stroke are still lacking in clinical practice.Metabolomics is a growing field in systems biology.It is starting to show promise in the identification of biomarkers and in the use of pharmacometabolomics to help patients with certain disorders choose their course of treatment.The development of metabolomics has enabled further and more biological appli-cations.Particularly,metabolomics is increasingly being used to diagnose diseases,discover new drug targets,elucidate mechanisms,and monitor therapeutic outcomes and its potential effect on precision medicine.In this review,we reviewed some recent advances in the study of metabolomics as well as how metabolomics might be used to identify novel biomarkers and understand the mechanisms of IS.Then,the use of metabolomics approaches to investigate the molecular processes and active ingredients of Chinese herbal formulations with anti-IS capabilities is summarized.We finally summarized recent developments in single cell metabolomics for exploring the metabolic profiles of single cells.Although the field is relatively young,the development of single cell metabolomics promises to provide a powerful tool for unraveling the pathogenesis of IS.

Objective:To study the clinical effects of portal vein embolization (PVE) with N-butyl cyanoacrylate copolymer (NBCA) and with gelatin sponge (GS) as embolization materials in patients with initially unresectable hepatocellular carcinoma (HCC).Methods:Clinical data of 90 patients with initial unresectable HCC who underwent PVE treatment at the Third Affiliated Hospital of Naval Medical University from November 2014 to April 2020 were included. There were 77 males and 13 females, aged 48 (25, 67) years old. Patients were divided into two groups according to the embolization materials selected in PVE: NBCA group ( n=60) and GS group ( n=30). Forty-eight and 18 patients finally underwent secondary hepatectomy in NBCA group (resectable NBCA group) and GS group (resectable GS group), respectively. Clinical data including future liver remnant (FLR) growth rate and secondary hepatectomy rate were analyzed. Survivals after hepatectomy was followed up by telephone, WeChat, and outpatient review. Results:The secondary hepatectomy rate in NBCA group was higher than that in GS group [80%(48/60) vs. 60%(18/30), P=0.043]. The waiting time from primary intervention to secondary hepatectomy in resectable NBCA group was 15 (7, 96) d, which was shorter than that in resectable GS group [40 (28, 118) d, P<0.001]. The FLR growth rate of resectable NBCA group was 9.03 (1.24, 29.64) ml/d, which was faster than that in resectable GS group [3.76 (0.08, 8.03) ml/d, P<0.001]. The recurrence-free survival (RFS) rates of patients in resectable NBCA group were 69.1%, 62.0% and 44.7% at 1, 2 and 3 years after surgery, and the overall survival (OS) rates were 76.4%, 69.5% and 59.6%, respectively. The RFS rates of patients in resectable GS group were 60.6%, 48.5% and 35.4% at 1, 2 and 3 years after surgery, and the OS rates were 66.7%, 60.6% and 42.4%, respectively. There were no significant differences in RFS and OS between two groups (all P>0.05). Conclusions:PVE with NBCA and GS as embolization material showed good efficacy in patients with initially unresectable HCC. The FLR growth rate and secondary hepatectomy rate of patients using NBCA were better than those of patients using GS.

Vigabatrin-associated brain abnormalities on magnetic resonance imaging (VABAM) is a relatively rare side effect of vigabatrin, most of which are asymptomatic. However, there will be extremely rare cases with hyperkinetic disorders, myoclonus, tremor, and acute encephalopathy under certain circumstances. VABAM is often underappreciated by physicians and its accurate incidence remains unclear. A female infant who was diagnosed with infantile spasms and required adrenocorticotropic hormone therapy accompanied by various antiseizure medicines was reported. Unfortunately, she became lethargic and her spasm deteriorated gradually after vigabatrin exposure. Her brain magnetic resonance imaging revealed abnormal signals bilaterally in the dorsal midbrain, thalamus, and rostral part of the pallidum. She had a seizure amelioration and became lively as a result of vigabatrin withdrawal. In the meanwhile, magnetic resonance imaging returned to normal. Attempts were made to discover the risk factors of VABAM and potential pathogenesis. Further understanding of the disease should contribute to decreasing misdiagnosis and making precise decisions.

【Objective】 To investigate the establishment of a competitive performance evaluation management program for blood centers to ensure the blood supply. 【Methods】 A competitive performance evaluation system for Blood Donor Service Department of blood centers in eastern Shenzhen was established. The data concerning blood collection after (May to October 2021, the experiment group) and before (the corresponding period in 2020, the control) the launch of evaluation system was compared, including the proportion of total/novel blood donors in fixed donation sites, the donation rate of 400 mL and pre-collection deferral rate; collected units per shift, the average collection volume of staff, and the growth rate of per capita donation; the proportion of first-time/repeated/double-dose platelet apheresis donors; the proportion of transfer-in/transfer-out of red blood cells; the ratio of group to street blood donors. 【Results】 The proportion of total/novel blood donors in fixed donation sites(81.13% vs 75.87%), the donation rate of 400 mL(58.14% vs 57.91%) and pre-collection deferral rate(76.55% vs 65.92%) in the experimental group was higher than that of the control, while the proportion of pre-collection deferral was lower(18.87% vs 24.13%) (P<0.05). Compared by the control, the units collected per shift, the average collection volume of staff and the blood donation per capita at fixed sites in the experiment group increased by 54.29%, 52.21%, and 3.36% (P<0.05). The proportion of first-time platelet donors was greater than that in the control(43.90% vs 19.61%), while the proportion of repeated platelet donors was lower (56.10% vs 80.39%). The proportion of double-dose platelet donors was lower than that in the control(12.62% vs 22.19%) (P<0.05). The amount of red blood cells transfer-in was 0%, lower than 2.38% in the control group(P<0.05), while the amount of red blood cell transfer-out was 1.86%, higher than 0% in the control group (P<0.05). The proportion of group blood donors decreased from 24% to 15.19%, while street blood donors increased from 76% to 84.81% (P<0.05). 【Conclusion】 Proper competitive performance evaluation system can effectively mobilize employee motivation, improve the efficacy of blood collection and internal management, and ensure clinical blood supply.