OBJECTIVE To explore the changes in chemical compositions and the characteristics of “fried charcoal and saving properties” based on the carbon-frying process of Sophora japonica and its bud. METHODS The slightly， moderately and heavily carbon-fried samples of S. japonica and its bud were prepared. The fingerprints of S. japonica， its bud and carbon-fried samples were established， and common peaks were identified. HPLC method was used to determine the contents of identified components and differential analysis was also performed； the differential components were screened by using chemometric methods， and their content ratios were used to characterize the “fried charcoal and saving properties” of S. japonica and its bud. RESULTS There were 9 common peaks in the fingerprints of S. japonica and its carbon-fried samples， 8 common peaks in those of S. japonica bud and its carbon-fried samples. In the fingerprints of S. japonica and its bud， and their different fried products， 6 components were identified， such as rutin， kaempferol-3-O-rutinoside， isorhamnetin-3-O-rutinoside， quercetin， kaempferol，isorhamnetin. Among them， the contents of rutin， kaempferol-3-O-rutinoside and isorhamnetin-3-O-rutinoside were the highest in slightly carbon-fried samples of S. japonica bud， and the contents of quercetin and isorhamnetin were the highest in moderately carbon-fried samples of S. japonica bud， and the contents of kaempferol were higher in moderately and healily carbon-fried samples of S. japonica bud. The chemometric results showed that the variable importance projection values of rutin and quercetin were both greater than 1. The range of rutin-quercetin content ratio between 9.00-14.00 and 3.00-6.00 respectively could characterize “fried charcoal and saving properties” of S. japonica and its bud. CONCLUSIONS There are significant differences in the chemical compositions of raw and fried products of S. japonica and its bud. Rutin and quercetin may be the differential components that affect their quality， and the ratio range of the two can be used to characterize the “fried charcoal and saving properties” of S. japonica and its bud in the future.

Objective To analyze the influencing factors of aspiration risk in patients with acute poisoning during gastric lavage,and to build and validation a prediction model of aspiration risk in patients with acute poisoning during gastric lavage.Methods Through literature search and analysis,the risk factors of aspiration during gastric lavage was summarized in patients with acute poisoning.A retrospective study was conducted on patients with acute poisoning in the emergency department of a tertiary A general hospital in Ningbo from January 2020 to June 2023.Through R 4.2.1 and Python 3.11 programming language,the random forest,logistic regression,extreme gradient boosting tree and gradient boosting decision tree algorithms in machine learning were used to establish a prediction model of aspiration risk during gastric lavage in patients with acute poisoning and carry out internal verification.The prediction effects of the 4 prediction models were evaluated by confusion matrix,calibration curve,receiver operating characteristic curve,area under curve,Kolmogorov-Smirnov value,accuracy,precision,recall rate and F1 score,and the best model was selected.Results The modeling results of the 4 machine learning algorithms show that the area under the curve of the Random Forest,Logistic Regression,Extreme Gradient Boosting Tree,and Gradient Boosting Decision Tree algorithms are 0.954(0.934～0.974),0.878(0.843～0.913),0.910(0.880～0.939),and 0.917(0.889～0.945),respectively.The internal validation results show that the area under the curve of the random forest,logistic regression,extreme gradient boosting tree,and gradient boosting decision tree algorithms are 0.910(0.864～0.955),0.877(0.824～0.931),0.849(0.790～0.908),and 0.873(0.819～0.928),respectively.Age,state of consciousness,D-dimer and the time of absorption of poison are the 3 characteristics that are particularly prominent in the order of importance of the influencing factors of aspiration during gastric lavage in patients with acute poisoning.Conclusion Among the 4 prediction models,random forest model has better prediction effect,with good discrimination ability for the risk of aspiration during gastric lavage in patients with acute poisoning,and it is convenient for clinical use,which can provide references for medical staff to take preventive treatment and care.

ObjectiveTo investigate the transformation mechanism and content variation of saponins from Polygalae Radix before and after being boiled with licorice juice and water. MethodSimulated licorice juice boiled products and simulated water boiled products of onjisaponin B， onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ were prepared by simulated processing technology， and analyzed by ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Exactive Orbitrap/MS）. Then the contents of onjisaponin B， onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ and tenuifolin in Polygalae Radix， licorice-boiled Polygalae Radix and water-boiled Polygalae Radix were determined by UPLC-triple quadrupole tandem mass spectrometry（UPLC-QQQ-MS/MS）. ResultDuring the boiling process with licorice juice and water， onjisaponin B could be hydrolyzed to produce 4-methoxycinnamic acid， desacylsenegin Ⅲ， polygalasaponin ⅩⅩⅧ and tenuifolin， onjisaponin Z could be hydrolyzed to produce 3，4，5-trimethoxycinnamic acid， onjisaponin TF， polygalasaponin ⅩⅩⅧ and tenuifolin， onjisaponin F could be hydrolyzed to produce 3，4，5-trimethoxycinnamic acid， onjisaponin G， polygalasaponin ⅩⅩⅧ and tenuifolin， and polygalasaponin ⅩⅩⅧ was hydrolyzed to produce tenuifolin. After being boiled with licorice juice or water， the content of onjisaponin B decreased significantly（P<0.05， P<0.01）， but the contents of onjisaponin Z， onjisaponin F， polygalasaponin ⅩⅩⅧ and tenuifolin increased significantly（P<0.05， P<0.01） in Polygalae Radix. Compared with the water-boiled products， the contents of onjisaponin Z and tenuifolin increased significantly（P<0.05， P<0.01）， and the change of tenuifolin content was the most significant in the licorice-boiled products.However， there was no significant difference in the content of onjisaponin B， onjisaponin F and polygalasaponin ⅩⅩⅧ between the water-boiled products and the licorice-boiled products. ConclusionBeing boiled with licorice juice or water can hydrolyze onjisaponin B， onjisaponin Z， onjisaponin F and polygalasaponin ⅩⅩⅧ， and generate secondary glycosides and aglycones（organic acids） through deglycosylation， which leads to obvious changes in the contents of onjisaponins after Polygalae Radix being processed.It is inferred that licorice juice can promote the hydrolysis of some onjisaponins in Polygalae Radix to onjisaponin Z and tenuifolin.This study provides an experimental basis for revealing processing mechanism of Polygalae Radix.

OBJECTIVE To study the correlation between processing time, chroma value and UPLC fingerprint map of Dipsaci Radix. METHODS Established the UPLC fingerprint of Dipsaci Radix. Monitored the changes of chemical components in the processing process of wine and salt processed Dipsaci Radix, spectrophotometer was used to objectively quantify the chroma value of different processed products. SPSS 20.0 and SIMCA 14.0 statistical software was used to analyze the correlation between processing time and chroma value and fingerprint. RESULTS In the process of processing, the decoction pieces color of the powder deepened and L*, b* and E* values decreased. The correlation analysis showed that the processing time was significantly correlated with the chroma value and fingerprint of decoction pieces. CONCLUSION The method of UPLC fingerprint is stabled and reliabled, combines with the objective discriminant analysis of the chroma value of the Dipsaci Radix processed products, which lay the foundation for standardizing the processing technology of wine and salt processed products and evaluating the quality of Dipsaci Radix.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To analyze the correlation of fetal cervical cystic hygroma (CCH) with chromosomal and structural abnormalities and to assess the prognosis of CCH.Methods:This study retrospectively enrolled 70 fetuses with CCH diagnosed by prenatal ultrasound in the First Affiliated Hospital of Xi'an Jiao Tong University from July 2015, to December 2021. According to whether complicated by structural malformations or other anomalies, all the subjects were divided into the non-isolated and isolated CCH groups. The correlation of CCH and the gestational age at detection with chromosomal and structural abnormalities were analyzed and the prognosis of the cases were summarized using Chi-square test. Results:There were 34 isolated CCH (34/70, 49%) and 36 non-isolated CCH (36/70, 51%) among the 70 cases. In the non-isolated CCH group, there were eight cases (22%, 8/36) with abnormal heart structure, ten (28%, 10/36) with abnormal anterior abdominal wall, 16 (44%,16/36) with systemic edema and/or pleural effusion, one (3%,1/36) with craniocerebral abnormalities and one with holoprosencephaly and cardiac structural abnormalities. Eighteen out of 44 cases undergoing chromosome testing had chromosomal abnormalities, which were trisomy-18 ( n=6), trisomy-21 ( n=3), trisomy-13 ( n=3), 45,XO ( n=3), and chromosome segment duplication or deletion ( n=3). The detection rate of chromosome abnormality was higher in non-isolated CCH group comparing with isolated CCH group [59%(13/22) vs 23%(5/22), χ2=6.02, P=0.014]. There was no significant difference in the gestational age at the detection of CCH or proportion of women of advanced maternal age between the isolated and non-isolated CCH groups (both P>0.05). The ratios of isolated CCH cases with normal chromosome detected at the gestational weeks of 14-27 +6 was higher than those detected at 11-13 +6 weeks [62%(13/21) vs 17%(4/23), χ2=7.39, P=0.001]. Out of the 17 cases with isolated CCH and normal chromosomes, 12 were live births. One of the 12 cases still had a cystic mass with a diameter of 3 cm in the neck nine months after birth, and the other 11 cases had no mass at birth but one case died at the age of five months (hospitalized one week for neonatal edema),one case was found with anal atresia three days after birth and underwent operation and the remaining nine cases were normal during five months to six years follow-up. Conclusions:Non-isolated CCH is at a higher risk of chromosomal abnormalities. Isolated CCH cases detected later had higher rate of normal chromosome and often have a higher survival rate.

Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.

OBJECTIVE：To establish characteristic chromatogram of Cornus officinalis and its different wine-processedproducts，investigate the differences of chromaticity values，and analyze them with chemical pattern recognition technology.METHODS：UPLC method was adopted. Using loganin as reference，UPLC characteristic chromatograms were drawn for 10batches of C. officinalis and 20 batches of different wine-processed products （stewing with wine，steaming with wine）. TCMFingerprint Similarity Evaluation System（2012A edition）was used for similarity evaluation，and common peaks were confirmed.The chromaticity values [lightness（L），red and green tone value（a），yellow and blue tone value（b），color difference value（ΔE）]were determined by spectrophotometer. SPSS 20.0 and SIMCA 14.0 software were used for cluster analysis，principal componentanalysis and partial least squares-discriminant analysis；taking the area of characteristic peak and chromaticity value as indexes，andthe variable importance projection greater than 1 as the standard，the difference markers affecting its quality were screened.RESULTS：There were 6 common peaks in the chromatograms for decoction piece of C. officinalis，7 common peaks forwine-processed C. officinalis（stewing with wine）and wine-processed C. officinalis（steaming with wine）. Four components wereidentified as gallic acid，5-hydroxymethylfurfural，morroniside，loganin. 5-hydroxymethylfurfural was produced after processing.The similarity between C. officinalis and different wine-processed products （stewing and steaming with wine） was low（0.869-0.937，0.845-0.944），but the similarity between different wine-processed products was higher than 0.99. ΔL，Δa，Δb and ΔEof C. officinalis decoction pieces and wine-processed C. officinalis decoction pieces（stewing in wine）were －9.42-－3.58，－24.92- －15.00，－11.33- －7.00 and 17.01-28.12，respectively. ΔL，Δa，Δb and ΔE of C. officinalis decoction pieces and wine-processed C. officinalis（steaming in wine）decoction pieces were －8.58-－2.42，－25.08-－13.83，－10.92-－6.08，15.58-28.67. ΔL，Δa，Δb and ΔE of wine-processed C. officinalis decoction pieces（stewing and steaming with wine）were －2.17-3.00，－0.75-2.50， 0.25-1.42 and 1.25-3.83，respectively. Results of cluster analysis showed that 30 batches of sample were clustered into two categories，S1-S10 were clustered into one category，and S11-S30 were clustered into other category. Principal component analysis showed that cumulative contribution rate of former two main components was 83.147％. Results of partial least squares-discriminant analysis showed that morroniside，No.5 peak and chromaticity values（L，a，b）were the difference markers affecting its quality. CONCLUSIONS：Established UPLC characteristic chromatogram is stable and feasible，and can be used to rapidly identify C. officinalis and its different wine-processed products. Established chemical mode can be used to identify different wine-processed products.

Objective: To compare cooperation degree and visual acuity difference between Lea Symbols chart and ETDRS chart in Chinese preschool children. Methods: A prospective self-control study design was performed.Two hundred and forty-one children aged from 42 months to 78 months in Quanzhou Quangang Experimental Kindergarten were enrolled and the mean age was (61.9±10.3) months.Among them, 132 pre-school children had normal refractive index.All children completed comprehensive ophthalmological examinations and measurement of monocular visual acuity using Lea Symbols chart and ETDRS chart.All monocular visual acuity scores were recorded in LogMAR form.This study followed the Declaration of Helsinki and this study protocol was approved by Medical Ethics Committee of The Second Affiliated Hospital of Fujian Medical University (No.2017[62]). Written informed consent was obtained from all guardians before entering the study. Results: The cooperation degrees of Lea Symbols chart and ETDRS chart were 96.7% and 95.0% in 42-78 months of children, respectively, with no significant difference between the two visual acuity tables (χ²=1.669, P>0.05). The visual acuity measured by Lea Symbols chart was positively correlated with that measured by ETDRS chart (r_s=0.726, P<0.001). The measurement consistency of the two chart was good (Kappa=0.531). Among 132 normal refractive children, the visual acuity level measured by Lea Symbols chart was higher than that measured by ETDRS chart (W=-7.461, P<0.001); the measurement consistency of the two visual acuity chart was good (Kappa=0.467). There was no significant difference between the two charts in measuring the binocular vision difference (W=-0.889, P=0.374); the visual acuity levels of boys measured by Lea Symbols chart and ETDRS chart were higher than those of girls, and the difference was statistically significant (U=-3.352, -4.679; both at P<0.001); the visual acuity values measured by Lea Symbols chart and ETDRS chart were negatively correlated with age (r_s=-0.423, -0.437; both at P<0.001); the visual acuity measured by Lea Symbols chart was higher than that measured by ETDRS chart in different age groups, and the differences were statistically significant (all at P<0.001). Conclusions The measurement of visual acuity by Lea Symbols chart and ETDRS chart can be achieved with a high cooperation degree in 42 months and older children.The visual acuity measured by Lea Symbols chart is higher than that measured by ETDRS chart.In the preschool children's vision screening, we should pay attention to the difference between the two kinds of visual charts, and be careful to judge the abnormal vision.

Objective To investigate whether follicular helper T(Tfh) cells were involved in the development of Henoch-Sch?nlein purpura(HSP) and Henoch-Sch?nlein purpura nephritis(HSPN) in chil-dren through affecting CD40/CD40L axis. Methods Fifty-five subjects were enrolled in this study and di-vided into four groups as follows:22 children with HSP but without renal involvement(Group A),11 chil-dren with HSPN presenting with microhematuria(Group B),11 children with HSPN presenting with micro-hematuria and proteinuria (Group C) and 11 healthy children (control group). Flow cytometry was per-formed to detect the percentages of CD19+B cells and their subsets,CD19+B cells and CD19+CD38+B cells secreting different Ig classes,CD19+CD40+B cells and their subsets and Tfh cells expressing CD40 ligand (CD40L). Results Compared with the control group,the percentages of CD19+CD86+B,CD19+CD138+B and CD40L+Tfh cells significantly increased in Group C(P<0.05) and slightly increased in Groups A and B (P>0.05). No significant difference in the percentages of CD19+B cells, CD19+CD27+B cells, CD19+B cells or CD19+CD38+B cells expressing IgG, IgM, IgD, CD19+B cells or CD19+B cell subsets secreting CD40 was found between the control group and Groups A,B and C(P>0.05). Moreover,the percentages of CD19+B and CD19+CD38+B cells secreting IgA and IgE in Groups A,B and C were higher than those in the control group(P<0.05). Secretion of IgA by CD19+B and CD19+CD38+B cells were positively correla-ted with the expression of CD40L by Tfh cells(P<0.05). Conclusion Tfh cell-mediated abnormal expres-sion of CD40/CD40L might play an important role in the development of HSP and be related to the clinical severity of renal involvement in HSPN.