The chemical constituents from the n-butanol fraction of ethanol extract of safflower (Carthamus tinctorius L.) were isolated and purified using chromatographic process including MCI Gel CHP-20, ODS, Sephadex LH-20 column chromatography, and semi-preparative HPLC method, and one alkyne and two phenylpropanoid derivants were obtained. Their structures were identified as (5R,E)-tetradecane-12-ene-8,10-diyne-1,5,14-triol (1), (E)-8-O-β-D-glucopyranosyl n-butyl cinnamate (2), and (7S,8S)-7-(4-hydroxy-3-methoxybenzene)-7-butyl-8,9-diol (3) by modern spectroscopy methods (1D NMR, 2D NMR, UV, IR and MS). 1-3 are all new compounds. Compounds 1-3 were screened for their anti-renal fibrosis activities in vitro, and none of them showed obvious effect.

Objective To explore the changes in serum energy metabolites in patients with peripheral T-cell lymphoma,and investigate serum biomarkers for monitoring peripheral T-cell lymphoma from the perspective of energy metabolism.Methods Multiple/selected reaction monitoring(MRM/SRM)was used to detect the energy-related metabolites in the sera of 16 patients with newly diagnosed peripheral T-cell lymphoma admitted in the Hematology Medical Center of the Second Affiliated Hospital of Army Medical University from November 2020 to December 2021,as well as 10 recruited healthy volunteers.The corresponding clinical data including medical history,laboratory results and image data were collected and retrospectively analyzed.Results Significant differences were seen in the contents and expression profiles of serum energy metabolism-related products between the patients and the healthy volunteers.The patients had significantly reduced serum contents of cyclic AMP,succinate,citrate and cis-aconitate(P＜0.05),and elevated D-glucose 6-phosphate content(P＜0.05).The serum contents of citrate and succinate were negatively correlated with the risk stratification(low-,moderate-and high-risk)and clinical stage of the disease(P＜0.05).Meanwhile,there was a negative correlation between the contents of L-malic acid and citrate and the mid-term efficacy evaluation results,such as complete/partial response(CR/PR)or stable disease(SD)(P＜0.05).For patients with extranodal NK/T cell lymphoma(n=10),there were also significant reductions in the contents of cyclic AMP,succinate,citrate,isocitrate and cis-aconitate in the sera of patients compared with healthy volunteers(P＜0.05),and the contents of citrate and succinate were negatively correlated with the clinical stage(P＜0.05)and were rather correlated with mid-term efficacy evaluation results(CR/PR or SD)(P＜0.05).For patients with angioimmunoblastic T-cell lymphoma(n=6),the serum contents of cyclic AMP,citrate and succinate were significantly lower,while the content of D-glucose 6-phosphate was higher when compared with the healthy volunteers(P＜0.05),and the content of succinate was negatively correlated with both clinical stage and risk grade of the patients(P＜0.05).Conclusion There are 5 serum differential metabolites identified between patients with peripheral T-cell lymphoma and healthy controls,and succinate and citrate are expected to be serum biomarkers of peripheral T-cell lymphoma.

Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.

AIM To investigate the influencing factors in scale-up of extraction process for Yunpi Xiaoshi Prescription.METHODS HPLC was adopted in the content determination of catechin,ferulic acid,taxifolin,isovitexin,narirutin,atractylenolideⅡ,naringin,morin,hesperidin,luteolin,hederagenin,atractylenolideⅠ,naringenin and hesperetin,the fingerprints were established,after which the effects of container volume,optimal fire and feeding quantity on the contents of various constituents were evaluated.RESULTS Fifteen batches of samples demonstrated the similarities of more than 0.995.Fourteen constituents showed good linear relationships within their own ranges(r>0.999 0),whose average recoveries were 96.4%-103.3%with the RSDs of 0.5%-2.7%.The influencing degree of optimal fire was greater than that of container volume and feeding quantity.CONCLUSION The combination of multi-component content determination and fingerprints can provide data basis and theoretical reference for the technology of consistency evaluation in scale-up of extraction process for Yunpi Xiaoshi Prescription.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective To compare the application effect of different doses of rivaroxaban on anticoagulation therapy in patients with pulmonary thromboembolism(PTE)during maintenance period,and to evaluate its benefit-risk.Methods The patients with PTE were divided into conventional-dose group and low-dose group according to the cohort method.Conventional-dose group were given of rivaroxaban 15 mg,twice a day and changed to 20 mg once a day after 3 weeks;low-dose group were given rivaroxaban 10 mg twice a day and changed to 15 mg once a day after 3 weeks,and the anticoagulation treatment time in both groups was ≥ 3 months.The clinical efficacy in the two groups was recorded.Serum indicators[D-dimer(D-D),N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin Ⅰ(cTn Ⅰ)]and liver-kidney function[glutamic-pyruvic transaminase(GPT),glutamic-oxaloacetic transaminase(GOT),blood urea nitrogen(BUN),creatinine(Cr)]were compared before treatment and after 3 months of treatment.The patients were followed up for 3 months after treatment,and the endpoint events such as PTE recurrence and death and the bleeding events were recorded in the two groups.Results There were 42 cases in conventional-dose group,44 cases in low-dose group.After 3 months of treatment,the total effective rates in low-dose group and conventional-dose group were both 100.00％,with no significant difference(P＞0.05).After 3 months of treatment,serum D-D levels in low-dose group and conventional-dose group were(0.31±0.08)and(0.29±0.07)mg·L-1,NT-proBNP levels were(125.49±24.16)and(121.39±22.08)ng·L-1,cTn Ⅰ levels were(0.02±0.00)and(0.02±0.00)μg·L-1,all with significant differences(all P＞0.05).There were no significant changes in GPT,GOT,BUN and Cr in the two groups before and after treatment(all P＞0.05),and there were no statistically significant differences between the two groups(all P＞0.05).The total incidences of bleeding events during follow-up was 6.82％in low-dose group and was 23.81％in conventional-dose group(P＜0.05).Conclusion Compared with conventional-dose rivaroxaban,low-dose rivaroxaban has similar anticoagulant effect,but the latter one can better reduce the risk of bleeding events in patients with PTE.

Allergic conjunctivitis is the most common type of allergic eye disease, and the incidence in children and adolescents is increasing year by year. Drug therapy can only relieve some symptoms and only in a short period, while allergen immunotherapy is currently a therapy that can significantly improve the symptoms of chronic allergy and the course of the disease. This method has been used abroad for many years but has yet to be reported in China. The author reviews the effective mechanism and clinical efficiency of allergen immunotherapy and provides a reference for the further clinical application in China.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To compare the efficacy of ulnar Z-shaped shortening osteotomy combined with arthroscopic deep suture anchor repair of the triangular fibrocartilage complex (TFCC) and ulnar Z-shaped shortening osteotomy alone in the treatment of ulnar impaction syndrome with moderate or severe distal radioulnar joint instability.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with ulnar impaction syndrome accompanied by moderate or severe distal radioulnar joint instability, who were admitted to Affiliated Hospital of Qingdao University from January 2016 to June 2023, including 16 males and 14 females, aged 27-58 years [(42.4±9.9)years]. All the patients presented with positive ulnar variance and TFCC type IB injury, with the deep layer of TFCC affected. Fifteen patients were treated with Z-shaped shortening osteotomy of the ulna alone (osteotomy alone group), while the other 15 patients received Z-shaped shortening osteotomy of the ulna combined with arthroscopic suture anchor repair of the deep layer of TFCC (osteotomy combined with repair group). The operation time, intraoperative blood loss, and length of ulnar shortening were compared between the two groups. The forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, visual analogue scale (VAS), patient-rated wrist evaluation (PRWE) score, modified Mayo wrist score, and disabilities of the arm, shoulder, and hand (DASH) questionnaire score were assessed preoperatively, at 6 and 12 months postoperatively, and at the last follow-up. The incidence of postoperative complications was recorded.Results:The patients were followed up for 6-24 months [(15.8±4.9)months]. The operation time in the osteotomy combined with repair group was 3.0 (2.3, 3.0)hours, longer than 1.5 (1.3, 2.0)hours in the osteotomy alone group ( P<0.01). There were no significant differences in intraoperative blood loss and the length of ulnar shortening between the two groups ( P>0.05). There were no significant differences in forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, VAS, PRWE score, modified Mayo wrist score, and DASH score between the two groups preoperatively ( P>0.05). At 6 and 12 months postoperatively, and at the last follow-up, the forearm rotation degrees in the osteotomy combined with repair group were (130.3±8.8)°, (135.2±7.9)°, and (141.9±6.9)°, greater than (120.5±9.4)°, (123.7±10.2)°, and (130.9±8.5)° in the osteotomy alone group; the ulnar-radial deviation angles in the osteotomy combined with repair group were 23.0 (23.0, 26.5)°, 33.0 (30.0, 36.0)°, and 36.0 (32.5, 41.5)°, greater than 22.0 (20.0, 23.0)°, 23.0 (23.0, 28.0)°, and 25.0 (23.0, 33.5)° in the osteotomy alone group ( P<0.05 or 0.01). In the osteotomy combined with repair group, the palmar-dorsal flexion angles at 12 months postoperatively and at the last follow-up were (125.8±10.8)° and (132.9±16.8)°, greater than those in the osteotomy alone group [(99.1±15.7)° and (121.2±17.4)°] ( P<0.01), while there was no significant difference in the palmar-dorsal flexion angle between the two groups at 6 months postoperatively ( P>0.05). In the osteotomy combined with repair group, the grip strength at 6 months postoperatively was (14.6±1.0)N, greater than (12.8±1.8)N in the osteotomy alone group ( P<0.05), while there was no significant difference in grip strength between the two groups at 12 months postoperatively and at the last follow-up ( P>0.05). At 6, 12 months postoperatively, and at the last follow-up, the VAS scores in the osteotomy combined with repair group were (4.3±1.9)points, (2.7±1.1)points, and (2.1±0.7)points, lower than (6.5±2.5)points, (4.7±1.4)points, and (4.3±0.9)points in the osteotomy alone group; the PREW scores were (57.6±4.1)points, (47.3±2.4)points, and (35.0±3.4)points, lower than (67.8±4.5)points, (53.1±4.4)points, and (43.5±4.1)points in the osteotomy alone group ( P<0.05 or 0.01). The modified Mayo wrist scores in the osteotomy combined with repair group at 6, 12 months postoperatively, and at the last follow-up were (78.3±2.9)points, (80.1±3.0)points, and (83.5±3.9)points, higher than those in the osteotomy alone group [(69.0±4.3)points, (75.5±2.9)points, (78.8±2.4)points] ( P<0.01). The DASH scores in the osteotomy combined with repair group at 12 months postoperatively and at the last follow-up were (35.8±4.6)points and (28.4±5.4)points, lower than (43.3±5.0)points and (34.2±4.4)points in the osteotomy alone group ( P<0.01), while there was no significant difference in DASH scores between the two groups at 6 months postoperatively ( P>0.05). In both groups, forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, and modified Mayo wrist scores at all time points postoperatively were all higher than the preoperative values ( P<0.05), while the postoperative VAS, PREW, and DASH scores were lower than the preoperative values ( P<0.05), with statistically significant differences among different time points postoperatively ( P<0.01). The incidence of postoperative complications in the osteotomy combined with repair group was 6.7% (1/15), lower than 46.7% (7/15) in the osteotomy alone group ( P<0.05). Conclusion:Compared with the ulnar Z-shaped shortening osteotomy alone, ulnar Z-shaped shortening osteotomy with arthroscopic suture anchor deep repair of TFCC has the advantages of increased wrist range of motion, reduced pain, improved function, and lower incidence of complications, etc in treating ulnar impaction syndrome with moderate or severe instability of the distal radioulnar joint.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.