A universal method for profiling and characterization of oligosaccharides in traditional Chinese medicines

Oligosaccharides constitute fundamental components in numerous traditional Chinese medicines (TCMs). Conventional chromatographic methods for natural product analysis are not suitable for oligosaccharides due to their large polarity and structural similarity. Herein, an ultra-high performance liquid chromatography with charged aerosol detector (UHPLC-CAD) method was developed for the profiling of oligosaccharides using 9 neutral (DP3-DP11) reference oligosaccharides. Various factors, including columns, mobile phase, elution conditions, flow rate, and column temperature were systematically examined. Optimal separation was achieved using an Amide column with gradient elution within 18 min, at 0.5 mL/min flow rate and 30°C column temperature. Moreover, an ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) method was also optimized to provide structural information. The developed method was applied to detect oligosaccharides in several TCMs, including Morindae Officinalis Radix (MOR), Ziziphi Spinosae Semen (ZSS), Menthae Haplocalycis Herba (MHH) and Chrysanthemi Indici Flos (CIF), revealing 9 and 16 oligosaccharides being uncovered from MHH and CIF respectively for the first time. This study presents a versatile UHPLC-CAD and UHPLC-Q-TOF/MS method with the potential for advancing oligosaccharides discovery and contributing to the quality analysis of TCMs.

Proactive Versus Reactive Control Strategies Differentially Mediate Alcohol Drinking in Male Wistars and P Rats

Problematic alcohol consumption is associated with deficits in decision-making and alterations in prefrontal cortex neural activity likely contribute. We hypothesized that the differences in cognitive control would be evident between male Wistars and a model of genetic risk: alcohol-preferring P rats. Cognitive control is split into proactive and reactive components. Proactive control maintains goal-directed behavior independent of a stimulus, whereas reactive control elicits goal-directed behavior at the time of a stimulus. We hypothesized that Wistars would show proactive control over alcohol seeking whereas P rats would show reactive control over alcohol seeking. Neural activity was recorded from the prefrontal cortex during an alcohol seeking task with two session types. On congruent sessions, the conditioned stimulus (CS+) was on the same side as alcohol access. Incongruent sessions presented alcohol opposite the CS+. Wistars, but not P rats, made more incorrect approaches during incongruent sessions, suggesting that Wistars utilized the previously learned rule. This motivated the hypothesis that neural activity reflecting proactive control would be observable in Wistars but not P rats. While P rats showed differences in neural activity at times of alcohol access, Wistars showed differences prior to approaching the sipper. These results support our hypothesis that Wistars are more likely to engage in proactive cognitive control strategies whereas P rats are more likely to engage in reactive cognitive control strategies. Although P rats were bred to prefer alcohol, the differences in cognitive control may reflect a sequela of behaviors that mirror those in humans at risk for an AUD.

Bioactive metabolites reveal the therapeutic consistency of epimedii folium from multi-plant sources for the treatment of kidney-yang deficiency

ETHNOPHARMACOLOGICAL RELEVANCE

Epimedii Folium (Yin-yang-huo in Chinese), a traditional and commonly used herbal medicine (HM), is a representative of multi-plant sources. To date, little is known about the reasons for similar therapeutic effects of this HM from multi-plant sources.

AIM OF THE STUDY

To investigate the underlying reasons for the similar pharmacological effects of Epimedii Folium from two botanical sources (Epimedium koreanum Nakai and Epimedium wushanense T. S. Ying).

MATERIALS AND METHODS

Firstly, the phytochemicals of the extracts of E. koreanum and E. wushanense were systematically analyzed. Meanwhile, their pharmacological effects on kidney-yang deficiency (KYD) syndrome were evaluated in rats induced by hydrocortisone. Subsequently, we proposed a combined effect index (CEI) to assess the effects of two plants on the secretion of testosterone by combing the system exposure of twelve active components in vivo with their regulation activities of testosterone production in vitro. Moreover, the label-free proteomics and Western blot analysis were conducted to evaluate the possible mechanism of Epimedii Folium from two botanical sources.

RESULTS

E. koreanum and E. wushanense exhibited similar pharmacological effects on KYD syndrome with promoting the mating behaviors and testosterone levels of rats, although there is a certain difference in the main components between two plants. The CEI analysis showed that there was no difference (P > 0.05) in the sum of CEIs of two Epimedium, indicating that their similar therapeutic effects are attributed to bioactive metabolites in vivo. Furthermore, Epimedii Folium can regulate testosterone production in rat Leydig cell via reversing expressions of key steroidogenic enzymes, such as steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD).

CONCLUSION

Our results supply critical evidence for the similar pharmacological effects of two Epimedium species, acting by consistent bioactive components directly exposing in vivo, not chemical compositions presenting in herbs. It provides a reasonable scientific basis for understanding of the HMs originated from multi-plant sources for the same clinical application.

Mediation of Regional Cerebral Blood Flow in the Relationship between Specific Gut Microbiota and Cognition in Vascular Cognitive Impairment

BACKGROUND

Gut microbiota could affect the onset and development of vascular cognitive impairment (VCI) through modulating metabolic and immune pathways. However, the vascular mechanisms involved remain unclear.

OBJECTIVE

To investigate the gut microbiota associated with VCI and examine the mediating effects of regional cerebral blood flow (CBF) to explore potential therapeutic targets for VCI.

METHODS

This prospective study enrolled patients with VCI (n = 16) and healthy controls (n = 18) from the Chinese Imaging, Biomarkers, and Lifestyle study between January 1 and June 30, 2022. The gut microbiota composition and diversity were determined by 16 S ribosomal RNA gene sequencing. The association between gut microbiota and Montreal Cognitive Assessment (MoCA) scores was determined using Spearman's correlation analysis. Regional CBF was calculated using pseudo-continuous arterial spin labeling. The mediating effects of regional CBF on the relationship between specific gut microbiota and cognition in VCI were investigated using mediation analysis.

RESULTS

Compared to healthy controls, patients with VCI had significantly greater abundance of Bifidobacterium, Veillonella, R uminococcus gnavus , Fusobacterium, and Erysipelatoclostridium and smaller abundance of Collinsella. The abundance of Ruminococcus gnavus was negatively associated with MoCA scores in patients with VCI, with the CBF in the left hypothalamus, right hypothalamus, and left amygdala accounting for 63.96%, 48.22%, and 36.51%, respectively, of this association after adjusting for confounders.

CONCLUSIONS

Ruminococcus gnavus is associated with cognition in VCI, which is strongly mediated by CBF in the bilateral hypothalamus and left amygdala. These findings highlight the potential regulatory roles of nutrition and metabolism-related areas of the brain in VCI.

Isolation and structural elucidation of prebiotic oligosaccharides from Ziziphi Spinosae Semen

Six oligosaccharides were discovered and isolated for the first time from Ziziphi Spinosae Semen. On the basis of spectroscopic analysis, their structures were determined to be verbascose (1), verbascotetraose (2), stachyose (3), manninotriose (4), raffinose (5), and melibiose (6). The prebiotic effect of the oligosaccharide fraction was assayed by eight gut bacterial growth in vitro, revealing a significant increase in cell density, up to 4-fold, for Lactobacillus acidophilus, Lactobacillus gasseri, and Lactobacillus johnsonii. The impact of six oligosaccharides with different degrees of polymerization (DPs) and structures on the growth of Lactobacillus acidophilus was evaluated. As a result, stachyose and raffinose demonstrated superior support for bacterial growth compared to the other oligosaccharides. This study explored the structure-activity relationship of raffinose family oligosaccharides (RFOs) and showed that the more the monosaccharide type, the more supportive the gut bacteria growth when oligosaccharides have the same molecular weight.

Two-dimensional liquid chromatography and ion mobility-mass spectrometry for the multicomponent characterization of different parts of the medicinal plant Gynostemma longipes

Herba Gynostemma (Jiaogulan) is an herbaceous plant of the genus Gynostemma in the family Cucurbitaceae. Gynostemma longipes has lipid-lowering activity, thus, it is used as a medicinal material. However, its medicinal using parts have been recorded as whole plants or aerial parts in different provincial quality standards; therefore, it is necessary to conduct a comprehensive compositional analysis of the different parts of G. longipes (rhizomes, stems, and leaves) used in traditional medicine. In this study, offline two-dimensional liquid chromatography-ion mobility-quadrupole time-of-flight mass spectrometry (2D-LC/IM-QTOF-MS) was used to analyze the different parts of G. longipes obtained from Shaanxi province, China. By combining the retention times, mass fragments, collision cross-section values, reference standards, and information concerning literature compounds, 396 components were identified from the three parts of the plant, including 94 groups of isomers, and 217 components were identified or tentatively identified as new compounds. In the rhizomes, leaves, and stems, 240, 220, and 168 compounds, respectively, were identified. Differential analysis of the compounds in the rhizomes and aerial parts was also carried out, and 36 differential components were identified, of which 32 had higher contents in the rhizomes. Therefore, these findings indicate that the number of chemical components and the content of major differential components are higher in the rhizomes than the leaves and stems of G. longipes from the Maobaling Planting Base in Pingli county, Shaanxi province. Thus, the rhizomes of G. longipes are also an important part for medicinal use. These results will contribute to the establishment of quality control methods for G. longipes.

Proactive Versus Reactive Control Strategies Differentially Mediate Alcohol Drinking in Wistar and P rats

Problematic alcohol consumption is associated with deficits in decision-making, and alterations in prefrontal cortex neural activity likely contributes. We hypothesized that differences in cognitive control would be evident between male Wistar rats and a model for genetic risk for alcohol use disorder (alcohol-preferring P rats). Cognitive control can be split into proactive and reactive components. Proactive control maintains goal-directed behavior independent of a stimulus whereas reactive control elicits goal-directed behavior at the time of a stimulus. We hypothesized that Wistars would show proactive control over alcohol-seeking whereas P rats would show reactive control over alcohol-seeking. Neural ensembles were recorded from prefrontal cortex during an alcohol seeking task that utilized two session types. On congruent sessions the CS+ was on the same side as alcohol access. Incongruent sessions presented alcohol opposite the CS+. Wistars, but not P rats, exhibited an increase in incorrect approaches during incongruent sessions, suggesting that Wistars utilized the previously learned task-rule. This motivated the hypothesis that ensemble activity reflecting proactive control would be observable in Wistars but not P rats. While P rats showed differences in neural activity at times relevant for alcohol delivery, Wistars showed differences prior to approaching the sipper. These results support our hypothesis that Wistars are more likely to engage proactive cognitive-control strategies whereas P rats are more likely to engage reactive cognitive control strategies. Although P rats were bred to prefer alcohol, differences in cognitive control may reflect a sequela of behaviors that mirror those in humans at risk for an AUD.

Response mechanism of growth and gypenosides content for Gynostemma longipes cultivated at two altitude habitats to fine root morphological characteristics

Introduction

Fine roots are the critical functional organs of plants to absorb water and nutrients from the soil environment, while the relation between fine root morphological characteristics and yield & quality has received less attention for medicinal plants.

Methods

Therefore, we investigated the relationship between fine root morphological characteristics and biomass & gypenosides content. We explored the primary environmental drivers of fine root indicators for Gynostemma longipes from three provenances cultivated at two altitude habitats.

Results

At the end of the growing season, compared with the low-altitude habitat, the underground biomass of G. longipes in the high-altitude habitat increased significantly by 200%~290% for all three provenances. The response of gypenosides content to different altitude habitats varied with provenance and plant organs. The biomass of G. longipes strongly depended on the fine root characteristic indicators (P < 0.001), fine root length density, and fine root surface area. Our results also showed that the harvest yield of G. longipes could be effectively increased by promoting the growth of fine roots per unit leaf weight (P < 0.001, R² = 0.63). Both fine root length density and fine root surface area had strong positive correlations with soil nutrient factors (R² > 0.55) and a strong negative correlation with soil pH (R² > 0.48). In a word, the growth of G. longipes is strongly controlled by the fine root morphological characteristics through the response of fine roots to soil nutrient factors and pH.

Discussion

Our findings will help to deepen the understanding of the root ecophysiological basis driven by soil factors for the growth and secondary metabolites formation of G. longipes and other medicinal plants under changing habitat conditions. In future research, we should investigate how environmental factors drive plant morphological characteristics (e.g., fine roots) to affect the growth & quality of medicinal plants over a longer time scale.

Safety and clinical activity of atezolizumab plus erlotinib in patients with non-small-cell lung cancer

BACKGROUND

Acquired resistance limits long-term epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) efficacy in patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC) in whom anti-programmed death-ligand 1 (PD-L1) efficacy is also limited. We hypothesized that combining atezolizumab with erlotinib could enhance antitumor immunity and extend efficacy in these patients.

PATIENTS AND METHODS

This open-label phase Ib trial was conducted in adults aged ≥18 years who had advanced, unresectable NSCLC. Stage 1 (safety evaluation) enrolled EGFR TKI-naive patients regardless of EGFR status. Stage 2 (expansion) enrolled patients with EGFR-mutant NSCLC treated with ≤1 prior non-EGFR TKI therapy. Patients received 150 mg erlotinib orally once daily. After a 7-day erlotinib run-in, atezolizumab 1200 mg was administered intravenously every 3 weeks. The primary endpoint was the safety and tolerability of the combination in all patients; secondary endpoints included antitumor activity per RECIST 1.1 in stage 2 patients.

RESULTS

At the data cut-off on 7 May 2020, 28 patients (8 in stage 1, 20 in stage 2) were assessable for safety. No dose-limiting toxicities or grade 4 or 5 treatment-related adverse events occurred. Grade 3 treatment-related adverse events occurred in 46% of patients; the most common were increased alanine aminotransferase, diarrhea, pyrexia, and rash (each in 7% of patients). Serious adverse events occurred in 50% of patients. Pneumonitis (grade 1) was reported in a single patient (4%). The objective response rate was 75% [95% confidence interval (CI) 50.9% to 91.3%]), median response duration was 18.9 months (95% CI 9.5-40.5 months), median progression-free survival was 15.4 months (95% CI 8.4-39.0 months), and median overall survival was not estimable (NE) (95% CI 34.6-NE).

CONCLUSIONS

Atezolizumab combined with erlotinib demonstrated a tolerable safety profile and encouraging, durable clinical activity in patients with advanced EGFR mutation-positive NSCLC.

[Observational study on perioperative outcomes of pelvic exenteration]

Objective: To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration (PE) for locally advanced, recurrent pelvic malignancies and complex pelvic fistulas. Methods: This was a descriptive study.The indications for performing PE were: (1) locally advanced, recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy; (2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required; and (3) findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction, poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria, had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022, had complete perioperative clinical data, and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables, postoperative pathological findings (curative resection), and early postoperative complications were analyzed. Results: Of the 141 included patients, 43 (30.5%) had primary malignancies, 61 (43.3%) recurrent malignancies, 28 (19.9%) complex fistulas after radical resection of malignancies,and nine (6.4%)complex fistulas caused by benign disease. There were 79 cases (56.0%) of gastrointestinal tumors, 30 cases (21.3%) of reproductive tumors, 16 cases (11.3%) of urinary tumors, and 7 cases (5.0%) of other tumors such mesenchymal tissue tumors. Among the 104 patients with primary and recurrent malignancies, 15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team; the other 89 patients were evaluated for radical PE surgery. All surgeries were successfully completed. Total PE was performed on 73 patients (51.8%),anterior PE on 22 (15.6%),and posterior PE in 46 (32.6%). The median operative time was 576 (453,679) minutes, median intraoperative blood loss 500 (200, 1 200) ml, and median hospital stay 17 (13.0,30.5)days.There were no intraoperative deaths. Of the 89 patients evaluated for radical PE surgery, the radical R0 resection was achieved in 64 (71.9%) of them, R1 resection in 23 (25.8%), and R2 resection in two (2.2%). One or more postoperative complications occurred in 85 cases (60.3%), 32 (22.7%)of which were Clavien-Dindo grade III and above.One patient (0.7%)died during the perioperative period. Conclusion: PE is a valid option for treating locally advanced or recurrent pelvic malignancies and complex pelvic fistulas.

Porphyromonas gingivalis Evades Immune Clearance by Regulating Lysosome Efflux

Porphyromonas gingivalis, a major periodontal pathogen, invades autophagosomes of cells, including gingival epithelial cells, endothelial cells, gingival fibroblasts, macrophages, and dendritic cells, to escape antimicrobial autophagy and lysosome fusion. However, it is not known how P. gingivalis resists autophagic immunity, survives within cells, and induces inflammation. Thus, we investigated whether P. gingivalis could escape antimicrobial autophagy by promoting lysosome efflux to block autophagic maturation, leading to intracellular survival, and whether the growth of P. gingivalis within cells results in cellular oxidative stress, causing mitochondrial damage and inflammatory responses. P. gingivalis invaded human immortalized oral epithelial cells in vitro and mouse oral epithelial cells of gingival tissues in vivo. The production of reactive oxygen species (ROS) increased upon bacterial invasion, as well as mitochondrial dysfunction-related parameters with downregulated mitochondrial membrane potential and intracellular adenosine triphosphate (ATP), upregulated mitochondrial membrane permeability, intracellular Ca²⁺ influx, mitochondrial DNA expression, and extracellular ATP. Lysosome excretion was elevated, the number of intracellular lysosomes was diminished, and lysosomal-associated membrane protein 2 was downregulated. Expression of autophagy-related proteins, microtubule-associated protein light chain 3, sequestosome-1, the NLRP3 inflammasome, and interleukin-1β increased with P. gingivalis infection. P. gingivalis may survive in vivo by promoting lysosome efflux, blocking autophagosome-lysosome fusion, and destroying autophagic flux. As a result, ROS and damaged mitochondria accumulated and activated the NLRP3 inflammasome, which recruited the adaptor protein ASC and caspase 1, leading to the production of proinflammatory factor interleukin-1β and inflammation.

Qualitative and quantitative studies on two commercial specifications of Polygonatum odoratum

The rhizoma of Polygonatum odoratum (PO) is used to treat yin injuries of the lung and stomach in traditional Chinese medicine. The chemical constituents of this herb are steroidal saponins, homoisoflavanones, and alkaloids. Xiangyuzhu (XPO) and Guanyuzhu (GPO) are available in the market as two specifications of the commodity. Nonetheless, systematic research on the identification and comparison of chemical constituents of these two commercial specifications is yet lacking. Herein, an integrated method combing ultra-high-performance liquid chromatography-quadruple time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) with ultra-high-performance liquid chromatography-charged aerosol detection (UHPLC-CAD) was employed for the comprehensively qualitative and quantitative analyses of PO. A total of 62 compounds were identified by UHPLC-Q-TOF/MS, among which 13 potential chemical markers were screened out to distinguish two commercial specifications. Subsequently, the absolute determination method for polygodoraside G, polygonatumoside F, and timosaponin H1 was established and validated by UHPLC-CAD. The contents of the three compounds were 13.33-236.24 μg/g, 50.55-545.04 μg/g, and 13.34-407.83 μg/g, respectively. Furthermore, the ratio of timosaponin H1/polygodoraside G could be applied to differentiate the two specifications. Samples with a ratio <2 are considered XPO and >5 are considered GPO. Therefore, the above results provide a valuable means for the quality control of PO.

An instant beverage rich in nutrients and secondary metabolites manufactured from stems and leaves of Panax notoginseng

Introduction

Radix Notoginseng, one of the most famous Chinese traditional medicines, is the dried root of Panax notoginseng (Araliaceae). Stems and leaves of P. notoginseng (SLPN) are rich in secondary metabolites and nutrients, and authorized as a food resource, however, its utilization needs further research.

Methods

A SLPN-instant beverage was manufactured from SLPN through optimization by response surface design with 21-fold of 48.50% ethanol for 39 h, and this extraction was repeated twice; the extraction solution was concentrated to 1/3 volume using a vacuum rotatory evaporator at 45°C, and then spray dried at 110°C. Nutritional components including 14 amino acids, ten mineral elements, 15 vitamins were detected in the SLPN-instant beverage; forty-three triterpenoid saponins, e.g., ginsenoside La, ginsenoside Rb3, notoginsenoside R1, and two flavonoid glycosides, as well as dencichine were identified by UPLC-MS.

Results

The extraction rate of SLPN-instant beverage was 37.89 ± 0.02%. The majority nutrients were Gly (2.10 ± 0.63 mg/g), His (1.23 ± 0.07 mg/g), α-VE (18.89 ± 1.87 μg/g), β-VE (17.53 ± 1.98 μg/g), potassium (49.26 ± 2.70 mg/g), calcium (6.73 ± 0.27 mg/g). The total saponin of the SLPN-instant beverage was 403.05 ± 34.98 mg/g, majority was notoginsenoside Fd and with contents of 227 ± 2.02 mg/g. In addition, catechin and γ-aminobutyric acid were detected with levels of 24.57 ± 0.21 mg/g and 7.50 ± 1.85 mg/g, respectively. The SLPN-instant beverage showed good antioxidant activities with half maximal inhibitory concentration (IC₅₀) for scavenging hydroxyl (OH^-) radicals, superoxide anion (O^2-) radicals, 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonate) (ABTS+) radicals were 0.1954, 0.2314, 0.4083, and 0.3874 mg/mL, respectively.

Conclusion

We optimized an analytical method for in depth analysis of the newly authorized food resource SLPN. Together, an instant beverage with antioxidant activity, rich in nutrients and secondary metabolites, was manufactured from SLPN, which may improve the utilization of SLPN.

[Quantitative proteomics reveals the abnormal liver metabolism-relieving effect of Anemarrhenae rhizoma in type 2 diabetes mellitus rats]

Type 2 diabetes mellitus (T2DM) is a global metabolic disease with potentially life- threatening complications. Liver metabolism plays a vital role in the occurrence and development of diabetes mellitus. It has been reported that the Chinese medicinal Anemarrhenae rhizoma (AR) can relieve insulin resistance and diabetes mellitus. However, the effect on abnormal liver metabolism in diabetes mellitus is still unclear. Therefore, we extracted liver proteins of T2DM rats induced by high-fat diet (HFD) and streptozotocin (STZ), T2DM rats treated with AR extract (ARE), obesity rats (fed with HFD), and normal control rats (fed with normal diet). Then, through tandem mass tag (TMT) labeling combined with mass spectrometry (MS), we obtained the quantitative proteomic data. Bioinformatics software was used for hierarchical cluster analysis and principal component analysis of the data in each group. The volcano map for differentially expressed proteins (P < 0.05, fold change > 1.5) was plotted. It was found that the treatment group was closer to the normal control group, indicating that the quantitative proteomic data of liver tissue can reflect the therapeutic effect of ARE on T2DM rats. Key protein clusters closely related to the treatment of ARE were screened out. The Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of the protein clusters were analyzed by David, and the result showed that AR's alleviation of abnormal fatty acid metabolism in livers of T2DM rats may be related to the regulation of the expression of key proteins Ndufa6 and Prkar2b.

New 8-prenylated quercetin glycosides from the flowers of Epimedium acuminatum and their testosterone production-promoting activities

Phytochemical investigation was carried out for the flowers of Epimedium acuminatum Franchet. by first conducting LC-MS analysis, leading to the identification of 32 compounds. Furthermore, guided by LC-MS profiling, three new 8-prenylated quercetin glycosides (3′-hydroxylikarisoside C, 3′-hydroxylepimedoside E, 3′-hydroxyldiphylloside B), one new anthocyanin (delphinidin-3-O-p-coumaroyl-sophoroside) and six known compounds were isolated from the flowers of E. acuminatum for the first time, and their structures were characterized based on spectroscopic methods including 1D and 2D NMR, and HRESIMS. Combining our discoveries and literature survey, a revised classification of Epimedium flavonols was proposed as Type A (8-prenylated kaempferol based), which was further subdivided into subtype icaritin and subtype demethylicaritin, and Type B (8-prenylated quercetin based), which was further subdivided into subtype 3′-hydroxylicaritin and subtype 3′-hydroxyldemethylicaritin. The structure-activity relationship (SAR) study was carried out by comparing testosterone production-promoting activities of all the new compounds along with nine related Epimedium flavonols, revealing that the new 8-prenylated quercetin glycosides (subtype 3′-hydroxyldemethylicaritin in Type B) exhibited lower testosterone production-promoting activities in rat primary Leydig cells than Epimedium flavonols of subtype demethylicaritin in Type A, but possessed higher activities than the Epimedium flavonols of subtype icaritin in Type A. These results suggested that either methylation at C-4′ position or hydroxylation at C-3′ position of ring B could significantly reduce the testosterone production-promoting activities of Epimedium flavonols.

Characteristics of vertical drop jump to screen the anterior cruciate ligament injury

OBJECTIVE

To clarify the characteristics of vertical drop jump (VDJ) for screening athletes at high risk of ACL injury by comparing the kinematic, kinetic and electromyographic variables of different VDJ.

SUBJECTS AND METHODS

Thirty male soccer players were recruited to measure parameters of knee kinematics, kinetics, and surface electromyograph during VDJ in four kinds of movements measured (the distance between the take-off feet is 5 cm or 30 cm, and the distance between the landing feet is 5 cm or 30 cm) using the Vicon motion capture system, Kistler3-D dynamometer, and Noraxon surface electromyograph test system.

RESULTS

The peak knee abduction moment was significantly greater for landing feet distance of 30 cm compared to landing feet distance of 5 cm, regardless of whether the distance between take-off feet was 5 cm (0.58 vs. 0.44) or 30 cm (0.61 vs. 0.40); regardless of whether the distance between landing feet was 5 cm (22.78 vs. 20.45) or 30 cm (24.32 vs. 21.87), the peak vertical Ground Reaction Force was significantly increased for the take-off feet distance was 5 cm compared to take-off feet of 30 cm.

CONCLUSIONS

In the test of VDJ, athletes will adopt different landing strategies for different movement instructions, and the VDJ with the distance of 5 cm between the take-off feet and the distance of 30 cm between the landing feet may be the better maneuver to screen for risk of ACL injury.

[Development of a Ranking Tool for Scientificity, Transparency and Applicability of Clinical Practice Guidelines]

Objective: To address the limitations of existing methods and tools for evaluating clinical practice guidelines, we aimed to develop a comprehensive instrument focusing on the three main dimensions of guideline development: scientificity, transparency, applicability. We will use it to rank the guidelines according to the scores. We abbreviated it as STAR, and its reliability, validity and usability were also tested. Methods: A multidisciplinary expert working group was set up, including methodologists, statisticians, journal editors, medical professionals, and others. Scoping review, Delphi methods and hierarchical analysis were used to determine the final checklist of STAR. Results: The new instrument contained 11 domains and 39 items. Intrinsic reliability of each domain was indicated by Cronbach's α coefficient, with a average value of 0.646. The Cohen's kappa coefficients for methodological evaluators and clinical evaluators were 0.783 and 0.618. The overall content validity index was 0.905. The R2 for the criterion validity analysis was 0.76. The average score for usability of the items was 4.6, and the mean time spent to evaluate each guideline was 20 minutes. Conclusion: The instrument has good reliability, validity and evaluating efficiency, and can be used for evaluating and ranking guidelines more comprehensively.

Sleep Duration and Frailty Risk among Older Adults: Evidence from a Retrospective, Population-Based Cohort Study

OBJECTIVES

Frailty and sleep duration complaints are both prevalent and often coexist among older adults. The purpose of this study was to examine the prospective association between sleep duration and frailty risk in a nationally representative cohort study.

DESIGN

Prospective cohort study, ten-year follow-up.

SETTING

Community-based setting in 23 provinces of China.

PARTICIPANTS

A total of 7623 older adults age 65 and over without frailty at baseline were included in the analysis.

MEASUREMENTS

The participants were divided into three groups according to self-reported sleep duration: short (≤6 hours per day), middle (>6 but <10 hours per day) and long (≥10 hours per day). Frailty was measured according to the accumulation of health deficits by the construction of a frailty index of 38 items with 0.25 as the cutoff. A Cox proportional hazard model, a competing risk model and a generalized estimating equation (GEE) model with multiple adjustments were performed to evaluate the association between sleep duration and frailty risk.

RESULTS

During a median follow-up period of 4.4 years (IQR 2.9-9.0), 2531 (33.2%) individuals developed frailty. Compared with participants with middle sleep duration, the risk of frailty was increased among participants with long sleep duration (HR 1.26, 95% CI 1.14-1.38) in the fully adjusted Cox proportional hazard model. However, short sleep duration was insignificantly associated with frailty risk. The competing risk model and the GEE model yielded similar results.

CONCLUSION

Long sleep duration is significantly associated with frailty incidence among older adults even after adjustment for confounding factors. This study provides reinforcing longitudinal evidence for the need to design sleep quality improvement interventions in health care programs to prevent frailty among older adults.

A non-dispersive infrared sensor for real-time detection of cyanogen chloride

Cyanogen chloride, as a systemic toxic agent, can cause death rapidly. In this paper, a non-dispersive infrared sensor was designed for the infrared absorption detection of cyanogen chloride at 800 cm−1. The roughness of the internal coating material was analyzed by experiments, and the gold-plated gas chamber was selected. The light path propagation of different cross-section gas chambers was simulated, and the circular section gas chamber was selected to increase the infrared detector signal. The effect of flow rate on voltage was studied. The standard curve between voltage and concentration was obtained under the optimal condition of 0.4 L min−1. The maximum response time was 19 s, and RSD was less than 2%. The interference experiment results showed that common gases entering the gas chamber do not cause interference. The non-dispersive infrared sensor for cyanogen chloride has good stability and detects cyanogen chloride in real-time.

[Clinical effects of negative pressure wound therapy in treating the poor healing of incisions after different abdominal operations]

Objective: To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations. Methods: The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed. Results: The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes. Conclusions: NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

An Active Fraction of Trillium tschonoskii Promotes the Regeneration of Intestinal Epithelial Cells After Irradiation

Despite significant scientific advances toward the development of safe and effective radiation countermeasures, no drug has been approved for use in the clinic for prevention or treatment of radiation-induced acute gastrointestinal syndrome (AGS). Thus, there is an urgent need to develop potential drugs to accelerate the repair of injured intestinal tissue. In this study, we investigated that whether some fractions of Traditional Chinese Medicine (TCM) have the ability to regulate intestinal crypt cell proliferation and promotes crypt regeneration after radiation. By screening the different supplements from a TCM library, we found that an active fraction of the rhizomes of Trillium tschonoskii Maxim (TT), TT-2, strongly increased the colony-forming ability of irradiated rat intestinal epithelial cell line 6 (IEC-6) cells. TT-2 significantly promoted the proliferation and inhibited the apoptosis of irradiated IEC-6 cells. Furthermore, in a small intestinal organoid radiation model, TT-2 promoted irradiated intestinal organoid growth and increased Lgr5⁺ intestinal stem cell (ICS) numbers. More importantly, the oral administration of TT-2 remarkably enhanced intestinal crypt cell proliferation and promoted the repair of the intestinal epithelium of mice after abdominal irradiation (ABI). Mechanistically, TT-2 remarkably activated the expression of ICS-associated and proliferation-promoting genes and inhibited apoptosis-related gene expression. Our data indicate that active fraction of TT can be developed into a potential oral drug for improving the regeneration and repair of intestinal epithelia that have intestinal radiation damage.

Challenges to effective breastfeeding among indigenous Ngäbe-Bugle communities in Panama

Background

Panama's overall infant mortality rate is 13.2 deaths per 1000 live births and 28.4 per 1,000 among indigenous populations such as the Ngäbe-Bugle. 93.8% of the Ngäbe population is impoverished and the cost of formula is prohibitive, resulting in poor substitutes such as cheap sugary beverages. These mothers received little education for breastfeeding and it is understandable why breastmilk ‘alternatives' are used. This study explored factors impeding effective breastfeeding in a representative community-based cohort of indigenous Ngäbe-Bugle mothers. This study used the hypothesis that preventable breastfeeding challenges are common and likely negatively impact infant health.

Methods

We conducted a closed response and open questionnaire survey of 139 selectively sampled Ngäbe women with 529 live births in 2018-2019. Mothers reported the need for support, use of milk substitutes, and breastfeeding complications such as mastitis. Systemic barriers such as poor access to healthcare professionals were also assessed. Data was analyzed with SAS and Power-BI statistical software by independent statisticians.

Results

71% of mothers stated a need for more support. 32% ceased breastfeeding and used milk substitutes. Latching difficulties (2%), pain (3%), sore, cracked, and bleeding nipples (2%), and mastitis (8%) contributed to cessation. 80% reported no formal education on infant feeding and 83% were unaware of breastmilk benefits. 12% received breastfeeding support from healthcare professionals and 2% received it from a village midwife.

Conclusions

Among the Ngabe, lack of knowledge or access to health services contribute to breastfeeding complications and challenges resulting in cessation and the use of poor milk substitutes.

Key messages

Breastfeeding initiation and continuation rates are negatively affected by poor education, poor healthcare access, and complications resulting in breastfeeding cessation and milk substitution. Supporting mothers with community-based education and improved healthcare access seems likely to positively impact these challenges to effective infant nutrition.

[Potential suitable habitats of Haemaphysalis longicornis in China under different climatic patterns]

OBJECTIVE

To evaluate the impact of environmental and climatic factors on the distribution of suitable habitats of Haemaphysalis longicornis, and to predict the potential distribution of H. longicornis under different climate patterns in China.

METHODS

Data pertaining to the distribution of H. longicornis were retrieved from public literatures. The effects of 19 climatic factors (annual mean temperature, annual mean temperature difference between day and night, isothermality, standard deviation of seasonal variation of temperature, maximum temperature of the warmest month, minimum temperature of the coldest month, temperature annual range, mean temperature of the wettest season, mean temperature of the driest season, mean temperature of the warmest season, mean temperature of the coldest season, annual mean precipitation, precipitation of the wettest month, precipitation of the driest month, coefficient of variance of precipitation, precipitation of the wettest season, precipitation of the driest season, precipitation of the warmest season and precipitation of the coldest season) and 4 environmental factors (elevation, slope, slope aspect and vegetation coverage) on the potential distribution of H. longicornis were assessed using the maximum entropy (MaxEnt) model based on the H. longicornis distribution data and climatic and environmental data, and the potential distribution of H. longicornis was predicted under the RCP 2.6 and 8.5 emissions scenarios.

RESULTS

Among the environmental and climatic factors affecting the geographical distribution of H. longicornis in China, the factors contributing more than 10% to the distribution of H. longicornis mainly included the precipitation of the driest month (26.0%), annual mean temperature (11.2%), annual mean precipitation (10.0%) and elevation (24.2%). Under the current climate pattern, the high-, medium- and low-suitable habitats of H. longicornis are 1 231 900, 1 696 200 km² and 1 854 400 km² in China, respectively. The distribution of H. longicornis increased by 336 100 km² and 367 300 km² in 2050 and 2070 under the RCP 2.6 emissions scenario, and increased by 381 000 km² and 358 000 km² in 2050 and 2070 under the RCP 8.5 emissions scenario in China, respectively.

CONCLUSIONS

Climatic and environmental factors, such as precipitation, temperature and elevation, greatly affect the distribution of H. longicornis in China, and the suitable habitats of H. longicornis may expand in China under different climate patterns in future.

[Distribution and suitable habitats of ticks in the Yangtze River Delta urban agglomeration]

OBJECTIVE

To investigate the current distribution of ticks and predict the suitable habitats of ticks in the Yangtze River Delta urban agglomeration in 2017, so as to provide insights into tick control and management of tick-borne diseases in these areas.

METHODS

All publications pertaining to tick and pathogen distribution in the Yangtze River Delta urban agglomeration were retrieved, and the geographical location of tick distribution was extracted. The effects of 19 climatic factors on the distribution of ticks were examined using the jackknife method, including the mean temperature of the wettest quarter, precipitation of the coldest quarter, mean temperature of the driest quarter, maximum temperature of the warmest month, precipitation of the driest month, minimal temperature of the coldest month, annual precipitation, mean daily temperature range, precipitation seasonality, annual temperature range, temperature seasonality, annual mean temperature, mean temperature of the warmest quarter, precipitation of the wettest quarter, isothermality, mean temperature of the coldest quarter, precipitation of the wettest month, precipitation of the driest quarter and precipitation of the warmest quarter. The distribution of ticks was analyzed in 2020 using the maximum entropy (MaxEnt) model, and the potential suitable habitats of ticks were predicted in 2070 using the MaxEnt model based on climatic data.

RESULTS

A total of 380 Chinese and English literatures were retrieved, and 148 tick distribution sites were extracted, with 135 sites included in the subsequent analysis. There were 7 genera (Haemaphysalis, Rhipicephalus, Ixodes, Dermacentor, Boophilus, Hyalomma and Amblyomma) and 27 species of ticks detected in the Yangtze River Delta urban agglomeration. The climatic factors affecting the distribution of ticks in the Yangtze River Delta urban agglomeration mainly included the mean temperature of the wettest quarter and the precipitation of the coldest quarter, with 26.1% and 23.6% contributions to tick distributions. The high-, medium- and low-suitable habitats of ticks were 20 337.08, 40 017.38 km² and 74 931.43 km² in the Yangtze River Delta urban agglomeration in 2020, respectively. The climate changes led to south expansion of the suitable habitats of ticks in the Yangtze River Delta urban agglomeration in 2070, and the total areas of suitable habitats of ticks was predicted to increase by 18 100 km². In addition, the high-, medium- and low-suitable habitats of ticks were predicted to increase to 24 317.84, 45 283.02 km² and 83 766.38 km² in the Yangtze River Delta urban agglomeration in 2070, respectively.

CONCLUSIONS

Multiple tick species are widespread in the Yangtze River Delta urban agglomeration, and the future climate changes may lead to expansion of tick distribution in these areas.

[Effects of climate changes on the distribution of Rhipicephalus microplus in China]

OBJECTIVE

To identify the environmental factors affecting the geographical distribution of Rhipicephalus microplus in China, and to examine the impact of climate changes on the distribution of R. microplus in China.

METHODS

The national and international publications pertaining to the geographical distribution of R. microplus in China were retrieved, and the geographical location was extracted. The suitable habitats of R. microplus and the dominant environmental factors affecting the distribution of suitable habitats of R. microplus were predicted in China based on the geographical data and environmental variables using the ArcGIS 10.7 software and the maximum entropy model.

RESULTS

Among the main climatic factors affecting the geographical distribution of R. microplus in China, the factors contributing more than 10% to the suitable habitats of R. microplus mainly include the annual mean precipitation (38.2%), the average temperature of the coldest quarter (28.4%) and the precipitation of the driest month (14.2%). The current suitable habitats of R. microplus were mainly found in southern China, and the high-, medium- and low-suitable areas accounted for 8.6%, 13.1% and 10.5% of the total land area of China, respectively. The suitable habitats of R. microplus were predicted to increase by 399 800 km² in China using the maximum entropy model under the RCP 4.5 emissions scenario in 2070, and the emerging suitable habitats were mainly distributed in Gansu Province, Ningxia Hui Autonomous Region, Qinghai Province, Hebei Province, Shaanxi Province, Liaoning Province, Inner Mongolia Autonomous Region, Shandong Province, Sichuan Province and Tibeten Autonomous Region. In addition, the suitable habitats of R. microplus were predicted to show an overall expansion towards northward from present to 2070.

CONCLUSIONS

Climate changes affect the distribution of suitable habitats of R. microplus in China, and annual mean precipitation may be a key factor affecting the distribution of suitable habitats of R. microplus.

[Effects of environmental factors on the distribution of suitable habitats of Ixodes ovatus in China]

OBJECTIVE

To identify the environmental factors affecting the distribution of suitable habitats of Ixodes ovatus, and to examine the effects of environmental changes on the distribution of suitable habitats of I. ovatus.

METHODS

Data pertaining to the distribution of I. ovatus in China were captured by literature review. The distribution of suitable habitats of I. ovatus in China was simulated using the maximum entropy model with the environmental variable data and the I. ovatus distribution data. In addition, the potential distribution of suitable habitats of I. ovatus was predicted based on the 2050 and 2070 environmental data.

RESULTS

The current suitable habitats of I. ovatus cover 3.11 million km², accounting for 32.28% of the total land area of China, and they are mainly concentrated in southwestern and northwestern China. Among the screened 16 environmental factors, the standard deviation of seasonal variation of temperature, average annual precipitation and altitude were predominant environmental factors affecting the distribution of suitable habitats of I. ovatus, and these three variables contributed 76.5% to the distribution of suitable habitats of I. ovatus in China. The suitable habitats of I. ovatus were predicted to showing a tendency towards expansion to northwestern and northeastern China in 2050 and 2070, and the proportion of highly suitable habitats of I. ovatus was predicted to increase.

CONCLUSIONS

Moderate climate, adequate precipitation and high altitude are favorable for the survival of I. ovatus. Future climate changes may cause expansion of suitable habitats of I. ovatus in China.

[Prediction of suitable habitats of Ixodes persulcatus in China]

OBJECTIVE

To evaluate the effects of environmental factors the distribution of Ixodes persulcatus, and to predict the future suitable habitats of I. persulcatus in China.

METHODS

The known distribution sites of I. persulcatus in China were captured from national and international published literatures. The effects of 14 environmental factors on the distribution of I. persulcatus were examined using the Jackknife test, including mean annual temperature, mean monthly temperature range, isothermality, temperature seasonality, maximum temperature of the warmest month, minimum temperature of the coldest month, temperature annual range, mean temperature of the wettest quarter, mean temperature of the driest quarter, mean temperature of the wet-test quarter, mean temperature of the coldest quarter, annual mean precipitation, precipitation of the wettest month, precipitation of the driest month, precipitation seasonality, precipitation of the wettest quarter, precipitation of the driest quarter, precipitation of the warmest quarter, precipitation of the coldest quarter, elevation, slope, aspect and vegetation. The suitable habitats of I. persulcatus were predicted in China using the maximum entropy model and ArcGIS 10.7 software with the environmental factors.

RESULTS

Currently, the highly suitable habitats of I. persulcatus covered an area of 886 600 km² in China, which were predominantly located in northeastern China. The environmental factors that contributed more than 10% to the distribution of the suitable habitats of I. persulcatus in China included annual temperature variation range (39.1%), the coldest quarterly precipitation (23.2%), and the annual mean precipitation (11.9%). Based on the maximum entropy model, the suitable habitats of I. persulcatus were predicted to show a shrinking tendency towards northeastern China in 2070.

CONCLUSIONS

The suitable habitat of I. persulcatus strongly correlates with temperature and precipitation, and climate and environmental changes may lead to shrinking of the future suitable habitat of I. persulcatus in China.

Chemical profiling and multicomponents quantitative analysis of Panzerina lanata by ultra-fast liquid chromatography with tandem mass spectrometry

Panzerina lanata is a Chinese medicine with the bioactivity of detumescence and detoxification. In this study, novel qualitative and quantitative methods were established by ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry and ultra-high-performance liquid chromatography-triple quadrupole linear ion trap mass spectrometry, respectively. As a result, 20 compounds were identified or tentatively characterized including flavonoids, organic acids, alkaloids, and lignans, five of which were identified for the first time based on the reference standards. The quantitative approach exhibited good linearity (R²  > 0.995), precision (RSDs < 4.97%), stability (RSDs < 4.77%), and recovery (96.04-104.14%). Afterward, this method was implemented to determine 11 flavonoids in four batches of P. lanata. Among them, seven compounds were quantified for the first time. Narcissin was abundant in each batch of P. lanata (average of 10.890-14.230 mg/g) with the highest quantities. The results provide valuable information for quality evaluation.

Lycium barbarum mitigates radiation injury via regulation of the immune function, gut microbiota, and related metabolites

Previous studies have suggested that Lycium barbarum (L. barbarum) has a radioprotective function, although more in-depth investigation is still required. We investigated the radioprotective efficacy of extract of the fruits of L. barbarum (LBE) and its radioprotective mechanisms. Mice were exposed to 8.5 Gy, 5.5 Gy, or 6.0 Gy total body irradiation (TBI), and the survival rate, lymphocyte percentage, amount of cytokines, and viability of the irradiated cells, as well as the gut microbiome and fecal metabolomics were studied. LBE enhanced the survival of the mice exposed to 8.5 Gy γ-ray TBI or 5.5 Gy X-ray TBI. After 6.0 Gy γ-ray TBI, LBE exhibited good immunomodulatory properties, mainly characterized by the accelerated recovery of lymphocyte percentages, and the enhanced expression of immune-related cytokines. LBE reconstituted the gut microbiota of irradiated mice, increased the relative abundance of potentially beneficial genera (e.g., Turicibacter, Akkermansia), and decreased the relative abundance of potentially harmful bacterial genera (e.g., Rikenellaceae_RC9_gut_group). Beneficial regulatory effects of LBE on the host metabolites were also noted, and the major upregulated metabolites induced by LBE, such as Tetrahydrofolic acid and N-ornithyl-L-taurine, were positively correlated with the immune factor interleukin (IL)-6. In vitro, LBE also increased the vitality of rat small intestinal epithelial cells (IEC-6) after 4.0 Gy γ-ray irradiation and promoted the growth of Akkermansia muciniphila. These results confirmed a radioprotective function of LBE and indicated that the radioprotective mechanism may be due to immunomodulation and the synergistically modulating effect on the gut microbiota and related metabolites.

Screening and Selection of a New Medium for Diosgenin Production via Microbial Biocatalysis of Fusarium sp

Steroidal saponins are widely used as starting precursors and medical intermediates for the semi-/total-synthesis of hundreds of steroidal drugs. One such steroidal saponin is diosgenin, which has attracted significant attention due to the huge market demand in the pharmaceutical industry. Due to water waste and severe environmental pollution, the traditional diosgenin production process based on direct acid hydrolysis is no longer used. In this study, to develop a submerged fermentation (SmF) medium for clean diosgenin production via efficient microbial biocatalysis, the Box-Behnken design (BBD) in combination with the Plackett-Burman design (PBD) was used to determine the medium compositions for Fusarium strains. Three components (wheat bran, phosphate, and Tween-80) were determined as significant factors by the PBD. Using the BBD, the three significant factors were further optimized, and the optimum values were determined for maximal diosgenin production. With 21.16 g/L of wheat bran, 9.60 g/L of phosphate, and 1.97 g/L of Tween-80, the diosgenin yield was 2.28%, i.e., 3.17 mg/L/h. The experimental values agreed with the predicted values, representing a significant increase in diosgenin production compared to its production using the basic SmF medium. For the first time, we reported the development of a new medium for Fusarium strains to produce diosgenin via microbial biocatalysis of the root of Dioscorea zingiberensis C. H. Wright (DZW). A simple-composition, low-cost, and high-efficiency medium was developed for the first time for the SmF of Fusarium strains. The medium is considered useful for large-scale SmF and may be applicable to other fungi. This study lays a solid foundation for diosgenin production in an acid-free and wastewater-free way. It may also provide fundamental support for producing other value-added products via microbial biocatalysis of low-value materials by endophytic fungi.

Propofol improves intestinal ischemia-reperfusion injury in rats through NF-κB pathway

OBJECTIVE

The aim of this study was to investigate the effects of propofol on intestinal ischemia-reperfusion injury in rats through the nuclear factor-kappa B (NF-κB) pathway.

MATERIALS AND METHODS

A total of 24 Sprague-Dawley rats were selected and randomly divided into three groups, including sham operation group, ischemia group and propofol group. Rats in sham operation group were only treated with isolation of superior mesenteric artery, which was clipped for 1 h and reperfused for 2 h in ischemia group. Meanwhile, propofol (60 mg/kg) was injected into the femoral vein 1 h before ischemia in propofol group. TUNEL assay was performed to detect cell apoptosis of intestinal tissues. Real-time quantitative polymerase chain reaction (RT-qPCR) was conducted to measure the expression levels of malondialdehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), caspase-3 and B-cell lymphoma-2 (Bcl-2) in rats of each group. Western blotting was utilized to detect the protein expression levels of NF-κB pathway related molecules, such as myeloid differential protein-88 (MyD88), v-rel avian reticuloendotheliosis viral oncogene homolog A (RelA) and NF-κB. Furthermore, changes in plasma cytokine levels were determined via enzyme-linked immunosorbent assay (ELISA).

RESULTS

The number of apoptotic cells in ischemia group was remarkably higher than that in sham operation group (p<0.05). However, it decreased notably in propofol group compared with ischemia group (p<0.05). In comparison with sham operation group, significantly up-regulated expression of caspase-3 and down-regulated expression of Bcl-2 were observed in the intestinal tissues of rats in ischemia group (p<0.05). Caspase-3 was lowly expressed, while Bcl-2 was highly expressed in the intestinal tissues of rats in propofol group compared with ischemia group (p<0.05). In addition, no statistically significant differences were observed in the expression level of SOD among sham operation group, ischemia group and propofol group (p>0.05). The expression levels of MDA and MPO were overtly higher in the intestinal tissues of rats in ischemia group than those in sham operation group and propofol group (p<0.05). Besides, the protein expression levels of MyD88, RelA and NF-κB in the intestinal tissues of rats in ischemia group were remarkably higher than those in sham operation group and propofol group (p<0.05). The activity of the NF-κB pathway in the intestinal tissues of rats in propofol group significantly declined compared with ischemia group (p<0.05). Moreover, compared with sham operation group, plasma levels of TNF-α, interleukin (IL)-2, IL-6 and IL-4 increased significantly in rats of ischemia group (p<0.05). However, they were markedly lower in propofol group than those in ischemia group (p<0.05).

CONCLUSIONS

Propofol protects rats from intestinal ischemia-reperfusion injury through the NF-κB pathway.

Development of a New Bioprocess for Clean Diosgenin Production through Submerged Fermentation of an Endophytic Fungus

Diosgenin is used widely to synthesize steroidal hormone drugs in the pharmaceutical industry. The conventional diosgenin production process, direct acid hydrolysis of the root of Dioscorea zingiberensis C. H. Wright (DZW), causes large amounts of wastewater and severe environmental pollution. To develop a clean and effective method, the endophytic fungus Fusarium sp. CPCC 400226 was screened for the first time for the microbial biotransformation of DZW in submerged fermentation (SmF). Statistical design and response surface methodology (RSM) were implemented to develop the diosgenin production process using the Fusarium strains. The environmental variables that significantly affected diosgenin yield were determined by the two-level Plackett-Burman design (PBD) with nine factors. PBD indicates that the fermentation period, culture temperature, and antifoam reagent addition are the most influential variables. These three variables were further optimized using the response surface design (RSD). A quadratic model was then built by the central composite design (CCD) to study the impact of interaction and quadratic effect on diosgenin yield. The values of the coefficient of determination for the PBD and CCD models were all over 0.95. P-values for both models were 0.0024 and <0.001, with F-values of ∼414 and ∼2215, respectively. The predicted results showed that a maximum diosgenin yield of 2.22% could be obtained with a fermentation period of 11.89 days, a culture temperature of 30.17 °C, and an antifoam reagent addition of 0.20%. The experimental value was 2.24%, which was in great agreement with predicted value. As a result, over 80% of the steroidal saponins in DZW were converted into diosgenin, presenting a ∼3-fold increase in diosgenin yield. For the first time, we report the SmF of a Fusarium strain used to produce diosgenin through the microbial biotransformation of DZW. A practical diosgenin production process was established for the first time for Fusarium strains. This bioprocess is acid-free and wastewater-free, providing a promising environmentally friendly alternative to diosgenin production in industrial applications. The information provided in the current study may be applicable to produce diosgenin in SmF by other endophytic fungi and lays a solid foundation for endophytic fungi to produce natural products.

Comparative analysis of chemical components in different parts of Epimedium Herb

Epimedium herb is a well-known traditional Chinese medicine (TCM) that is used for treating kidney-yang deficiency, impotence and rheumatism, and flavonoids are the main active ingredients. The leaves and rhizomes of Epimedium herb are two separate kinds of medicinal materials with different functional indications and clinical applications. This study aimed to comprehensively analyze the chemical components of different parts of the herb from three Epimedium species (Epimedium sagittatum, E. pubescens and E. myrianthum) by using ultra high-performance liquid chromatography coupled with photo-diode array and quadrupole time-of-flight mass spectrometry (UHPLC-PDA-Q-TOF/MS) and multivariate statistical analysis to clarify the differences. Firstly, the workflow of UHPLC-Q-TOF/MS combined with UNIFI informatics was developed for characterizing the chemical compounds in different parts of Epimedium herb. Based on the exact mass information, the fragmentation characteristics and the retention times of compounds, all chromatographic peaks (74 chemical components) were identified. Secondly, 21 potential chemical markers for differentiating different parts of Epimedium herb were selected through PCA and PLS-DA analysis. The characteristic components in the leaves included flavonoids with Anhydroicaritin (type A, C-4' linked methoxy) as the backbone, and the characteristic components in the stems and rhizomes were Magnoline and flavonoids with Demethylanhydroicaritin (type B, C-4' linked hydroxyl) as the backbone. Thirdly, the UHPLC-PDA combined with heatmap visualization was employed to clarify the distribution of chemical components with high content in different parts of Epimedium herb. The results showed clear differences in the contents of chemical components in leaves, stems and rhizomes. The levels of flavonoids with Anhydroicaritin backbone were high in the leaves, and levels of flavonoids with Demethylanhydroicaritin backbone were high in the rhizomes. The levels of Magnoline in stems and rhizomes were higher than that in leaves. The contents of most of the compounds in stems remained low. The leaves and the other two parts (stems and rhizomes) can be distinguished by qualitative and semi-quantitative analysis of Magnoline and Epimedoside A (type B backbone). These results indicated that the different plant parts of Epimedium herb can be quickly and accurately distinguished by this method, establishing a foundation for the application of Epimedium herb.

Anemarrhena asphodeloides modulates gut microbiota and restores pancreatic function in diabetic rats

Anemarrhena asphodeloides is an herb widely used to treat symptoms associated with diabetes in traditional Chinese medicine. However, its key components and metabolites have low bioavailability and poor host absorption. To clarify the anti-diabetic mechanism of A. asphodeloides extract (AAE), we examined the anti-diabetic effects of AAE in rats with diabetes induced by a high-fat diet and streptozotocin. Faeces levels of the main components and metabolites of AAE were significantly higher than levels in plasma, which indicated that gut microbiota might play important roles in its anti-diabetic effect. Microbiological studies showed that unabsorbed components increased the diversity of the gut microbiota, enriched potentially beneficial bacteria, and suppressed potentially harmful bacteria. In vitro studies showed that AAE promoted the proliferation of Blautia coccoides, a bacterium with positive implication for diabetes, in a dose-dependent manner. AAE also promoted pancreatic cell regeneration and restored the function of pancreatic islet cells via peroxiredoxin 4 overexpression. Overall, these results suggest that AAE alleviates diabetes via modulating gut microbiota and protein expression.

Long noncoding RNA FAM201A mediates the metastasis of lung squamous cell cancer via regulating ABCE1 expression

OBJECTIVE

Long noncoding RNA (lncRNA) family with sequence similarity 201-member A (FAM201A) is a novel lncRNA promoting the development of various cancers. However, the biological function of FAM201A on the metastasis of lung squamous cell carcinoma (LSCC) remains unknown. The aim of this study was to explore the molecular mechanism of FAM201A and its target protein in advanced LSCC.

PATIENTS AND METHODS

Quantitative Polymerase Chain Reaction (qPCR) was applied to evaluate FAM201A expression in lung cancer tissues. The impact of high FAM201A expression on the overall survival in patients with lung cancer was tested using the log-rank test. The relevance between aberrant FAM201A and clinicopathological characteristics in patients with lung cancer was analyzed using the Chi-square tests. Cell proliferation was assayed using the Cell Counting Kit-8 (CCK-8) and a transwell assay, and the mice xenograft models were applied to determine the promoting effects of FAM201A on LSCC in vitro and in vivo. The underlying regulatory mechanism was explored through RNA transfection, qPCR, and Western blotting. The correlation between ATP-binding cassette transporter E1 (ABCE1) and FAM201A expression was verified using Spearman's correlation coefficient.

RESULTS

FAM201A is aberrantly elevated in tissues from patients with non-small cell lung cancer. High levels of FAM201A expression were more likely to present in patients with squamous type, M1 stage, and inferior overall survival. Differential expression was found between non-metastatic and metastatic squamous carcinoma, but not in adenocarcinoma. FAM201A knockdown inhibits cell proliferation, migration, and invasion of LSCC cells in vitro, and represses tumor growth in vivo. Furthermore, ABCE1 in LSCC cells was downregulated by silencing FAM201A. The tissue level of ABCE1 was positively correlated with FAM201A expression in patients with LSCC.

CONCLUSIONS

FAM201A may markedly induce migration and invasion of LSCC, resulting in the M1 stage and poor survival. These findings suggest the FAM201A-ABCE1 axis as a novel therapeutic target in LSCC.

Epidemiological Investigation of OHCWs with COVID-19

During the coronavirus disease 2019 (COVID-19) pandemic, there is an important risk of infection in health care workers, including oral health care workers (OHCWs), due to the characteristics of dental practice. In this retrospective study, data pertaining to the 31 OHCWs diagnosed with COVID-19 in Wuhan, Hubei Province, were retrieved and analyzed. Questionnaires were administered to the subjects over the Internet and telephone. Clinical and epidemiological characteristics and information on the use of personal protective equipment (PPE) were collected. There were 22 females and 9 males, with a median age of 39 y. Although the severity of most cases of COVID-19 (93.5%) was mild or moderate, 1 case was severe, and another case was critical, resulting in death. Fever was the main first symptom of COVID-19, followed by fatigue and myalgia. Most of the OHCWs routinely used PPE such as medical masks, gloves, caps, and work clothes while performing clinical work. N95 or KN95 masks were rarely available because of the scarcity of PPE during the outbreak. Nineteen OHCWs reported a contact history, among whom 7 worked in a fever clinic, 5 reported contact with dental patients suspected of having COVID-19, and 7 reported contact with family members with COVID-19–related symptoms at least 1 d earlier. Our findings indicated that there were few clusters of COVID-19 in dental settings. Since the outbreak, the Hospital of Stomatology, Wuhan University, has provided emergency dental treatment, and none of their staff were infected while providing dental service, which indicates that comprehensive measures such as the use of advanced PPE and environmental disinfection can prevent cross-infection in dental practice. The analysis of the procedures followed during the emergency treatments indicated that OHCWs preferred to recommend conservative treatment to patients, suggesting that attention should be paid to the psychological impact of COVID-19 on dental practitioners.

Furostanol Saponins from Trillium tschonoskii Promote the Expansion of Human Cord Blood Hematopoietic Stem and Progenitor Cells

Trillium tschonoskii is a medicinal plant known to biosynthesize steroidal saponins. A phytochemical investigation of the rhizomes of T. tschonoskii led to the isolation of nine new furostanol saponins (1-9) and 11 known analogues (10-20). Five of these new compounds were shown to have hydroxy groups at the C-5 and C-6 positions, while two possess a rare aglycone containing carbonyl groups at the C-16 and C-22 positions as well as a Δ¹⁷⁽²⁰⁾ double bond, and the others have conjugated double bonds in the E-ring or have different sugar chains at the C-3 position. All the isolates were tested for their effect on the expansion of human cord blood (CB) CD34⁺ hematopoietic stem and progenitor cells. It was found that CB CD34⁺ cells treated with compounds 6, 7, 9, 10, 14, 15, and 19 showed increased numbers of rigorously phenotype-defined hematopoietic stem cells. Notably, compounds 9, 10, 13, and 14 demonstrated an enhanced ability to increase the percentages and numbers of CB CD34⁺CD38^- cells and multipotential progenitors. The present study is the first to report that furostanol saponins from T. tschonoskii rhizomes can promote hematopoietic stem/progenitor cell (HSPC) expansion.

Development of a New High-Cell Density Fermentation Strategy for Enhanced Production of a Fungus β-Glucosidase in Pichia pastoris

Traditional diosgenin manufacturing process has led to serious environmental contamination and wastewater. Clean processes are needed that can alternate the diosgenin production. The β-glucosidase FBG1, cloned from Fusarium sp. CPCC 400709, can biotransform trillin and produce diosgenin. In this study, Pichia pastoris production of recombinant FBG1 was implemented to investigate various conventional methanol induction strategies, mainly including DO-stat (constant induction DO), μ-stat (constant exponential feeding rate) and m-stat (constant methanol concentration). The new co-stat strategy combining μ-stat and m-stat strategies was then developed for enhanced FBG1 production during fed-batch high-cell density fermentation on methanol. The fermentation process was characterized with respect to cell growth, methanol consumption, FBG1 production and methanol metabolism. It was found that large amounts of formaldehyde were released by the enhanced dissimilation pathway when the co-stat strategy was implemented, and therefore the energy generation was enhanced because of improved methanol metabolism. Using co-stat feeding, the highest volumetric activity reached ∼89 × 10⁴ U/L, with the maximum specific activity of ∼90 × 10² U/g. After 108 h induction, the highest volumetric production reached ∼403 mg/L, which was ∼91, 154, and 183 mg/L higher than the maximal production obtained at m-stat, μ-stat, and DO-stat strategies, respectively. FBG1 is the first P. pastoris produced recombinant enzyme for diosgenin production through the biotransformation of trillin. Moreover, this newly developed co-stat induction strategy represents the highest expression of FBG1 in P. pastoris, and the strategy can be used to produce FBG1 from similar Pichia strains harboring Fbg1 gene, which lays solid foundation for clean and sustainable production of diosgenin. The current work provides unique information on cell growth, substrate metabolism and protein biosynthesis for enhanced β-glucosidase production using a P. pastoris strain under controlled fermentation conditions. This information may be applicable for expression of similar proteins from P. pastoris strains.

[Effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis]

Objective: To explore the effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis. Methods: From March 2014 to December 2018, 6 patients with skin and soft tissue defects in perineal region caused by necrotizing fasciitis were admitted to Department of Burns of Hanzhong Central Hospital (hereinafter referred to as our hospital). Two female patients had labia major defects and 4 male patients had scrotum defects, with age of 43-68 years. The areas of skin and soft tissue defects after debridement were 4%-8% total body surface area. The wounds in non-joint and non-functional area were repaired with free split-thickness skin grafts from medial femoral region, and the residual wounds areas in perineal region after repair were 10 cm×4 cm-22 cm×10 cm, which were repaired with pedicled anterolateral thigh flaps, with area of 12 cm×5 cm-24 cm×12 cm. The secondary wounds in the donor sites were sutured directly or repaired with free split-thickness skin grafts from medial thigh on the same or opposite side of the wounds. The bacterial culture result of wound exudate, drug sensitivity test result, and blood bacterial culture result on admission were recorded. The postoperative flap survival was observed. The length of hospital stay, debridement times, and antibiotics use time were recorded. The flap swelling condition was observed to evaluate whether flap thinning operation was necessary, the sensory recovery of the flap and hip joint activity were evaluated, and the scrotum function of male patients was evaluated by urologist in our hospital during follow-up. Results: The bacterial culture results of wound exudate in 5 patients on admission showed Escherichia coli with 4 of them having the same bacteria and the other one having methicillin-resistant Staphylococcus aureus detected in their blood samples. All the flaps survived in 6 patients after the operation, with total length of hospital stay of (22±5) d, debridement of 3-5 times, and antibiotics use time of (13±3) d. During follow-up of 3 to 6 months after the operation, the flaps were slightly bloated in 2 patients, and the flap thinning operation was performed 6 months after wound repair. The sensory function recovered to normal in 2 flaps of patients with anterolateral femoral cutaneous nerve, and the superficial sensory function in the other flaps of patients recovered in different degrees.The hip joint activity was close to normal in all the patients, and the scrotum function was normal in 4 male patients. Conclusions: The pedicled anterolateral thigh flap showed good effects in repairing skin and soft tissue defects on perineal region caused by necrotizing fasciitis, with good appearance and function after operation, and the method is simple, safe, and easy to apply.

Molecular catalysis of CO2 reduction: recent advances and perspectives in electrochemical and light-driven processes with selected Fe, Ni and Co aza macrocyclic and polypyridine complexes

Earth-abundant Fe, Ni, and Co aza macrocyclic and polypyridine complexes have been thoroughly investigated for CO2 electrochemical and visible-light-driven reduction. Since the first reports in the 1970s, an enormous body of work has been accumulated regarding the two-electron two-proton reduction of the gas, along with mechanistic and spectroscopic efforts to rationalize the reactivity and establish guidelines for structure-reactivity relationships. The ability to fine tune the ligand structure and the almost unlimited possibilities of designing new complexes have led to highly selective and efficient catalysts. Recent efforts toward developing hybrid systems upon combining molecular catalysts with conductive or semi-conductive materials have converged to high catalytic performances in water solutions, to the inclusion of these catalysts into CO2 electrolyzers and photo-electrochemical devices, and to the discovery of catalytic pathways beyond two electrons. Combined with the continuous mechanistic efforts and new developments for in situ and in operando spectroscopic studies, molecular catalysis of CO2 reduction remains a highly creative approach.

Nasal timosaponin BII dually sensitive in situ hydrogels for the prevention of Alzheimer's disease induced by lipopolysaccharides

Alzheimer's disease (AD) is a common and severe brain disease with a high mortality among the elders, but no highly efficient medications are currently available. For example, timosaponin BII, an efficient anti-AD agent, has low oral bioavailability. Here, timosaponin BII was formulated in a temperature/ion-sensitive in situ hydrogel (ISG) that was well transformed into gels in the nasal environment. Timosaponin BII protected the PC12 cells injured by lipopolysaccharides (LPS) by decreasing TNF-α and IL-1β and stabilizing F-actin. Timosaponin BII ISGs were intranasally administered to the mice every day for 38 days. On Day 36, LPS was injected to the mice to establish an AD model. Morris water maze experiments showed that the number of the animals that were able to cross the platform returned to normal and the total distance over which the animals moved in the open field also increased, which demonstrated that the spatial memory and spontaneous behavior were improved after treatment compared to the model. Moreover, an AD improver, inducible nitric oxide synthase (iNOS) in the brain, was reduced after treatment. High brain targeting effect of timosaponin BII ISGs was confirmed by in vivo fluorescence imaging. The nasal timosaponin BII dually sensitive ISGs can serve as a promising medication for local prevention of AD.

Study on steroidal saponins in crude and stir-fried Fructus Tribuli by ultra-high-performance liquid chromatography-mass spectrometry coupled with multivariate statistical analysis

Fructus Tribuli is a traditional Chinese medicine used clinically for many years. Crude Fructus Tribuli and stir-fried Fructus Tribuli are recorded in the Pharmacopoeia of the People's Republic of China. However, the differences between steroidal saponins in crude Fructus Tribuli and stir-fried Fructus Tribuli have not been compared. In this study, ultra-high-performance liquid chromatography quadrupole time-of-flight mass spectrometry along with multivariate statistical analysis was developed to discriminate the chemical profiles and identify the steroidal saponins of crude Fructus Tribuli and stir-fried Fructus Tribuli. Additionally, an ultra-high-performance liquid chromatography triple-quadrupole mass spectrometer was used for the simultaneous quantification of nine major steroidal saponins to analyze the variations between crude Fructus Tribuli and stir-fried Fructus Tribuli. Finally, a total of 30 steroidal saponins whose structures or contents changed significantly after processing were found and identified. The mechanism of structural transformations deduced indicated that during the stir-frying of Fructus Tribuli, C-22 hydroxy furostanol saponins were converted to the corresponding furostanol saponins containing C-20-C-22 double bonds by dehydroxylation and deglycosylation reactions that occurred in the spirostanol saponins causing the generation of steroidal sapogenins. This study was successfully applied to the global analysis of crude Fructus Tribuli and stir-fried Fructus Tribuli. The results of this research will be beneficial to explore the processing mechanism of Fructus Tribuli.