Antisweet saponins from Gymnema sylvestre.

Three new oleanane-type triterpene glycosides (1-3), along with the sodium salt of alternoside II (4), were isolated from an ethanol extract of the leaves of Gymnema sylvestre. The structures of these new saponins were identified as 21 beta-O-benzoylsitakisogenin 3-O-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranoside (1), the potassium salt of longispinogenin 3-O-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranoside (2), and the potassium salt of 29-hydroxylongispinogenin 3-O-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranoside (3). The aglycon of 3, gymnemagenol (3a), was characterized as 3 beta,16 beta,28, 29-tetrahydroxyolean-12-ene. Structure elucidation was accomplished by interpretation of NMR (DQF-COSY, HMQC, and HMBC) results, FABMS, and hydrolysis. Saponin 1 and the sodium salt of alternoside II (4) exhibited antisweet activity.     

Isomalabaricane-type nortriterpenoids and other constituents of the marine sponge Geodia japonica.

Twelve compounds were isolated from the sponge Geodia japonica collected from the South China Sea, including two new isomalabaricane-type nortriterpenoids, geoditins A (1) and B (2), and a new sterol derivative (4). All chemical structures were established by interpretation of the spectroscopic data.     

上海市夫妇产后首选避孕措施社会心理行为学影响因素的研究

对7101对上海市80年末初婚并已生育的队列夫妇进行8年的前瞻性调查。选择14项夫妇社会心理性学变量,拟合多项分布Logistic回归模型,分析影响夫妇产后首选避孕措施因素的重要性。结果显示妻子单位的性质及医务人员掌握放置宫内节育器指征为两项重要外界因素,白领阶层、避孕知识得分较高的妻子、愿意接受新式男用避孕法的丈夫;具有明确避孕动机者或了解避孕套能预防性病或艾滋病的夫妇均明显倾向非首选放置宫内节育器(包括人工流产后)。分析提示单位管理者及医务人员除应继续掌握指征对妇女于产后放置宫内节育器外,有必要结合夫妇特性指导使用各类她们所乐意使用的避孕措施,及进一步开展有关避孕措施健康效益的教育,以增加夫妇对各类常用避孕措施的可接受性和使用效果。     

GOS Ameliorates Nonalcoholic Fatty Liver Disease Induced by High Fat and High Sugar Diet through Lipid Metabolism and Intestinal Microbes

The treatment of nonalcoholic fatty liver disease (NAFLD) remains very challenging. This study investigated the therapeutic effect of galactose oligosaccharide (GOS), an important prebiotic, on NAFLD through in vivo and in vitro experiments and preliminarily explored the mechanism by which GOS improves liver lipid metabolism and inflammation through liver and intestinal microbiological analysis. The results of mouse liver lipidomics showed that GOS could promote body thermogenesis in mice with high-fat and high-sugar diet (HFHSD)-induced NAFLD, regulate lipolysis in liver fat cells, and accelerate glycine and cholesterol metabolism. GOS dose-dependently reduced the contents of total cholesterol (TC) and triglyceride (TG) in cells and reduced the accumulation of lipid droplets in cells. GOS also reduced the Firmicutes/Bacteroidetes ratio and altered the composition of the intestinal microbiota in mice fed a HFHSD. GOS can improve liver lipid metabolism and intestinal structure of NAFLD. These results provide a theoretical and experimental basis supporting the use of GOS as a health food with anti-NAFLD functions.     

Effects of Chronic Exposure to Diets Containing Moldy Corn or Moldy Wheat Bran on Growth Performance,Ovarian Follicular Pool,and Oxidative Status of Gilts

Background: We investigated the effect of replacing normal corn (NC) or normal wheat bran (NW) with moldy corn (MC) or moldy wheat bran (MW) on growth, ovarian follicular reserves, and oxidative status. Methods: Sixty-three Landrace × Yorkshire gilts were assigned to seven diets formulated by using MC to replace 0% (control), 25% (25% MC), 50% (50% MC), 75% (75% MC), and 100% NC (100% MC), MW to replace 100% NW (100% MW), and MC and MW to replace 100% NC and 100% NW (100% MC + MW), from postnatal day 110 to day 19 of the second estrous cycle. Results: Feeding the gilts with MC or MW induced a lower average daily gain at days 29–56 of the experiment. Age at puberty remained unchanged, but MC inclusion resulted in a linear decrease in antral follicles with diameter >3.0 mm, and control gilts had a 12.7 more large antral follicles than gilts in the 100% MC + MW treatment. MC inclusion linearly decreased the numbers of primordial follicles, growing follicles, and corpora lutea, associated with a lower anti-Müllerian hormone level in serum and 17β-estradiol level in follicular fluid. MC inclusion decreased the serum concentrations of insulin-like growth factor 1 and its mRNA levels in the liver, combined with higher malondialdehyde concentration and lower total superoxide dismutase activities in serum and liver. Conclusion: Chronic exposure to MC-containing diets caused the loss of follicles, even if levels of deoxynivalenol, zearalenone, and aflatoxin B1 were below the levels allowed by China and Europe standards.     

Tei指数对高血压不同构型组心功能临床研究

目的评价心功能指标Tei指数在高血压患者各个不同构型组中的应用价值。方法对高血压组82例和正常对照组19例进行常规心脏超声、常规心脏收缩功能、心脏舒张功能指标及Tei指数测量。将原发性高血压划分为正常左室构型组Ⅰ、向心性重构组Ⅱ、向心性肥厚组Ⅲ、离心性肥厚组Ⅳ。结果(1)舒张功能:E/A值在Ⅰ、Ⅱ、Ⅲ组依次降低,Ⅳ组E/A反而增高,E/A>1。IVRT、EDT值高血压组各组间差异无显著意义。(2)收缩功能:EF、FS值在Ⅳ组才出现降低,SV和CO在Ⅰ和Ⅲ中无明显变化,Ⅱ减少,Ⅳ稍增加。(3)Tei指数高血压组较对照组皆增高,差异有显著意义。Ⅰ、Ⅱ、Ⅲ、Ⅳ组的Tei指数依次增高,除Ⅰ、Ⅱ组外,余各组之间差异有显著意义,Ⅳ组Tei值最高。结论Tei指数能早期发现反映整体功能的降低。这弥补了心脏舒张功能指标和收缩功能对高血压患者心功能评价的一些不足。     

Estimating health care delivery system value for each US state and testing key associations

ObjectiveTo estimate health care systems'' value in treating major illnesses for each US state and identify system characteristics associated with value.Data sourcesAnnual condition‐specific death and incidence estimates for each US state from the Global Burden Disease 2019 Study and annual health care spending per person for each state from the National Health Expenditure Accounts.Study designUsing non‐linear meta‐stochastic frontier analysis, mortality incidence ratios for 136 major treatable illnesses were regressed separately on per capita health care spending and key covariates such as age, obesity, smoking, and educational attainment. State‐ and year‐specific inefficiency estimates were extracted for each health condition and combined to create a single estimate of health care delivery system value for each US state for each year, 1991–2014. The association between changes in health care value and changes in 23 key health care system characteristics and state policies was measured.Data collection/extraction methodsNot applicable.Principal findingsUS state with relatively high spending per person or relatively poor health‐outcomes were shown to have low health care delivery system value. New Jersey, Maryland, Florida, Arizona, and New York attained the highest value scores in 2014 (81 [95% uncertainty interval 72‐88], 80 [72‐87], 80 [71‐86], 77 [69‐84], and 77 [66‐85], respectively), after controlling for health care spending, age, obesity, smoking, physical activity, race, and educational attainment. Greater market concentration of hospitals and of insurers were associated with worse health care value (p‐value ranging from <0.01 to 0.02). Higher hospital geographic density and use were also associated with worse health care value (p‐value ranging from 0.03 to 0.05). Enrollment in Medicare Advantage HMOs was associated with better value, as was more generous Medicaid income eligibility (p‐value 0.04 and 0.01).ConclusionsSubstantial variation in the value of health care exists across states. Key health system characteristics such as market concentration and provider density were associated with value.     

New views on ultrasonography in high-flow priapism,with typical cases

Dear Editor, Priapism is an uncommon pathological erection that mainly occurs in adult males between the ages of 20 years and 50 years.1 It is defined as an inv...     

硬膜外阻滞在中期妊娠引产镇痛时机选择的临床观察

目的：比较硬膜外阻滞在中期妊娠引产不同时点开始镇痛的临床效果。方法选取我院60例因计划外妊娠或有胎儿畸形等妊娠合并症要求终止妊娠者,随机分为两组实施硬膜外阻滞,A组为病房常规处理后产妇有疼痛感即开始实施麻醉,B组为病房常规处理后有规律宫缩开始实施麻醉,每组30例;记录镇痛开始前及镇痛后生命体征、各时点孕妇的VAS评分和运动神经阻滞分级、引产时间、出血量及不良反应情况。结果与B组比较,A组在镇痛后各时点VAS评分降低、引产时间延长,差异均有统计学意义（P＜0.05）;两组间孕妇引产期间生命体征平稳,出血量及不良反应差异无统计学意义（P＞0.05）。结论中期妊娠引产无须考虑胎儿因素,早期实施麻醉镇痛干预更为合理,在不增加出血量和不良反应的基础上引产时间略有延长。