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Background: Management errors during pre-hospital care, triage process and resuscitation have been widely reported as the major source of preventable and potentially preventable deaths in multiple trauma patients. Common tools for defining whether it is a preventable, potentially preventable or non-preventable death include the Advanced Trauma Life Support (ATLS®) clinical guideline, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS). Therefore, these surrogated scores were utilized in reviewing the study's trauma services. Methods: Trauma data were prospectively collected and retrospectively reviewed from January 1, 2018, to December 31, 2018. All cases of trauma death were discussed and audited by the Hospital Trauma Committee on a regular basis. Standardized form was used to document the patient's management flow and details in every case during the meeting, and the final verdict (whether death was preventable or not) was agreed and signed by every member of the team. The reasons for the death of the patients were further classified into severe injuries, inappropriate/delayed examination, inappropriate/delayed treatment, wrong decision, insufficient supervision/guidance or lack of appropriate guidance. Results: A total of 1913 trauma patients were admitted during the study period, 82 of whom were identified as major trauma (either ISS > 15 or trauma team was activated). Among the 82 patients with major trauma, eight were trauma-related deaths, one of which was considered a preventable death and the other 7 were considered unpreventable. The decision from the hospital's performance improvement and patient safety program indicates that for every trauma patient, basic life support principles must be followed in the course of primary investigations for bedside trauma series X-ray (chest and pelvis) and FAST scan in the resuscitation room by a person who meets the criteria for trauma team activation recommended by ATLS®. Conclusion: Mechanisms to rectify errors in the management of multiple trauma patients are essential for improving the quality of trauma care. Regular auditing in the trauma service is one of the most important parts of performance improvement and patient safety program, and it should be well established by every major trauma center in Mainland China. It can enhance the trauma management processes, decision-making skills and practical skills, thereby continuously improving quality and reducing mortality of this group of patients. [ABSTRACT FROM AUTHOR]

The fresh leaves of Metapanax delavayi (Araliaceae) have been used as a common wild vegetable for salad and soup, and also herbal tea by the local people living in its growing areas of Yunnan province, China. Detailed chemical investigation led to the identification of a new triterpenoid saponin, 3-O-α-L-arabinopyranosyl-28-O-β-D-glucopyranosyl-(1→6)-O-β-D-glucopyranosyl-3β-hydroxyolean-12-ene-28,29-dioic acid (1) from the fresh leaves, together with 11 known compounds, including six triterpenoid saponins (2–7), two caffeoylquinic acid derivatives (8–9), and three flavonoid glycosides (10–12). Their structures were determined on the basis of spectroscopic analysis and acidic hydrolysis. Compounds 3–5 and 8–12 were isolated from M. delavayi for the first time. Moreover, the known saponins 3-O-β-D-xylopyranosyl-3β-hydroxyolean-12-ene-28,29-dioic acid (3) and yiyeliangwanoside IV (5) exhibited protective effects on HepG2 cells damaged by the alcohol intakes, at a concentration of 1.0 µg/mL. The results indicated M. delavayi is an ideal dietary vegetable and herbal tea with potential hepatoprotective activity. [ABSTRACT FROM AUTHOR]

The sequential extraction method was used to determine the fraction of arsenic (As) in different-sized particulate matters (PMs) (i.e., PM2.5, PM10, and total suspended particles (TSP)). Samples were collected from Baoding, a typical medium-sized city with the serious haze pollution in China. The bioavailabilities of As in the samples were estimated based on the fraction results. A large percentage of fine particles were detected in TSP, with the average PM2.5/PM10 and PM10/TSP ratios all above 0.69. The total concentrations of As in PM2.5, PM10, and TSP samples were in the range of 4.5–296.4, 14.1–708.0, and 32.8–798.0 ng m−3, respectively. The mass percentages of As in PM2.5, PM2.5–10, and PM10–100 were calculated; the results indicated that As tended to concentrate in fine particles. PM-bound As mainly presented in the nonspecifically sorbed fraction (F1) during all of the sampling periods. The percentages of F1-As and bioavailability of As were higher in PM2.5, followed by PM10 and TSP. By contrast, the residual fraction (F5-As) contents declined in the order of TSP > PM10 > PM2.5. Significant differences in the speciation and bioavailability of As in different-sized PMs were found, and the influence of particle size on the speciation and bioavailability of As in PMs was verified. Fine particles adsorbed more As with higher bioavailability, and potentially led to more serious adverse effects on human health than the larger ones. [ABSTRACT FROM AUTHOR]

Nine new minor dehydrogenated and cleavaged dammarane-type triterpenoid saponins, namely notoginsenosides ST6-ST14 ( 1 – 9 ) were isolated from the steamed roots of Panax notoginseng , together with 14 known ones. Among them, 5–7 and 21–22 were protopanaxadiol type and the left 18 compounds, including 1–4 , 8–20 , and 23 were protopanaxatriol type saponins. Their structures were identified by extensive analysis of MS, 1D and 2D NMR spectra, and acidic hydrolysis. Resulted from the side chain cleavage, the new saponins 1 and 2 featured in a ketone group at C-25, and 3–5 had an aldehyde unit at C-23. The known saponins 12 , 16 and 18 displayed the enhancing potential of neurite outgrowth of NGF-mediated PC12 cells at a concentration of 10 μM, while 20 exhibited acetyl cholinesterase inhibitory activity, with IC 50 value of 13.97 μM. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Piper wallichii (Miq.) Hand.-Mazz. is a medicinal plant used widely for the treatment of rheumatoid arthritis, inflammatory diseases, cerebral infarction and angina in China. Previous study showed that lignans and neolignans from Piper spp. had potential inhibitory activities on platelet aggregation. In the present study, we investigated the chemical constituents of Piper wallichii and their antithrombotic activities, to support its traditional uses. Materials and methods The methanolic extract of the air-dried stems of Piper wallichii was separated and purified using various chromatographic methods, including semi-preparative HPLC. The chemical structures of the isolates were determined by detailed spectroscopic analysis, and acidic hydrolysis in case of the new glycoside 2 . Determination of absolute configurations of the new compound 1 was facilitated by calculated electronic circular dichroism using time-dependent density-functional theory. All compounds were tested for their inhibitory effects on platelet aggregation induced by platelet activating factor (PAF) in rabbits׳ blood model, from which the active ones were further evaluated the in vivo antithrombotic activity in zebrafish model. Results A new neolignan, piperwalliol A ( 1 ), and four new aromatic glycosides, piperwalliosides A–D ( 2 – 5 ) were isolated from the stems of Piper wallichii , along with 25 known compounds, including 13 lignans, six aromatic glycosides, two phenylpropyl aldehydes, and four biphenyls. Five known compounds ( 6 – 10 ) showed in vitro antiplatelet aggregation activities. Among them, (–)-syringaresinol ( 6) was the most active compound with an IC 50 value of 0.52 mM. It is noted that in zebrafish model, the known lignan 6 showed good in vivo antithrombotic effect with a value of 37% at a concentration of 30 μM, compared with the positive control aspirin with the inhibitory value of 74% at a concentration of 125 μM. Conclusion This study demonstrated that lignans, phenylpropanoid and biphenyl found in Piper wallichii may be responsible for antithrombotic effect of the titled plant. [ABSTRACT FROM AUTHOR]

A novel highly oxygenated norbisabolane sesquiterpene, namely phyllanthacidoid U (1), along with nine known sesquiterpenes (2-10) was isolated from the roots and stems of Phyllanthus acidus (L.) Skeels (Phyllanthaceae), collected from Xishuangbanna, Yunnan province, China. Their structures were elucidated by means of extensive spectroscopic analysis and by comparison of their data with reported values in literatures. Instead of the C-13 ester O -glycosyl found mostly in the titled plant growing in Thailand, compound 1 possessed a rare N - β -glucosamine-2- N -acetate moiety linked directly to the carbonyl at C-13 through an amido bond. Moreover, the acyl group at C-10 in 1 was ( Z )-2-(2-hydroxyethyl)-pent-2-enedioyl group, instead of benzoic or p -hydroxybenzoic moieties found commonly in the reported norbisabolane sesquiterpenes. The known sesquiterpene 5 displayed stronger anti hepatitis B virus (HBV) activity with IC 50 values of 1.69 ± 0.22 and 2.79 ± 0.69 μM towards HBV surface antigen (HBsAg) and HBV excreted antigen (HBeAg) secretion, respectively.

Phytochemical investigation on the nonpolar extracts of P. acidus leaves afforded three new cleistanthane diterpenoids, named phyllanacidins A-C (1-3), in addition to three known ones (4-6). Among them, compounds 2 and 3 represent the first examples of 17-nor cleistanthane diterpenoids. Their structures including absolute configurations were elucidated on the basis of extensive spectroscopic data and single crystal X-ray diffraction analysis. All the isolated cleistanthane diterpenoids were evaluated for their cytotoxic activities against five human cancer cell lines. Compounds 4-6 exhibited moderate cytotoxicity with IC 50 values ranging from 16.11 to 30.82 μM., (Copyright © 2020 Elsevier B.V. All rights reserved.)

As a subgroup of flavoalkaloids, N -ethyl-2-pyrrolidinone substituted flavan-3-ols are reported to possess various biological activities that may play important roles in the beneficial healthcare functions of tea. The HPLC and LC-MS analyses showed the existence of N -ethyl-2-pyrrolidinone substituted flavan-3-ols in 'Jin-Ya', which is a Yunnan black tea produced only from the buds of the tea plant Camellia sinensis var. assamica . Further phytochemical study on this precious black tea led to the identification of 8 flavoalkaloids, 1 - 8 , along with 11 known flavan-3-ols ( 9 - 14 ) and flavonol glycosides ( 15 - 19 ). The new compounds, (-)-6-(5″ S )- N -ethyl-2-pyrrolidinone-epiafzelechin ( 1 ), (-)-8-(5″ R )- N -ethyl-2-pyrrolidinone-epiafzelechin-3- O -gallate ( 2a ), and (-)-8-(5″ S )- N -ethyl-2-pyrrolidinone-epiafzelechin-3- O -gallate ( 2b ), were identified based on extensive spectroscopic analysis. Flavoalkaloids 2 - 6 showed inhibitory activity on α-glucosidase with IC 50 values ranging from 2.09 to 8.47 μM, compared to those of quercetin and acarbose (IC 50 = 6.87 and 228.9 μM, respectively). Moreover, compounds 2 , 3 , and 6 displayed an inhibitory effect on acetyl-cholinesterase with IC 50 values of 14.23, 33.79, and 34.82 μM, respectively, compared to tacrine (IC 50 = 0.223 μM).

An elaborated phytochemical study on the fresh fruits of Terminalia chebula var. tomentella (Combretaceae) led to the isolation of five new lignans, including three tetrahydrofuran (1-3) and two furofuran (4 and 5) derivatives, namely termitomenins A-E (1-5), along with 10 known ones. All of them were obtained from the titled plant for the first time. Their structures were determined by extensive spectroscopic analysis, including 1D/2D NMR, MS, UV, IR, electronic circular dichroism (ECD), time-dependent density functional theory (TDDFT) calculation of ECD spectra, and single crystal X-ray diffraction in case of 3. Compounds 1-15 exhibited certain anti-inflammatory activities. Interestingly, compounds 6 (IC 50  = 18.17 ± 0.57  μM) and 7 (IC 50 = 13.66 ± 0.38 μM) which contain an aldehyde group displayed stronger NO inhibitory activity than the positive control L-NMMA (IC 50  = 42.34 ± 0.66 μM)., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Arsenic (As) can be easily enriched in atmospheric particulate matters (PMs), especially in fine particulate matters (PM 2.5 ). In this study, thirty two PM 2.5 samples were collected in four seasons in Baoding, China, where the haze pollution was very serious in recent years. The total contents, species and bioavailability of arsenic in PM 2.5 samples were investigated. Species of arsenic in the PM 2.5 samples were discriminated as five fractions using a sequential extraction method: non-specifically sorbed fraction (F1), specifically-sorbed fraction (F2), amorphous and poorly-crystalline hydrous oxides of Fe and Al fraction (F3), well-crystallized hydrous oxides of Fe and Al fraction (F4) and residual fraction (F5). Bioavailabilities of arsenic in the PM 2.5 samples were evaluated by in vitro tests using both solubility bioavailability research consortium (SBRC) and Gamble's solution extraction methods. The total volume concentrations of As in PM 2.5 were significantly higher in winter than the other seasons. However, the highest mass concentration of As was found in spring. Scanning electron microscopy (SEM) characterization indicated that the physical morphology of the particles varied in different seasons. Significant differences of fraction distribution and BFs were found between different seasons. Arsenic in PM 2.5 samples mainly presented in F1 with high bioavailability factor (BF), especially for the samples in summer. In vitro tests indicated that arsenic in PM 2.5 could be dissolved more easily in gastric phase rather than intestinal and lung phases. There was a significant correlation between species and in vitro tests. Interestingly, a synergy effect was found between F2 and F3. Health risk assessment indicated that arsenic in PM 2.5 via inhalation exposure for both children and adults could cause adverse effects. Principal component analysis suggested that the arsenic in PM 2.5 was from the similar sources between summer and autumn, winter and spring, respectively., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background/aims: To compare the colonoscopy findings of a tertiary Chinese hospital with those of an American tertiary hospital., Materials and Methods: Hundred consecutive colonoscopies performed in August 2008 at the First Affiliated Hospital of Nanchang University in China and at the Emory University Hospital, United States of America, were investigated. The endoscopic findings and the histopathology results were statistically compared., Results: The average age of Chinese patients who underwent colonoscopy in this study was 45.23±15.38 years, whereas that of American patients was 55.38±12.11 years; no difference in sex ratio was observed (p=0.202) between the two populations. Screening colonoscopy accounted for 38% of patients in the American group and zero patients in the Chinese group. Polyps and diverticula were the most common findings in both groups. Abnormal findings in the American patients were three times higher than those in the Chinese patients. Proximal colon polyps were more common in the American group. Conversely, proximal colon diverticula were more common in the Chinese group. The prevalence of non-neoplasm lesions was not different between the two groups (p=0.232); the prevalence of adenomas significantly increased in patients who were more than 50 years old in both groups and was higher in the American group (p=0.038)., Conclusion: The prevalence of bowel diseases in American patients was higher than that in Chinese patients. Polyps and diverticula were the main bowel abnormalities in both groups. Chinese patients lacked awareness of colonoscopy screening and should be enhanced aged 50 years old or older, because the prevalence of advanced neoplasia was increased in this age group in both groups.

Arbutin (1), chlorogenic acid (2) and 6'-O-caffeoylarbutin (3) are three major components in Vaccinium dunalianum Wight with various promising bioactivities. A reliable, reproducible and accurate method for simultaneous and quantitative determination of 1-3 is developed by RP-HPLC analysis. This method should be appropriate for the quality assurance of unprocessed and processed materials of V. dunalianum. The contents of 1-3 in different parts of V. dunalianum from different origins were analysed. The content of 3 was much higher than those of 1 and 2, accounting for up to 31.76% in the dried leaf buds. Moreover, the leaf buds, flower buds and leaves showed a tendency towards higher contents of 1-3 than the other plant parts.

Ripe Pu-er tea, a special microbial postfermented tea originated from Yunnan Province, China, since ancient times, is made from green Pu-er tea prepared from the leaves of Camellia sinensis var. assamica (Theaceae). Chemical investigation on thearubigin (n-BuOH-soluble) fraction of the commercial ripe Pu-er tea, led to the identification of four new flavan-3-ol derivatives, 8-carboxymethyl-(+)-catechin (1), 8-carboxymethyl-(+)-catechin methyl ester (2), 6-carboxymethyl-(+)-catechin (3), and 6-carboxyl-(-)-gallocatechin (4), together with 18 known compounds, including other three flavan-3-ol derivatives (5-7), 10 flavonoid glycosides (8-17), two hydrolyzable tannins (18 and 19), two quinic acid derivatives (20-21), and a purine alkaloid (22). Flavonoid glycosides 8-11 are reported from tea plants for the first time. The thearubigin fraction of ripe Pu-er tea was qualitatively analyzed by HPLC, and gallic acid was found to be the major component. Compounds 4, 6-17, 21 and 22 were tested for their acute activities on insulin sensitivity in differentiated 3T3-L1 adipocytes, but none of them showed significant bioactivity at a concentration of 10 μM.