Hepatic fibrosis refers to excessive accumulation and abnormal proliferation of fibrous connective tissue in the liver triggered by multiple pathogenic factors， and it may progress to liver cirrhosis， portal hypertension， and liver cancer. The pathological mechanisms of hepatic fibrosis involve hepatocyte injury， inflammatory cell infiltration with the release of inflammatory mediators， hepatic stellate cell activation， and extracellular matrix deposition. Recent studies have focused on mitochondrial dysfunction in disease progression， including the molecular pathways for hepatic fibrosis driven by metabolic disorders， energy deficiency， oxidative stress， mitochondrial dynamic imbalance， and autophagic dysfunction， all of which can induce liver injury. This article reviews the latest advances in hepatic fibrosis， in order to provide new therapeutic strategies for clinical management.

Background Climate change poses a significant threat to public health. In China, relevant health intervention research is still in its early stages, and evidence for evaluating the effectiveness of regional climate change health adaptation strategies and measures is scarce. Objective To investigate the level of climate change-related health literacy among residents in Shenzhen, implement targeted health interventions, and assess the intervention effects as well as their influencing factors. Methods From July 2023 to January 2024, 4 communities were randomly selected in Shenzhen, and a total of 896 community residents were enrolled and divided into an intervention group (444 participants) and a control group (452 participants). Baseline and follow-up surveys on climate change-related health literacy were conducted among residents for both groups. During the period between the two surveys, the intervention group received targeted health interventions. Health literacy—comprising 3 dimensions: basic health knowledge and concepts, basic health skills, and healthy lifestyles—was defined as achieving ≥80% of the total score. A differences-in-differences model was adopted to analyze the impact of the intervention, and multiple linear regression was used to explore the factors influencing the intervention effect. Results The baseline survey showed that 240 out of the 896 surveyed residents (26.79%) possessed climate change health literacy. For the 3 dimensions, the number of residents and the proportions with corresponding literacy in descending order were: basic health skills (521, 58.15%), healthy lifestyles (345, 38.50%), and basic health knowledge and concepts (44, 4.91%). After the intervention, the intervention group showed a 3.19% increase in the total health literacy score, a 3.55% increase in basic health knowledge and concepts, and a 4.24% increase in basic health skills (t=2.79, 2.77, and 2.47 respectively) (P<0.05). No significant change was observed in healthy lifestyle scores (t=0.70, P>0.05). Further analysis showed that awareness of the “dual carbon goals” and occupation were significantly associated with the intervention effect on overall health literacy (P<0.05). For basic health knowledge and concepts, occupation, history of chronic diseases, and awareness of the “dual carbon goals” had statistically significant effects on the intervention outcomes (P<0.05). Regarding basic health skills, awareness of the “dual carbon goals” significantly influenced the intervention effect (P<0.001). In terms of healthy lifestyles, gender, educational level, occupation, and awareness of climate change were significantly associated with the intervention effect (P<0.05). Conclusion The climate change-related health literacy among community residents in Shenzhen is in urgent need of improvement. Health interventions can effectively enhance residents' basic health knowledge and concepts, basic health skills, and overall literacy level. In the future, it is necessary to strengthen the popularization of climate change health knowledge based on different population characteristics and further optimize intervention strategies, to comprehensively improve residents' health adaptation capacity to climate change.

Objective:To compare the etiological characteristics between influenza-like illness (ILI) cases in outpatient and emergency departments and those with severe acute respiratory infection (SARI) in Guangdong Province, hoping to provide scientific evidence for the treatment, prevention, and control of respiratory infectious diseases.Methods:Laboratory testing for multiple respiratory pathogens was conducted on 6 090 specimens collected from ILI and SARI cases in Guangdong Province from August to December 2023. Chi-square test was used to analyze the differences in positive rates. Results:The overall positive rate of respiratory pathogens was 49.5% (3 016/6 090). The positive rate was 54.5% (2 260/4 145) in ILI cases and 38.9% (756/1 945) in SARI cases. The overall positive rate was higher in ILI cases than in SARI cases across all genders and age groups, and in most cities of the province, with statistically significant differences ( P<0.05). No significant difference was found in the overall positive rate between different genders. However, the difference between different age groups was statistically significant( P<0.001), with the highest rate identified in children aged 5-14 years (57.2%, 957/1 673). The main pathogens detected in ILI cases were influenza virus, human rhinovirus/enterovirus, and Streptococcus pneumoniae, while in SARI cases they were Mycoplasma pneumoniae, human rhinovirus/enterovirus, and influenza virus. The positive rates of adenovirus, human parainfluenza virus, SARS-CoV-2, human coronavirus, influenza virus, and Streptococcus pneumoniae were significantly higher in ILI cases than in SARI cases, while the positive rate of Mycoplasma pneumoniae was significantly higher in SARI cases ( P<0.05). Moreover, ILI cases were characterized by a higher risk of coinfection compared with SARI cases, especially in males or those aged 25-59 years. Conclusions:There are differences in the detection rates and spectrum of respiratory pathogens between ILI and SARI cases in Guangdong Province. Case features should be considered when developing strategies for preventing and treating respiratory infections.

Objective To assess the anti-skin photoaging properties of total flavonoids(TFT)extracted from the Chinese herb tulip,a preliminary analysis of its mechanism in combating skin photoaging were conducted.Methods UVB-induced photoaging mouse model was used to assess the anti-skin photoaging effects of TFT.A network pharmacology approach was used to conduct a preliminary analysis of TFT's mechanism of action against skin photoaging.Furthermore,molecular simulation was employed to predict the interactions between the active ingredients and target proteins.Results Treatment with TFT effectively improved skin condition in UVB-induced photoaging mice.The mechanism of action of TFT against skin photoaging likely involved the regulation of transcription factors such as NF-κB and AP-1,modulation of SASPs transcription,and inhibition of MMPs activity.Conclusion TFT is an effective anti-skin photoaging ingredient that deserves further research and development.

Objective To investigate the effect of interactions between hypoxia-inducing factor 1α(HIF-1α)and transforming growth faction-β2(TGF-β2)on the development of primary open-angle glaucoma(POAG)in high myopia(HM)and their early prediction value.Methods A prospective cohort study was conducted on 265 patients(421 eyes)with HM who were admitted to our hospital from February 2021 to June 2023.All patients underwent comprehensive oph-thalmological examinations,including optical coherence tomography to measure the total Bruch's membrane opening-disc edge minimum width(BMO)parameter,and the Humphrey field analyzer to measure the visual field index(VFI)and mean defect(MD)values.After a follow-up of 1 year(2 cases lost to follow up),the patients were divided into an occurrence group(51 cases,82 eyes)and a non-occurrence group(212 cases,337 eyes)according to whether POAG occurred.The clinical data[including age,gender,body mass index(BMI),central corneal thickness(CCT),axial length(AL),refrac-tive power,VFI,visual field MD,optic disc horizontal diameter,optic disc vertical diameter,elliptical index,optic disc ar-ea,optic cup area,disc rim area,cup-to-disc area ratio,and total BMO],tear HIF-1α and TGF-β2 were compared be-tween the two groups.The receiver operating characteristic(ROC)curves of tear HIF-1α and TGF-β2 for predicting HM with POAG were plotted to obtain the optimal cutoff value.The effects of tear HIF-1α,TGF-β2 and their interactions on the development of POAG in HM were analyzed.The Pearson method was used to analyze the correlation of tear HIF-1α and TGF-β2 with the optic disc structure of HM patients.The ROC analysis was used to evaluate the value of HIF-1α combined with TGF-β2 for predicting POAG.Results Compared with those in the non-occurrence group,the VFI and BMO were lower while the visual field MD,disc cup area,cup-to-disc area ratio,tear HIF-1α and TGF-β2 were higher in the occur-rence group(all P＜0.05).The interaction analysis showed that the interaction between tear HIF-1 α and TGF-β2 was a su-per-multiplication model,with a positive interaction effect on the occurrence of POAG in HM(P＜0.05).The Pearson analysis showed that tear HIF-1α and TGF-β2 were negatively correlated with VFI and total BMO,and positively correlated with their visual field MD,disc cup area,and cup-to-disc area ratio in patients with HM(all P＜0.05).The ROC curve analysis showed that the area under the ROC curve(AUC)of the effect of tear HIF-1α combined with TGF-β2 for predic-ting POAG in HM was 0.925(95％CI:0.896-0.949).The predictive value of tear HIF-1α combined with TGF-β2 was bet-ter than that of the two indicators alone.Conclusion HIF-1α and TGF-β2 are up-regulated in tears of HM patients com-plicated with POAG,and they interact positively during the occurrence of POAG.The combined detection of HIF-1α and TGF-β2 has predictive value for POAG.They can be used as an auxiliary clinical predictor of POAG,and can guide its clini-cal prevention and treatment.

Objective:To investigate the factors influencing sound localization in patients with unilateral sudden sensorineural hearing loss, so as to provide the reference for hearing rehabilitation of patients with unilateral sudden hearing loss.Methods:This study was a cross-sectional study that retrospectively analyzed the clinical data and audiological examination results of 228 patients with unilateral sudden sensorineural hearing loss(103 males and 125 females; aged from 18 to 80 years, with an average age of 46.2 years; 107 cases in the left ear and 121 cases in the right ear; 8 cases of low-frequency decline type, 42 cases of high-frequency decline type, 92 cases of flat decline type, and 86 cases of total deafness type)at the Eye and ENT Hospital of Fudan University from June 2023 to April 2024. The minimum audible angle (MAA) was calculated by the angle discrimination test of 1000 Hz and 4000 Hz warble tones, which were recorded as MAA 1 000 and MAA 4 000 according to the frequency of the given sound stimulus. The root mean square error (RMSE) was calculated by the angle recognition test with daily natural sounds as the stimulus sound. Using SPSS 27.0 statistical software, correlation and multiple regression analysis were used to research the clinical factors affecting the ability of sound localization in patients with unilateral sudden sensorineural hearing loss. Results:The mean MAA 1 000, MAA 4 000, RMSE of patients with unilateral sudden deafness were (53.97±29.14)°, (46.34±28.87)° and (30.06±13.64)°, respectively. Univariate analysis of variance revealed that there were significant differences between different classifications of sudden sensorineural hearing loss for sound localization tests (MAA 1 000: F=6.338, P<0.001,MAA 4 000: F=14.334, P<0.001,RMSE: F=49.918, P<0.001), post-hoc analysis observed that all significant contrasts were included the type of total deafness and low-frequency deafness. Correlation analysis showed the age of subjects in this study was weak positively correlated to the MAA 1 000 ( r=0.165, P=0.013), the duration of sudden sensorineural hearing loss was weak negatively related to RMSE ( r=-0.144, P=0.030), there were significant positive relationships between the threshold of PTA, PTA 1kHz, PTA 4kHz for the affected side, as well as the binaural PTA difference and sound localization test (MAA 1 000,MAA 4 000,RMSE) (all P<0.001). The multiple regression analysis showed the age and the binaural PTA difference for the affected side were the significant factors for the MAA 1 000 and MAA 4 000, the binaural PTA difference was the significant factors for the RMSE. The R 2 of multivariable linear regression model for MAA 1 000, MAA 4 000 and RMSE results in unilateral sudden deafness patients were 0.149, 0.207 and 0.553, respectively. Conclusion:Age, the hearing of the affected side, and binaural PTA difference are the significant factors for sound localization ability in patients with unilateral sudden sensorineural hearing loss, hearing compensation of the affected ear for these patients is hopeful to enhance the sound localization ability.

Objective To explore the relationship between serum chitosinase 3-like protein 1(CHI3L1)and Syndecan-1(SDC1)levels and bone metabolism in elderly patients with type 2 diabetes mellitus and their predictive efficacy on osteoporosis.Methods A total of 412 elderly patients with type 2 diabetes admitted to this hospital from May 2019 to May 2023 were included in this study,and were divided into normal bone mass group(n=151),reduced bone mass group(n=138)and osteoporosis group(n=123)according to the iffer-ences in bone mineral density.Serum CHI3L1 and SDC1 levels were detected by enzyme-linked immunosor-bent assay,and serum levels of type 1 collagen cross-linked carboxyl terminal peptide(CTX),25-hydroxyvita-min D[25-(OH)D],osteocalcin(OC),and type 1 procollagen N-terminal propeptide(P1NP)were deter-mined by automatic chemiluminescence immunoassay.Pearson correlation analysis was used to investigate the relationship between serum CHI3L1,SDC1 and bone metabolism in elderly patients with type 2 diabetes.Re-ceiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum CHI3L1 and SDC1 on osteoporosis in elderly patients with type 2 diabetes.Multivariate Logistic regression analysis was used to investigate the influencing factors of osteoporosis in elderly patients with type 2 diabetes.Results There were significant differences in diabetes course,fasting blood glucose,HbA1c and HDL-C a-mong normal bone mass group,decreased bone mass group and osteoporosis group(P＜0.05).The levels of serum CHI3L1,25-(OH)D,P1NP and osteocalcin in osteoporosis group were lower than those in osteopenia group,and those in osteopenia group were lower than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum SDC1 and CTX levels in osteoporosis group were higher than those in osteopenia group,and those in osteopenia group were higher than those in normal bone mass group,the differences were statistically significant(P＜0.05).Serum CHI3L1 was positively correlated with 25-(OH)D,P1NP and OC(P＜0.05),and negatively correlated with CTX(P＜0.05).Serum SDC1 was negatively correlated with 25-(OH)D,P1NP,OC(P＜0.05),and positively correlated with CTX(P＜0.05).The area under the curve(AUC)of serum CHI3L1,SDC1 and their combination predicted osteoporosis in elderly pa-tients with type 2 diabetes were 0.851,0.772 and 0.904,respectively.Multivariate Logistic regression analysis showed that long duration of diabetes,increased HbA1c,high expression of OC,CHI3L1＞4.16 ng/mL,SDC1≥50.94 ng/mL were all influential factors for osteoporosis in elderly patients with type 2 diabetes(P＜0.05).Conclusion Low expression of CHI3L1 and high expression of SDC1 in serum are associated with ab-normal bone metabolism in elderly patients with type 2 diabetes.These two indexes are expected to be used as biological markers to predict osteoporosis in elderly patients with type 2 diabetes.

Objective:To explore the effects of Qingre Qudu Decoction for fumigation combined with three-gap drainage on wound healing and serum inflammatory factors in patients with acute perianal abscess.Methods:Randomized controlled trial was conducted. A total of 117 patients with acute perianal abscess in the hospital were enrolled as the observation objects between August 2022 and May 2024. According to random number table method, they were divided into observation group (59 cases) and control group (58 cases). Both groups received three-gap drainage therapy. On basis of three-gap drainage, control group was given potassium permanganate, while observation group was given Qingre Qudu Decoction for fumigation. All patients were treated for 14 d. The growth of granulation tissue and wound secretions before and after treatment was evaluated. VAS scale was used to evaluate the degree of incision pain, and Wexner score was used to assess incontinence; ELISA was used to detect serum activator A (ACTA), immunoturbidimetry was used to detect serum CRP, and radioimmunoassay was used to detect serum IL-6 levels. The occurrence of complications and abscess recurrence during treatment was recorded, and clinical efficacy was evaluated.Results:The total effective rate of the observation group was 96.61% (57/59), while that of the control group was 82.76% (48/58), with statistical significance ( χ2=6.10, P=0.014). After treatment, scores of granulation tissue growth and wound secretions in observation group, and scores of VAS and Wexner incontinence in observation group were lower than those in the control group ( t=9.66, 5.00, 7.98, 3.65, P<0.001), and wound healing time was shorter than that in control group ( t=8.41, P<0.001). After treatment, levels of serum ACTA, CRP and IL-6 in observation group were lower than those in control group ( t=15.30, 2.08, 19.34, P<0.01 or P<0.05). The incidence of postoperative complications in the observation group was 6.78% (4/59), while in the control group it was 27.59% (16/58), with statistical significance ( χ2=8.93, P=0.003). Conclusion:Qingre Qudu Decoction for fumigation combined with three-gap drainage can relieve postoperative incision pain, inhibit inflammatory response, accelerate the recovery of wound and promote the recovery of anal function and improve clinical efficacy.

Postoperative stress symptoms are caused by surgical trauma,and now still lack active intervention methods to promote the recovery of body function in the field of western medicine.Professor Cai Bingqin analyzed the etiology and pathogenesis of stress symptoms after abdominal surgery,which usually manifested as abnormal sweating,sleep disorders,emotional disorders,and gastrointestinal dysfunction,and then put forward the concept of postoperative stress syndrome for the perioperative period.Professor Cai Bingqin believes that surgical stimulation,as the important etiological factor responsible for postoperative stress symptoms,can cause excessive stress in the body,which results in a series of symptoms affecting the recovery of patients.Liver plays a defensive and adaptive role in postoperative stress by regulating qi movement,blood circulation and emotions.The symptoms of abnormal sweating,sleep disorders and emotional disorders are related with the function of the liver in governing emotions,housing the ethereal soul,and ensuring the free movement of qi,while the gastrointestinal dysfunction manifestations of poor appetite,abdominal distention and constipation are due to the disharmony of liver and spleen.For the treatment of postoperative stress syndrome,Professor Cai proposes the principle of treating disease from the perspective of liver,and the methods of soothing liver and alleviating depression,and warming and activating qi movement are adopted.Sini San(Sini Powder for Soothing Liver and Regulating Qi)is commonly used as the basic prescription to ensure the normal function of liver and to ensure the free movement of qi,and then the harmony of qi and blood and the unobstruction of blood vessels will be achieved.Additionally,the assistance of therapy for invigorating spleen to dissolve dampness,and replenishing qi to consolidate superficies can adjust zang-fu organs'dysfunction,and will restore the balance of qi-blood and yin-yang.The proposal of"postoperative stress syndrome"will provide an approach to the management of perioperative period with traditional Chinese medicine,and will become the beneficial supplement to the existing fast-track surgery system.

The global incidence of head and neck cancer (HNC) is rising, with over 60% of patients presenting at a locally advanced stage. Radiotherapy remains a cornerstone of HNC treatment, and advancements in modern techniques and concurrent chemotherapy have improved local control and survival rates of HNC patients. However, these benefits also bring challenges in the management of toxicities. Due to the proximity of salivary glands and tumors, especially the highly radiosensitive parotid and submandibular glands, this condition is among the most common adverse effects of radiotherapy. Radiation damages acinar cells and ducts, causing glandular atrophy, fibrosis, and reduced saliva secretion, thereby leading to xerostomia and related complications. The risk and severity of injury are associated with the radiation dose and volume affecting the glands. Prevention and management strategies emphasize precise radiotherapy planning, target optimization, and supportive care. Emerging multimodal imaging techniques offer potential for non-invasive prediction and early diagnosis and treatment of radiation-induced salivary gland injury. Future research in regenerative medicine, tissue engineering, and molecular biology aims to elucidate molecular mechanisms, such as signaling pathways and genomics, facilitating personalized strategies to mitigate radiotherapy-induced toxicities and enhance the quality of life of patients.