Hepatic fibrosis is a key intermediate stage in the progression of various chronic liver diseases to liver cirrhosis and liver cancer. Traditional Chinese medicine （TCM） has a good effect in the treatment of hepatic fibrosis， but its mechanism of action remains unclear. This article introduces the pathological mechanisms of hepatic fibrosis， including etiology and pathogenesis based on TCM theory and related mechanisms in Western medicine （such as hepatic stellate cell ［HSC］ activation， hepatic fibrosis driven by metabolic reprogramming， and key signaling pathways in hepatic fibrosis）. On this basis， this article analyzes the core mechanisms of TCM in the treatment of hepatic fibrosis， including inhibiting HSC activation and proliferation， suppressing liver inflammation and modulating immunity， counteracting lipid peroxidation damage， regulating the synthesis and secretion of pro-fibrotic factors， maintaining the metabolic balance of extracellular matrix， regulating key signaling pathways， modulating gut microbiota， and inhibiting sinusoidal capillarization， in order to summarize the mechanism of action of TCM in the treatment of hepatic fibrosis and lay a foundation for better developing TCM-based therapeutics for hepatic fibrosis.

Objective To investigate the regulatory mechanism of the central nervous system in patients with refractory overactive bladder (rOAB) using diffusion tensor imaging (DTI) and graph theory analysis. Methods A total of 43 rOAB patients (rOAB group) and 46 matched healthy controls (HC group) were recruited during May and Nov.2024. All participants were scanned with DTI, and surveyed with the overactive bladder symptom score (OABSS), and overactive bladder questionnaire (OAB-q). Their age, gender, height, weight, and educational years were collected.DTI plus graph theory analysis was employed to explore the alterations in global and local topological properties of the brain structural network in rOAB patients. Brain regions showing significant group differences in structural metrics [specifically, the right paracentral lobule (PCL.R) ]were further used as seed points for functional connectivity (FC) analysis. Correlations between the nodal clustering coefficient (NCp) of the identified region, FC strength, OABSS, and OAB-q score were investigated. Results The OABSS [8 (6,10) vs.0 (0,1) ]and OAB-q [71 (53,80) vs.20 (19,24) ]were higher in the rOAB group than the HC group (P<0.001). Graph theory analysis revealed no statistically significant differences in global network metrics between the two groups (P>0.05). However, the NCp was significantly higher in the PCL.R of rOAB group compared to HC group (P<0.05, FDR-corrected).FC analysis using the PCL.R as a seed region demonstrated significantly reduced FC value in the left cerebellar crus Ⅱ (Cerebelum_Crus2_L) of the rOAB group (P<0.05, FDR-corrected). Partial correlation analysis showed that the NCp of PCL.R was positively correlated with both OABSS (r=0.255, P=0.018) and OAB-q score (r=0.257, P=0.017). Conversely, the FC of Cerebelum_Crus2_L was significantly negatively correlated with OABSS (r=-0.545, P<0.001) and OAB-q score (r=-0.535, P<0.001). Conclusion Patients with rOAB exhibit distinct brain structural network alterations compared to healthy individuals, primarily manifestation in the NCp value of PCL.R increased, and the FC intensity of Cerebelum_Crus2_L is significantly weakened. These alterations in the topological properties of the structural network may be implicated in the pathogenesis of rOAB.

Objective To explore the efficacy of negative pressure ureteral access sheath combined with disposable flexible ureteroscope(UAS+FRUS)in the treatment of renal calculi of 2-3 cm,so as to provide reference for the treatment.Methods A retrospective analysis was conducted on 130 cases of renal calculi of 2-3 cm treated with surgery in Xiamen Third Hospital during Sep.2021 and Sep.2023,including 68 cases with UAS+FRUS and 62 cases with super-mini percutaneous nephrolithotripsy(SMP).The perioperative indexes and stone-clearance rate(SFR)were compared between the two groups.Results All operations were successful.There were no statistically significant differences in the total SFR and incidence of complications(5.88％vs.9.67％)between the two groups 3 days(88.24％vs.90.32％)and 1 month(91.18％vs.93.55％)after surgery(P＞0.05).For patients with lower calyceal calculi with infundibulopelvic angle(IPA)＜45°,the SFR of the UAS+FRUS group was significantly lower than that of the SMP group(57.14％vs.100％,P＜0.05).The UAS+FRUS group had a longer operation time than the SMP group[(104.94±8.79)minutes vs.(77.98±6.60)minutes,P＜0.001],higher hospitalization costs[(23 112.82±1152.34)yuan vs.(21 975.84±1512.24)yuan,P＜0.001],less postoperative decrease in hemoglobin[(6.71±2.07)g/L vs.(9.81±4.80)g/L,P＜0.001],and shorter postoperative hospitalization time[(3.28±0.51)d vs.(5.58±0.71)d,P＜0.001].The UAS+FRUS group had lower postoperative VAS score at 6,24,and 48 hours than the SMP group[(6.38±0.69)vs.(7.87±0.88);(3.62±0.73)vs.(5.81±0.83)and(3.12±0.33)vs.(3.81±0.60)],with statistical significance(P＜0.05).Conclusion Both surgical methods have a high SFR in the treatment of renal calculi of 2-3 cm.SMP has the advantages of short operation time,low hospitalization costs,and high SFR for lower calyx calculi,while UAS+FURS has the advantages of little bleeding,minimal trauma,and short hospital stay.Surgeons can make reasonable choices based on the patients'condition and willingness,combined with their own surgical experience.

【Objective】 To investigate the feasibility of allogeneic platelet-rich plasma (PRP) for the treatment of skin injury around enterostomy. 【Methods】 The treatment process by PRP of 2 patients with skin injury around enterostomy was analyzed, and the PRP for each patient was tested with platelet count, bacteria and 5 growth factors. The clinical efficacy of enteral nutrition support therapy combined with allogeneic PRP was explored through analyzing treatment key points and literature review. 【Results】 After cleaning the skin around enterostomy, the patients were treated with PRP once daily for 5 days, adjusted to once every other day, and cure was achieved at 15 and 18 days, respectively. 【Conclusion】 Allogeneic PRP is a safe and effective treatment to promote skin injury around enterostomy regeneration in a short time, which can provide a new perspective for clinical.

The latest research findings on bidirectional regulation of neuro-immunity through traditional neural circuits shed new light on the theoretical basis of the role of vidian neurectomy (VN). This article aims to provide a comprehensive understanding of VN, including the history of VN, the principle of neuroimmuno-interaction, the applied anatomy of VN as well as the methods of transnasal endoscopic surgery. Additionally, we introduce the concept of the nose-brain axis, which was proposed based on the advancement in the area of neuro-immune interactions.

Objective To explore whether liver cirrhosis markers aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4 index(FIB-4)based on blood biochemical indicators can predict disease free survival(DFS)and overall survival(OS)in patients with hepatocellular carcinoma(HCC)after resection.Methods 300 patients with HCC who underwent radical resection in Zhongshan Hospital,Fudan University from February 2005 to July 2017 were enrolled and the clinicopathological characteristics,recurrence and survival of these patients were retrospectively collected.The relationships between APRI,FIB-4 and postoperative recurrence and survival were evaluated.The ROC curve was used to evaluate the predictive values of APRI,FIB-4.Results The median follow-up of 300 patients was 61 months.Univariate Cox regression analysis showed that APRI,FIB-4,vascular invasion were risk factors affecting postoperative DFS and OS.The multivariate Cox regression analysis showed that vascular invasion was the independent risk factor for postoperative DFS(HR=1.518,95%CI 1.024-2.252,P=0.038)and OS(HR=2.301,95%CI 1.270-4.167,P=0.006).The time dependent ROC(time-ROC)curve showed that AUCs of APRI and FIB-4 predicting 1-year,3-year,and 5-year DFS were 0.555-0.596,which were 0.600-0.679 when predicting 1-year,3-year,and 5-year OS.Conclusions The predictive value of APRI and FIB-4 based on blood biochemical indicators alone for postoperative DFS and OS in HCC patients is limited.

Objective To investigate the expression of serum human cartilage glycoprotein 39(YKL-40)and soluble growth stimulating gene 2 protein(sST2)in elderly patients with acute myocardial infarction(AMI)and their relationship with myocardial fibrosis and myocardial injury.Methods From January 2020 to April 2023,a cohort of 212 AMI patients admitted in Department of Cardiovascular Diseases of Dongguan Hospital of Traditional Chinese Medicine were enrolled and assigned into the patient group,and another 80 ostensibly healthy volunteers taking physical examinations during the same period were subjected and served as control group.Serum levels of YKL-40 and sST2 and the indicators related myocardial fibrosis and injury[including hyaluronic acid(HA),type Ⅲ procollagen(PCⅢ),type Ⅲ procollagen amino terminal peptide(PⅢNP),cardiac troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),and N-terminal B-type natriuretic peptide precursor(NT-proBNP)]at admission were detected,and the correlation of serum YKL-40 and sST2 levels with myocardial fibrosis and injury was analyzed.According the occurrence of ma-jor adverse cardiovascular events(MACE)during 28-day follow-up,the patients were stratified in-to MACE(68 cases)and non-MACE(144 cases)subgroups.Multivariate logistic regression analysis was employed to analyze the determinants of serum YKL-40,sST2,myocardial fibrosis,and myocardial injury to the occurrence of MACE.Results The patients had significantly higher serum levels of YKL-40,sST2,PCⅢ,HA,PⅢ NP,cTnⅠ,CK-MB and NT-proBNP than the con-trol group(P＜0.01).Both serum YKL-40 and sST2 levels were positively correlated with the levels of PC Ⅲ,HA,PⅢ NP,cTnⅠ,CK-MB and NT-proBNP.The serum levels of YKL-40,sST2,PCⅢ,HA,PⅢNP,cTnⅠ,CK-MB and NT-proBNP were obviously higher in the MACE sub group than the non-MACE sub group(P＜0.01).Multivariate logistic regression analysis indicated that YKL-40(OR=1.964,95％CI:1.643-2.348,P=0.000),sST2(OR=2.457,95％CI:2.020-2.989,P=0.000),PC Ⅲ(OR=1.654,95％CI:1.312-2.084,P=0.000),HA(OR=1.505,95％CI:1.185-1.912,P=0.001),PⅢ NP(OR=1.483,95％CI:1.120-1.963,P=0.006),cTnⅠ(OR=1.365,95％CI:1.102-1.690,P=0.004),CK-MB(OR=1.514,95％CI:1.009-2.272,P=0.045)and NT-proBNP(OR=1.824,95％CI:1.011-3.290,P=0.046)were influencing factors for MACE in elderly AMI patients.Conclusion Serum YKL-40 and sST2 levels are abnormally higher in elderly AMI patients,and are closely associated with myocardial fibrosis and injury.

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

Objective To explore the clinical value of shear wave elastic imaging(SWE)for renal cortical elasticity in patients with hypertension.Methods According to the diagnostic criteria of 2020 International Society of Hypertension(ISH)Global Hypertension Practice Guidelines,44 patients with simple hypertension admitted to the Department of Cardiology of our hospital were selected and 46 healthy controls were selected for the same period.The general data and and renal function indicators of blood biochemical were recorded.All subjects were examined by two-dimensional ultrasound and SWE elasticity to obtain the conventional ultrasound parameters and the Young's modulus(YM)value of the right.The above parameters between the two groups were compared.The influence factors were analyzed by multiple linear regression among the YM value of the right renal cortex,the general data,conventional ultrasound indicators and renal function indicators in the simple hypertension group.Results The course,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the simple hypertension group was higher than those in the control group,and the difference was statistically significant(P＜0.05).The YM value of the right renal cortex in the simple hypertension group was higher than that in the control group,and the difference was statistically significant(P＜0.05).The correlation analysis showed that the YM value of the right renal cortex was positively correlated with the duration of hypertension(P＜0.05),but not with age,blood pressure,right renal volume,right renal cortex thickness,right renal artery trunk peak systolic flow velocity(PSV),right renal artery trunk resistance index(RI),blood urea nitrogen,blood creatinine,or uric acid(P＞0.05).Further simple linear regression analysis showed that the duration of hypertension was an independent factor affecting the YM value of the right renal cortex.Conclusion SWE may be used to find the variation in elasticity of renal cortex in patients with simple hypertension.

Objective To explore the safety and effectiveness of the comprehensive therapy of "Five-in-One" of traditional Chinese medicine combined with low concentration of atropine in the prevention and control of myopia in adolescents. Methods Eighty adolescents diagnosed with mild myopia were included in the study. According to the wishes of the subjects and their guardians, they were divided into control group with 40 cases and traditional Chinese medicine intervention group with 40 cases. The control group received 0.01% atropine sulfate eye drops in both eyes once before bedtime every night, the traditional Chinese medicine intervention group underwent twice-weekly comprehensive therapy of "Five-in-One" of traditional Chinese medicine on the basis of local application of medication in the control group. Both groups received a 12-month intervention course. Follow-up visits were conducted before intervention and at 3, 6, and 12 months after treatment. The international standard visual acuity chart was used to examine the changes in unaided distance visual acuity before and after treatment in both groups. The changes of distant visual acuity of naked eye before and after treatment were measured in two groups. The changes in equivalent spherical lens power before and after treatment in both groups were measured by mydriatic refraction combined with a computer optometer. The changes in axial length before and after treatment were measured using an optical biometer. The adverse reactions after treatment in both groups were compared. Results In the control group, the uncorrected distance visual acuity decreased compared with that before intervention as the treatment time prolonged, while was gradually increased in the traditional Chinese medicine intervention group compared with that before intervention (P < 0.05). At 12 months after treatment, the uncorrected distance visual acuity in the traditional Chinese medicine intervention group was higher than that in the control group (P < 0.05). With the prolongation of treatment time, the equivalent spherical lens power gradually increased in both groups (P < 0.05).At 12 months after treatment, the equivalent spherical lens power in the traditional Chinese medicine intervention group was lower than that in the control group (P < 0.05). The axial length gradually increased with the prolongation of treatment time in both groups (P < 0.05). At 6 and 12 months after treatment, the axial length in the traditional Chinese medicine intervention group was shorter than that in the control group (P < 0.05). After using 0.01% atropine, 8 children in the control group developed outdoor photophobia symptoms; after treatment with the comprehensive therapy of "Five-in-One" of traditional Chinese medicine combined with 0.01% atropine sulfate eye drops in the traditional Chinese medicine intervention group, 4 children developed outdoor photophobia symptoms, but the symptoms disappeared after 2 weeks of medication. Conclusion The comprehensive therapy of "Five-in-One" in traditional Chinese medicine combined with low-concentration atropine is significantly more effective than low-concentration atropine alone in effectively controlling the progression of refractive myopia and reducing its adverse reactions.