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.

This article summarizes Professor Shang Lili's experience in diagnosing and treating recurrent respiratory tract infections(RRTIs)in children based on the theory of"internal deficiency and external injury".Professor Shang believes that children are in the stage of growth and development,with delicate organs and insufficient vital energy,which is called"internal deficiency";external pathogens repeatedly invade the human body,resulting in clinical manifestations of both cold and heat,ultimately damaging the body's qi,blood,essence,and spirit,known as"external injury"."Internal deficiency and external injury"leads to repeated infections of pathogens in children and causes physical and mental distress,affecting their growth and development.The theory of"internal deficien-cy and external injury"emphasizes the influence of internal and external factors on RRTIs in children,reflecting the evolution of patho-genesis and guiding clinical staging treatment.During the acute infection period,the treatment of wind heat syndrome is based on the Xin Liang and Qing San methods,while the treatment of wind cold syndrome is based on the Xin Wen and Kai Bi methods.For the mixed deficiency and excess syndrome,various methods such as attacking,supplementing,harmonizing,and supporting should be used,and treatment should be based on syndrome differentiation,with adjustments made according to the symptoms;during the inter-mittent period of infection,Professor Shang aims to assist the righteous qi,taking into account the upper,middle,and lower Jiao,and adopting treatment principles such as nourishing the lungs,spleen,and kidneys.Professor Shang's experience provides useful ideas and methods for the treatment of RRTIs in children.

Background::Genetic variants of dopaminergic transcription factor-encoding genes are suggested to be Parkinson’s disease (PD) risk factors; however, no comprehensive analyses of these genes in patients with PD have been undertaken. Therefore, we aimed to genetically analyze 16 dopaminergic transcription factor genes in Chinese patients with PD.Methods::Whole-exome sequencing (WES) was performed using a Chinese cohort comprising 1917 unrelated patients with familial or sporadic early-onset PD and 1652 controls. Additionally, whole-genome sequencing (WGS) was performed using another Chinese cohort comprising 1962 unrelated patients with sporadic late-onset PD and 1279 controls.Results::We detected 308 rare and 208 rare protein-altering variants in the WES and WGS cohorts, respectively. Gene-based association analyses of rare variants suggested that MSX1 is enriched in sporadic late-onset PD. However, the significance did not pass the Bonferroni correction. Meanwhile, 72 and 1730 common variants were found in the WES and WGS cohorts, respectively. Unfortunately, single-variant logistic association analyses did not identify significant associations between common variants and PD. Conclusions::Variants of 16 typical dopaminergic transcription factors might not be major genetic risk factors for PD in Chinese patients. However, we highlight the complexity of PD and the need for extensive research elucidating its etiology.

To summarize XU Jingshi's clinical experience in treating fever from the perspective of latent pathogen. It is believed that latent pathogen heat accumulation is an important pathogenesis of fever. For latent pathogen in shaoyang and membrane-source， modified Xiaochaihu Decoction （小柴胡汤） plus Qinghao （Artemisiae Annuae Herba） could be used to expel pathogen through membrane and regulate shaoyang； for latent pathogen leading to yin fluids consumption， treatment should clear heat and expel pathogen， and prescribed with Chaihu （Bupleuri Radix）， Huangqin （Scutellaria baicalensis Georgi）， Qinghao （Artemisia carvifolia） combined with Baihu Decoction （白虎汤） or Zhuye Shigao Decoction （竹叶石膏汤） or Qinghao Biejia Powder （青蒿鳖甲散） or Shengmai Decoction （生脉饮） or Siyin Decoction （四阴煎） by syndrome differentiation； for latent pathogen leading to liver wind or reverse transmission to the pericardium， treatment should cool to open pathways， and prescribed with modified Angong Niuhuang Pill （安宫牛黄丸） to clear mind and open the orifices， clear heat and resolve toxins， resolve constraint with aromatics， and expel pathogens to outside； for fever after radiotherapy， chemotherapy or surgery for tumours， prescribed with self-prescribed Fuzheng Anzhong Decoction （扶正安中汤） plus Xiaochaihu Decoction （小柴胡汤） and modified Qinghao Biejia Decoction （青蒿鳖甲汤） to reinforce healthy qi and dispel pathogen， and support the middle jiao.

This paper summarized professor XU Jingshi's understanding and clinical experience of using Zhuru （Caulis Bambusae in Taenia）. It is suggested that suitable processed products should be flexibly selected according to the pathogenesis. Ginger-fried Zhuru is good at clearing the gallbladder and harmonizing the stomach， and balancing the ascending and descending， and self-made Xiaohua Funing Decoction （消化复宁汤）， modified Huanglian Wendan Decoction （黄连温胆汤）， and Danqi Heluo Beverage （丹七和络饮） can be used to treat palpitations， restlessness， upset， insomnia， and others. Dried Zhuru can resolve phlegm and clear heat， harmonize the center and calm spirit， and self-made Qingdan Cuimian Formula （清胆催眠方） is often used to treat palpitations， restlessness， insomnia， etc. Raw Zhuru is good at clearing the lung and dispelling phlegm， relieving cough and calming panting， which is commonly used in treating phlegm-heat cough and asthma caused by phlegm heat accumulating in the lung and ascending counterflow of lung qi. In addition， as Zhuru can clear heart and remove vexation， direct counterflow downward and relieve constraint， self-made Shugan Liyu Formula （疏肝理郁方） is often used to treat all diseases caused by constraints. Considering Zhuru has the function of harmonizing the actions of all medicinals in a formula， guiding the medicinals into the stomach， and regulating the ascending and descending of qi movement in central spleen and stomach， self-made Fuzheng Anzhong Decoction （扶正安中汤） can be used for postoperative treatment of various malignant tumors.

Objective: To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HG) for patients with high malignant biliary obstructive jaundice. Methods: A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group (n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge(PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed. Results: (1)The success rates were 100% in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362.15±138.27 μmol/L, 56.85±28.57 μmol/L in the EUS-HG group and 356.47±130.69 μmol/L, 60.93±25.79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896.57±357.29 U/L, 146.59±48.63 U/L in the EUS-HG group and 883.65±364.32 U/L, 151.57±49.73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252.36±38.77 U/L, 60.29±31.57 U/L in the EUS-HG group and 246.26±32.57 U/L, 62.56±32.87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259.37±30.64 U/L, 62.28±26.58 U/L in the EUS-HG group and 242.37±29.52 U/L, 60.28±29.57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52.57±31.95 mg/L, 16.95±8.77 mg/L in the EUS-HG group and 53.42±35.79 mg/L, 25.13±14.77 mg/L in the PTCD group (P<0.05). (3)There was significant difference in remission rate of anorexia and abdominal distension between the two groups [80.0%(16/20) VS 52.8%(19/36), P<0.05]. There was no significant difference in symptom relief of jaundice, pruritus or abdominal pain between the two groups [90.0%(18 /20)VS 91.7%(33/36), P>0.05]. (4) The incidence of total complications in the EUS-HG group (20.0%, 4/20) was significantly lower than that in the PTCD group (47.2%, 17/36, P<0.05). (5)The cost of operation in the EUS-HG group (22 685.26±2 356.16 yuan) was slightly higher than that in the PTCD group (20 529.57±4 135.63 yuan, P>0.05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days. Conclusion EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP.

This study was aimed to explore traditional Chinese medicine (TCM) compatibility patterns or rules in the treatment of ankylosing spondylitis (AS) in the real world clinical situations.The effect of TCM treatment and immune inflammatory biomarkers were analyzed by association rules,which provided evidences for AS syndrome differentiation and treatment.Retrospective study was conducted on records of hospitalized AS patients at the Department of Rheumatism,the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2012 to June 2016.The technology for complex networks was integrated to analyze the core prescription.The frequency and association rules of prescription patterns were analyzed using the SPSS 21.0 and SPSS modeler 14.2.The effect on immune inflammatory biomarkers was analyzed by association rules and random walk model.The results showed that,(1) warm,cold,and neutral herbs,sweet,bitter or pungent herbs,and with the channel tropism of spleen channel,stomach channel and liver channel are the most frequently prescribed herbs;(2) herbs with functions of tonifying and replenishing,blood-activating and stasis-resolving,qi-regulating,spleen-strengthening and dampness-resolving,wind-dampness dispelling,heatclearing are frequently prescribed,which are also interrelated and interacted on each other;(3) the top five pairs of couplet herbs with the highest confidence included Hong Hua paired with Tao Ren (98.15％),Yi Yi Ren paired with Fu Ling (95.47％),Gan Cao paired Gou Ji (94.57％),Gan Cao paired with Wei Ling Xian (94.48％),Pu Gong Ying paired Bai Hua She She Cao (94.40％);(4) Shan Yao was highly related to decreased C3,C4 and hs-CRP when compatibility with Fu Ling,Niu Xi,Ze Xie;Gou Ji was highly related to decreased IgA,IgG and IgM when compatibility with Bai Hua She She Cao,Chuan Xiong,Shah Yao.Xi Qian Cao was associated with Niu Xi when ESR and WBC decreased.Gou Ji and Du Huo were associated when SOD increased.(5) The group of internal medicine coordinated with external medicine has positive growth rate of walk and improvement index of inflammatory indexes (ESR,hs-CRP) compared to single internal medicine group.It was concluded that AS treatment in the Department of Rheumatism of our hospital was based on spleen.The treatment was focused on the regulation of cold and warm,sweet and bitter,liver and spleen.The treatment of AS is to eliminate evil factors and to reinforce healthy qi.TCM has advantages in the improvement of immune inflammatory indexes.The improvement of inflammatory indexes by the internal medicine coordinated with external medicine was better than the single use of internal medicine,which is worthy of further promotion.

Traditional Chinese medicine (TCM) is widely used in gouty arthritis treatment.Based on the real world,this article studied the implicit TCM prescription pattern in order to explore TCM prescription rule in acute gouty arthritis treatment.Based on herbs recorded in the Pharmacopoeia of the People's Republic of China,TCM prescriptions of 732 hospitalized acute gouty arthritis patients at the Department of Rheumatism and Immunology,the First Affiliated Hospital of Anhui University of Chinese Medicine from June 2012 to October 2016 were collected with software system.The frequency and association rules of prescription patterns were analyzed using the SPSS Modeler 14.2 Data Mining System.Cluster analysis was conducted using SPSS 22.0 statistical software.An initial statistical analysis was carried out to categorize herbs according to their medicinal types and dosage,natures,flavors,channel tropism and functions.Based on categorization,frequencies of occurrence were computed.The results showed that,(1) warm,cold or neutral herbs,sweet or bitter herbs,and with the channel tropism of spleen channel and stomach channel are the most frequently prescribed herbs (among 732 selected medicinal formulae);(2) spleen-strengthening and dampness-eliminating,wind-dispelling and damp-removing,blood-activating and stasis-resolving,heat-clearing,deficiency-tonifying,qi-regulating herbs are frequently used;(3) correlation analysis of TCM efficacy show that three couplet medicines with the highest confidence was spleen-strengthening and dampness-eliminating herbs and heat-clearing herbs (99.24％),blood-activating and stasis-resolving herbs and wind-dispelling and damp-removing herbs (99.01％),spleen-strengthening and dampnesseliminating herbs and qi-regulating herbs (98.92％).Correlation analysis of two TCM herbs showed that three couplet medicines with the highest confidence was Hong Hua paired with Tao Ren (99.7％),Yi Yi Ren paired with Shan Ci Gu (93.04％),and Yi Yi Ren paired with Chui Pen Cao (92.67％);(4) cluster analysis classified into five types,which were based on spleen-strengthening and dampness-eliminating and in combination with blood-activating and stasis-resolving herbs,heat-clearing and detoxification,wind-dispelling and damp-removing,representing prescription compatibility characteristics.It was concluded that gouty arthritis had a close relationship with the spleen.These prescriptions focus on herbs with spleen-strengthening and dampness-resolving which seems to be the key element in the treatment process.Meanwhile,the use of spleen-strengthening and dampness-eliminating herbs,blood-activating and stasis-resolving herbs,heat-clearing herbs,wind-dispelling and damp-removing herbs is the basis of prescription patterns.

Traditional Chinese medicine (TCM) is widely used as a complementary approach for osteoarthritis treatment.This article is based on the real world.The implicit prescription patterns behind TCM formulae were examined by association rules mining and cluster analysis,so as to explore the Chinese medicinal compatibility patterns or rules in osteoarthritis treatment.This study was based on real-world data from the hospital information system (HIS).Chinese medicinal prescriptions of hospitalized patients with osteoarthritis from June 2012 to June 2016 were collected from the Department of Rheumatism and Immunology,the First Affiliated Hospital of Anhui University of Chinese Medicine.TCM was listed according to the selected medicinal formulae and the added information was organized to establish a database.The frequency and association rules of prescription patterns were analyzed using the SPSS Modeler 14.2 Data Mining System.Cluster analysis of prescription patterns was also analyzed.An initial statistical analysis was carried out to categorize herbs according to their natures,flavors,channel tropisms and functions.Based on categorization,frequencies of occurrence were computed.At the same time,the relationship between TCM and immune and inflammatory markers was analyzed.The results showed that the main prescriptive features from the selected formulae of the mining data were that,(1) warm or cold herbs,sweet or bitter herbs,and with the channel tropism of spleen channel are the most frequently prescribed herbs in 3609 medicinal formulae;(2) herbs with blood-activating and stasis-resolving,restoring vital energy,water-eliminating and damp-removing,heat-clearing and or expelling wind-damp functions are frequently prescribed;(3) association rule analysis extracted three frequently used pairs of herbs,which are Hong Hua & Tao Ren (98.90％),Pu Gong Ying & Bai Hua She She Cao (97.88％),Fu Ling & Ze Xie (92.63％);(4) association rule between TCM and immune-inflammation index showed that the pair of Du Huo and Chen Pi was associated with increased superoxide dismutase (SOD) enzyme.The pair of Mai Ya and Dan Shen was associated with decreased high-sensitivity C-reactive protein (hs-CRP),erythrocyte sedimentation rate (ESR),complement component 3 (C3),complement component 4 (C4),immunoglobulin A (IgA) and immunoglobulin G (IgG).The pair of Mai Ya and Fu Ling was associated with decreased immunoglobulin M (IgM).It was concluded that osteoarthritis was closely related to spleen deficiency.These prescriptions focus on herbs for qi-nourishing and spleen-invigorating,blood-activating and stasis-resolving,spleen-invigorating and dampness-eliminating,heat-clearing and detoxicating which seems to be the key element in the treatment process.Meanwhile,the use of restoring vital energy herbs and spleen-strengthening herbs also forms the basis of prescription patterns.

Objective:Based on the hospital information system (hospital information system,HIS) were studied in rheumatology clinical medicine data hidden behind the prescription pattern,aims to explore the treatment of rheumatoid arthritis with patterns or rules from the spleen.Methods:This study from May 2012 to December 2016 in the treatment of active rheumatoid arthritis patients as the research object in the division of Rheumatology at the First Affiliated Hospital of Anhui TCM university.The use of Office 2010,the complex network technology and IBM Clementine 14.2 SPSS Apriori software module for Chinese medicine core prescription analysis,frequency statistics,association rule analysis.Results:a total of 4 000 copies of medical records and 3 643 prescriptions of traditional Chinese medicine were included in the study,the main results are as follows:(1) the clinical medication can be divided into jianpihuashi drugs,Huoxue Huayu drugs,dispelling dampness and heat drugs in four categories,more than 60％ times the frequency of tuckahoe,liquorice,tangerine peel,coix seed,Salvia miltiorrhiza the kernel,safflower,Chinese yam,clematis root,peach kernel,core prescription:tuckahoe,liquorice,tangerine peel,Salvia miltiorrhiza,coix seed,safflower,Chinese yam,clematis root,peach kernel,dandelion;(2) drug association analysis:Poria and Oldenlandia,dandelion,Herba Siegesbeckiae,peach kernel,Chinese medicine jianpihuashi the compatibility of blood stasis,dispelling dampness and heat drugs for 20 drug combinations;(3) compare the index difference between the two groups before and after treatment,the experimental group Hs-CRP,RF,ESR,IgA,IgG and C3 compared with the control group decreased significantly after treatment,the difference was statistically significant (P＜0.05 or P＜0.01);(4) the analysis of drug and two indicators of Relevance:Jiang Banxia,Herba Siegesbeckiae and Hs-CRP,ESR decreased the incidence is higher,white atractylodes rhizome,Salvia miltiorrhiza and RF reduce the high degree of relevance,yam,dandelion and C3 to reduce the high degree of relevance,Du Zhonghe,IGA,IGG and Honghua Weilingxian to reduce the high correlation.Analysis of the three Association:Jiang Banxia,Herba Siegesbeckiae respectively with Hs-CRP,ESR,dandelion,walnuts and reduce the high degree of relevance,astragalus,salvia,licorice and RF reduce the high degree of relevance,yam,dandelion,Herba Siegesbeckiae and C3 reduce the high degree of relevance,malt,dandelion,Radix Clematidis and IGA to reduce the high degree of relevance,eucommia,safflower,licorice and IGG reduce high correlation.Conclusion:This study on the treatment of rheumatoid arthritis from the real world to the spleen,spleen wet medicine as the core,and the compatibility between blood stasis,antipyretic,rheumatism medicine prescription is the key,which can effectively improve the patients' immune inflammation and other laboratory indexes.