Non-alcoholic fatty liver disease(NAFLD)is a metabolic disease characterized by abnormal deposition of lipid in hepatocytes.If not intervened in time,NAFLD may develop into liver fibrosis or liver cancer,and ultimately threatening life.NAFLD has complicated etiology and pathogenesis,and there are no effective therapeutic means and specific drugs.Currently,insulin sensitizers,lipid-lowering agents and hep-atoprotective agents are often used for clinical intervention,but these drugs have obvious side effects,and their effectiveness and safety need to be further confirmed.Adenosine monophosphate(AMP)-activated protein kinase(AMPK)plays a central role in maintaining energy homeostasis.Activated AMPK can enhance lipid degradation,alleviate insulin resistance(IR),suppress oxidative stress and inflammatory response,and regulate autophagy,thereby alleviating NAFLD.Natural herbal medicines have received extensive attention recently because of their regulatory effects on AMPK and low side effects.In this article,we reviewed the biologically active natural herbal medicines(such as natural herbal medicine formulas,extracts,polysaccharides,and monomers)that reported in recent years to treat NAFLD via regulating AMPK,which can serve as a foundation for subsequent development of candidate drugs for NAFLD.

Non-alcoholic fatty liver disease (NAFLD) is a metabolic disease characterized by abnormal deposition of lipid in hepatocytes. If not intervened in time, NAFLD may develop into liver fibrosis or liver cancer, and ultimately threatening life. NAFLD has complicated etiology and pathogenesis, and there are no effective therapeutic means and specific drugs. Currently, insulin sensitizers, lipid-lowering agents and hepatoprotective agents are often used for clinical intervention, but these drugs have obvious side effects, and their effectiveness and safety need to be further confirmed. Adenosine monophosphate (AMP)-activated protein kinase (AMPK) plays a central role in maintaining energy homeostasis. Activated AMPK can enhance lipid degradation, alleviate insulin resistance (IR), suppress oxidative stress and inflammatory response, and regulate autophagy, thereby alleviating NAFLD. Natural herbal medicines have received extensive attention recently because of their regulatory effects on AMPK and low side effects. In this article, we reviewed the biologically active natural herbal medicines (such as natural herbal medicine formulas, extracts, polysaccharides, and monomers) that reported in recent years to treat NAFLD via regulating AMPK, which can serve as a foundation for subsequent development of candidate drugs for NAFLD.

Objective To investigate the therapeutic efficacy of artesunate(AS)on polycystic ovary syndrome(PCOS)in mice and explore the potential mechanism primarily.Methods Twenty-five female C57BL/6J mice were randomly divided into Control group,model group(PCOS group),low-and high-dose AS groups(AS15 and AS30 groups)and metformin group(Met group).In addition to the Control group,the mouse model of PCOS was established by subcutaneous injection of dehydroepiandrosterone(DHEA,60 mg/kg)following by a high-fat diet for 21 d.After modeling,AS of 15 and 30 mg/kg was intraperitoneally injected into the mice of the AS 15 and AS30 groups,respectively,and 200 mg/kg Met was given to those of the Met group by gavage,once per day,for 6 weeks.ELISA was used to detect serum testosterone(T),fasting insulin(FINS),luteinizing hormone(LH)and follicle-stimulating hormone(FSH),and the LH/FSH ratio was calculated.The levels of fasting blood glucose(FBG),triglyceride(TG)and total cholesterol(TC)were detected by automatic biochemical analyzer,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.The estrous cycle was observed,and HE staining was performed for pathological changes in the ovary and uterus.Immunofluorescence assay was employed to measure the expression of p-eIF2α,ATF4 and CHOP in the ovarian tissue.After steroidogenic human granulosa-like tumor cell line KGN were exposed to 100 μmol/L DHEA to simulate the hyperandrogen environment of PCOS,and then treated with 5 and 10 μg/mL AS for 24 h,the protein levels of endoplasmic reticulum stress signaling pathway was detected by Western blotting.Results Compared with the Control group,the PCOS mice had disturbed estrous cycle,polycystic changes in the ovaries,and significantly increased serum T level and LH/FSH ratio(P＜0.05),and obviously elevated HOMA-IR,TC and TG levels in terms of metabolism(P＜0.01).The expression levels of p-eIF2α,ATF4 and CHOP were notably up-regulated in the ovarian granulosa cells of PCOS mice and KGN cells after DHEA exposure(P＜0.05).Additionally,AS treatment attenuated the pathological changes of ovary and uterine expression,decreased the serum T level and the LH/FSH ratio(P＜0.05),and reduced HOMA-IR,TC and TG levels(P＜0.05)when compared with the PCOS mice.Moreover,the expression levels of p-eIF2α,ATF4 and CHOP were significantly down-regulated after AS treatment in both ovarian granulosa cells of PCOS mice and KGN cells(P＜0.05).Conclusion AS significantly improves glycolipid metabolic disorder and reproductive dysfunction in PCOS mice,which may be associated with its suppressing endoplasmic reticulum stress by inhibiting the PERK/eIF2α/ATF4/CHOP pathway.

Objective To investigate the role of p300 in lipid metabolism disorders.Methods Bioinformatics analysis was performed to analyze the expression patterns of p300 in lipid metabolism disorder-related diseases and its correlation with SREBP-1c and downstream lipid metabolic enzymes.Immunofluorescence assay was used to detect the expression of p300 in the liver tissues of the patients with varying disease severity of non-alcoholic fatty liver disease(NAFLD).A mouse model of lipid metabolism disorder was established in male C57BL/6J mice by feeding high-fat diet(HFD)for 12 weeks.Western blotting was employed to assess p300 expression level in the liver tissues of HFD-fed mice.A cell model of lipid metabolism disorder was established in HepG2/AML-12 cells induced with free fatty acid(FFA).The effects of siRNA-mediated knockdown of p300 was observed to measure the levels of intracellular total cholesterol(TC)and triglyceride(TG),lipid deposition,and production of reactive oxygen species(ROS).Results Clinically,p300 was highly expressed in lipid metabolism disorders,and its level was positively correlated with NAFLD severity(P<0.05).Gene Set Enrichment Analysis(GSEA)revealed that p300 expression was significantly associated with fatty acid metabolism,cholesterol homeostasis,lipogenesis,PPAR signaling pathway,and peroxisome pathway.In vivo,p300 was significantly up-regulated in the livers of HFD-fed mice(P<0.01).In vitro,FFA stimulation markedly increased p300 expression in both HepG2 and AML-12 cells(P<0.01),whereas p300 knockdown significantly reduced intracellular TG and TC levels(P<0.01),attenuated lipid droplet accumulation,and reversed FFA-induced ROS elevation(P<0.01).Furthermore,p300 expression was positively correlated with the expression of SREBP-1c and its downstream key lipid synthesis enzymes.Conclusion p300 may promote hepatic lipid accumulation by acetylating and activating SREBP-1c and regulating downstream lipid metabolic enzymes,thereby affecting lipid synthesis and oxidative stress.These findings suggest that p300 may be a potential therapeutic target for lipid metabolism disorder-related diseases.

Objective To investigate the effect of Eriodictyol(ERI)on the development of metabolic dysfunction-associated steatotic liver disease by regulating the expression of ubiquitin A 52(UBA52)at both in vivo and in vitro levels.Methods A mouse metabolic dysfunction-associated steatotic liver disease model was established using a high-fat diet induction.The mice were randomly separated into the normal control group(normal group),the model group,the low-dose ERI group(ERI-L group,50 mg/kg ERI)and the high-dose ERI group(ERI-H group,100 mg/kg ERI),with 12 mice in each group.Oil red O staining was applied to observe lipid deposition in mouse liver tissue.HE staining was applied to observe pathological changes in mouse liver tissue.ELISA method was applied to detect serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC)and triglycerides(TG)in mice.The expression of UBA52 protein in liver was detected by Western blot assay.HepG2 cells were treated with 0.5 mmol/L oleic acid to induce an in vitro metabolic dysfunction-associated steatotic liver disease model.HepG2 cells were randomly divide into the control group,the oleic acid induced group,the low concentration ERI group(ERI low group,50 μmol/L ERI),the high concentration ERI group(ERI high group,100 μmol/L ERI),the high concentration ERI+si-NC group(ERI high+si-NC group,100 μmol/L ERI+transfected with si-NC)and the high concentration ERI+si-UBA52 group(ERI high+si-UBA52 group,100 μmol/L ERI+transfected with si-UBA52).Oil red O staining was applied to detect lipid deposition in HepG2 cells of each group.ELISA method was applied to detect the levels of TG,TC,SOD and MDA in HepG2 cells in each group.Immunoblotting was used to detect the expression levels of UBA52,p62 and autophagy related proteins in HepG2 cells.Results Compared with the normal group,serum levels of ALT,AST,LDL-C,TC,TG and the expression of UBA52 protein in liver tissue were increased in the model group(P＜0.05),and the lipid deposition in liver increased,pathological damage was severe,and the proportion of lipid deposition area and non-alcoholic fatty liver disease(NAFLD)activity score were also increased(P＜0.05).Changes in the corresponding indicators in the ERI-L group and the ERI-H group were opposite to those of the model group(P＜0.05),and the ERI-H group was even lower(P＜0.05).The lipid deposition in liver decreased and the pathological damage was alleviated.Compared with the control group,the levels of TG,TC,MDA,the proportion of lipid droplet area and the expression of UBA52 protein were increased in HepG2 cells of the oleic acid-induced group,while the levels of SOD,p62 and LC3Ⅱ/LC3Ⅰ decreased(P＜0.05).Changes in the corresponding indicators of the low-concentration ERI group and the high-concentration ERI group were opposite to those of the oleic acid-induced group(P＜0.05),and the therapeutic effect of ERI on metabolic dysfuntion-associated steatotic liver disease was enhanced after knocking down the expression of UBA52.Conclusion ERI may slow down the progression of metabolic dysfuntion-associated steatotic liver disease by down-regulating the expression of UBA52 at both in vivo and in vitro levels.

With the advancement of education,teaching methods have been continuously improved and optimized to en-hance students'learning experiences.In teaching the course of pathophysiology,a core discipline for medical students,integra-tion of Case-Based Learning(CBL)with the flipped classroom model can serve as a powerful pedagogical tool by stimulating students'interest,promoting collaborative learning,enhancing teacher-student interaction,and fostering a more active and en-gaging classroom environment.It also equips students with the confidence to better address real-world medical scenarios.This pa-per examines the application effect of the integrated teaching method on the teaching of pathophysiology and evaluates its pedagog-ical effectiveness.

Objective To explore the feasibility and corresponding implementation methods of constructing a sample resource bank based on individual-level data of completed clinical trials and using it to construct external controls for drug/device clinical trials.Methods Taking the pre-marketing clinical trial of transcatheter active valve replacement(TAVR)for the treatment of aortic valve stenosis as an example,the individual-level databases of multiple trials were standardized to form a sample bank.The original data of any trial in the sample bank were selected as the experimental group,and the remaining samples were selected as the control group.The potential confounding was handled by using the propensity score matching and stratification methods to clarify the process of constructing external controls based on the sample bank of individual-level data of clinical trials.Results This study included individual-level data of single-group trials of 4 TAVR devices,with a total of 569 subjects(59.2%male).The number of subjects in Trials 1 to 4 was 120,120,163,and 166,respectively.Propensity score matching enabled the matching of 113,117,125,and 147 subjects with comparable or similar characteristics from individual-level data from other trials,respectively,demonstrating a high matching success rate.The PS score distribution plot after stratification showed that the proportions of subjects in the experimental and control groups in strata 1 to 5 in scheme 1 were 4/103,11/103,22/92,32/87,and 51/64,respectively.For all constructed external controlled trials,a certain number of control samples with similar baseline characteristics to the experimental groups were distributed within each propensity score stratum.The results of the simulation test also reflected the potential differences between different devices in the 12-month all-cause mortality rate.Conclusions The sample bank constructed with individual-level data from clinical trials,as a high-quality data source,can serve as a source of external control for single-arm trials in the same field,and as a useful supplement to the external control scenario of real-world evidence to support drug and device development.At the same time,targeted research on research methods and bias control measures in related fields is also needed.

Objective To investigate the effect of Eriodictyol(ERI)on the development of metabolic dysfunction-associated steatotic liver disease by regulating the expression of ubiquitin A 52(UBA52)at both in vivo and in vitro levels.Methods A mouse metabolic dysfunction-associated steatotic liver disease model was established using a high-fat diet induction.The mice were randomly separated into the normal control group(normal group),the model group,the low-dose ERI group(ERI-L group,50 mg/kg ERI)and the high-dose ERI group(ERI-H group,100 mg/kg ERI),with 12 mice in each group.Oil red O staining was applied to observe lipid deposition in mouse liver tissue.HE staining was applied to observe pathological changes in mouse liver tissue.ELISA method was applied to detect serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC)and triglycerides(TG)in mice.The expression of UBA52 protein in liver was detected by Western blot assay.HepG2 cells were treated with 0.5 mmol/L oleic acid to induce an in vitro metabolic dysfunction-associated steatotic liver disease model.HepG2 cells were randomly divide into the control group,the oleic acid induced group,the low concentration ERI group(ERI low group,50 μmol/L ERI),the high concentration ERI group(ERI high group,100 μmol/L ERI),the high concentration ERI+si-NC group(ERI high+si-NC group,100 μmol/L ERI+transfected with si-NC)and the high concentration ERI+si-UBA52 group(ERI high+si-UBA52 group,100 μmol/L ERI+transfected with si-UBA52).Oil red O staining was applied to detect lipid deposition in HepG2 cells of each group.ELISA method was applied to detect the levels of TG,TC,SOD and MDA in HepG2 cells in each group.Immunoblotting was used to detect the expression levels of UBA52,p62 and autophagy related proteins in HepG2 cells.Results Compared with the normal group,serum levels of ALT,AST,LDL-C,TC,TG and the expression of UBA52 protein in liver tissue were increased in the model group(P＜0.05),and the lipid deposition in liver increased,pathological damage was severe,and the proportion of lipid deposition area and non-alcoholic fatty liver disease(NAFLD)activity score were also increased(P＜0.05).Changes in the corresponding indicators in the ERI-L group and the ERI-H group were opposite to those of the model group(P＜0.05),and the ERI-H group was even lower(P＜0.05).The lipid deposition in liver decreased and the pathological damage was alleviated.Compared with the control group,the levels of TG,TC,MDA,the proportion of lipid droplet area and the expression of UBA52 protein were increased in HepG2 cells of the oleic acid-induced group,while the levels of SOD,p62 and LC3Ⅱ/LC3Ⅰ decreased(P＜0.05).Changes in the corresponding indicators of the low-concentration ERI group and the high-concentration ERI group were opposite to those of the oleic acid-induced group(P＜0.05),and the therapeutic effect of ERI on metabolic dysfuntion-associated steatotic liver disease was enhanced after knocking down the expression of UBA52.Conclusion ERI may slow down the progression of metabolic dysfuntion-associated steatotic liver disease by down-regulating the expression of UBA52 at both in vivo and in vitro levels.

With the advancement of education,teaching methods have been continuously improved and optimized to en-hance students'learning experiences.In teaching the course of pathophysiology,a core discipline for medical students,integra-tion of Case-Based Learning(CBL)with the flipped classroom model can serve as a powerful pedagogical tool by stimulating students'interest,promoting collaborative learning,enhancing teacher-student interaction,and fostering a more active and en-gaging classroom environment.It also equips students with the confidence to better address real-world medical scenarios.This pa-per examines the application effect of the integrated teaching method on the teaching of pathophysiology and evaluates its pedagog-ical effectiveness.

Objective To explore the feasibility and corresponding implementation methods of constructing a sample resource bank based on individual-level data of completed clinical trials and using it to construct external controls for drug/device clinical trials.Methods Taking the pre-marketing clinical trial of transcatheter active valve replacement(TAVR)for the treatment of aortic valve stenosis as an example,the individual-level databases of multiple trials were standardized to form a sample bank.The original data of any trial in the sample bank were selected as the experimental group,and the remaining samples were selected as the control group.The potential confounding was handled by using the propensity score matching and stratification methods to clarify the process of constructing external controls based on the sample bank of individual-level data of clinical trials.Results This study included individual-level data of single-group trials of 4 TAVR devices,with a total of 569 subjects(59.2%male).The number of subjects in Trials 1 to 4 was 120,120,163,and 166,respectively.Propensity score matching enabled the matching of 113,117,125,and 147 subjects with comparable or similar characteristics from individual-level data from other trials,respectively,demonstrating a high matching success rate.The PS score distribution plot after stratification showed that the proportions of subjects in the experimental and control groups in strata 1 to 5 in scheme 1 were 4/103,11/103,22/92,32/87,and 51/64,respectively.For all constructed external controlled trials,a certain number of control samples with similar baseline characteristics to the experimental groups were distributed within each propensity score stratum.The results of the simulation test also reflected the potential differences between different devices in the 12-month all-cause mortality rate.Conclusions The sample bank constructed with individual-level data from clinical trials,as a high-quality data source,can serve as a source of external control for single-arm trials in the same field,and as a useful supplement to the external control scenario of real-world evidence to support drug and device development.At the same time,targeted research on research methods and bias control measures in related fields is also needed.