Hepatic encephalopathy （HE） is a common complication of severe liver disease in the end stage， and it is urgently needed to improve the rate of effective treatment and clarify the pathogenesis of HE. The liver is a crucial hub for immune regulation， and disruption of immune homeostasis is a key factor in the pathological mechanisms of HE. As the main metabolites of intestinal flora， short-chain fatty acids （SCFAs） play a vital role in the biological processes of both innate and adaptive immunity and can regulate the proliferation and differentiation of immune cells maintain the homeostasis of intestinal microenvironment and the integrity of barrier function. Studies have shown that SCFAs participate in bidirectional and dynamic interactions with the liver-gut-brain axis through immunomodulatory pathways， thereby playing an important role in the diagnosis， treatment， and prognostic evaluation of HE. Starting from the immunoregulatory effect of SCFAs， this article summarizes and analyzes the crosstalk relationship between SCFAs and the liver-gut-brain axis and the significance of SCFAs in the diagnosis and treatment of HE， in order to provide new ideas for optimizing clinical prevention and treatment strategies.

AIM: To investigate the effect of the relationship between scotopic pupil and optical zone diameters on short-term subjective and objective visual quality after small incision lenticule extraction(SMILE).METHODS:In this prospective cohort study, 98 patients(196 eyes)who underwent SMILE from September 2021 to June 2023 were included. Participants were divided into two groups based on the ratio of scotopic pupil diameter to optical zone diameter: group A(ratio >1, 70 eyes)and group B(ratio ≤1, 126 eyes). The preoperative and postoperative uncorrected visual acuity(UCVA), spherical equivalent(SE), total corneal high-order aberrations at 4, 6, and 8 mm of pupil diameters, objective scatter index(OSI), pre- and post-operative QoV subjective visual quality questionnaire were observed and recorded. The refractive status of different groups of patients at different time points before and after surgery, and differences in subjective and objective visual quality indices were analyzed. Furthermore, the changes in subjective and objective visual quality(postoperative-preoperative)at different postoperative time points were analyzed between the two groups.RESULTS:No significant differences in visual acuity or refractive state were observed between the two groups at 3 mo postoperatively. In both the group A and the group B, there was a difference in the changes of corneal total higher-order aberration centered on 8 mm cornea at 1 mo postoperatively(P<0.05), and there was a difference in the changes of total higher-order aberration and corneal spherical aberration centered on 8 mm cornea at 3 mo postoperatively(all P<0.05). At 3 mo after surgery, the most commonly reported symptoms in the group A were glare, starburst, hazy vision, and halo. In the group B, the most common symptoms were hazy vision, halo, starburst, and glare. Statistically significant differences were observed in the severity of glare and visual fluctuation between groups before surgery and at 3 mo postoperatively(all P<0.05). However, no significant differences were found in the severity of halo, starburst, blurred vision, double vision, or focusing difficulty at 3 mo postoperatively(all P>0.05).CONCLUSION:When the scotopic pupil diameter exceeds the optical zone, SMILE may increase postoperative corneal aberrations, as evidenced by an increase in high-order corneal aberrations within an 8-mm central corneal range, a higher incidence of postoperative glare, and more severe glare and visual fluctuation symptoms. Nevertheless, these symptoms are mild and remain within a safe range.

Nuclear factor-kappa B （NF-κB） is an important intracellular transcription factor widely involved in the processes such as immune response， inflammatory response， cell proliferation， and apoptosis. The abnormal activation of the NF-κB signaling pathway plays a pivotal role in various liver diseases including chronic hepatitis， liver fibrosis， liver cirrhosis， and hepatocellular carcinoma. Extensive studies have shown that inhibiting NF-κB activity may effectively reduce inflammation and fibrosis and improve metabolic disorders. Several natural compounds， such as matrine and salvianolic acid B， have shown the potential in suppressing NF-κB activity， thereby exerting anti-inflammatory， anti-fibrotic， and anti-tumor effects. This article systematically reviews the critical role of the NF-κB signaling pathway in liver diseases and its potential as a therapeutic target， in order to highlight its potential as a therapeutic target for liver diseases and provide new directions for the treatment of liver diseases.

OBJECTIVE: To provide the experience and demonstration for the transformation of acupuncture-moxibustion techniques standards from Chinese national standards to international standards. METHODS: Questionnaire research, literature research, semi-structured interviews and expert consultation were used. RESULTS: The safety of acupuncture-moxibustion techniques was evaluated through literature research, and based on the results of the questionnaire survey, expert interviews, and expert consultation, 11 main bodies and structure of the former Chinese national standard, Technical Benchmark of Acupuncture and Moxibustion: General Rules for Drafting, were adjusted and optimized in accordance with the requirements of international standard (including the language, normative references, purpose, scope, applicable environment, target population, work team, terms and definitions, general principles and basic requirements, structural elements and text structure, and compilation process); and the first international standard, World Federation of Acupuncture-Moxibustion Societis (WFAS) Technical Benchmark of Acupuncture and Moxibustion: General Rules for Drafting was formulated to specify the general rules for drafting. CONCLUSION The 3 key questions, "international compatibility", "technical operability" and "safety" should be solved technically on the basis of explicit international requirements. It is the core technical issue during transforming the national standards of technical benchmark of acupuncture and moxibustion into international standards.
Moxibustion/methods* ; Acupuncture Therapy/methods* ; Humans ; Translational Research, Biomedical/standards* ; Surveys and Questionnaires ; China ; Benchmarking/standards*

OBJECTIVES: To investigate the therapeutic mechanism of Wendan Decoction for phlegm syndrome in rats with metabolic syndrome (MS). METHODS: Forty Wistar rats were randomly divided into normal control group (n=8) and 3 phlegm syndrome model groups (induced by high-fat, high-sugar, and high-salt feeding and a single-dose intraperitoneal STZ injection; n=24) treated with daily gavage of saline, Wendan Decoction (3.6 g/kg), or metformin (0.1 g/kg) for 4 weeks. General conditions and glucose and lipid metabolism parameters of the rats were monitored, and serum LPS, liver histopathology, hepatic expressions of FXR, CYP7A1 and FGFR4 and ileal expressions of FXR and FGF15 were examined. Gut microbiota structure was analyzed using 16S rDNA sequencing, and serum bile acids were quantified with UHPLC-MS/MS. RESULTS: The rat models of phlegm syndrome exhibited severe hepatic steatosis and necrosis, increased body weight, abdominal circumference, Lee's index, FBG, FINS, HOMA-IR, TG, TC, LDL and LPS, and decreased HDL level. The abundance of Bacteroidetes, Megamonas, and Bacteroides in gut microbiota increased while Firmicutes, Lachnospiraceae_NK4A136_group, isohyodeoxycholic acid, and glycohyodeoxycholic acid decreased significantly; hepatic FXR and FGFR4 expressions and ileal FXR and FGF15 expressions decreased while hepatic CYP7A1 expression increased significantly in the rat models. Treatment with Wendan Decoction effectively alleviated hepatic pathology, reduced body weight and abdominal circumference, improved glucose and lipid metabolic profiles and gut microbiota structure, and reversed the changes in hepatic and ileal protein expressions. Correlation analysis revealed that Firmicutes and Lachnospiraceae_NK4A136_group were positively correlated while Bacteroidetes, Megamonas and Bacteroides were negative correlated with the levels of isohyodeoxycholic acid and hyodeoxycholic acid. CONCLUSIONS Wendan Decoction can significantly improve metabolic profiles in rats with phlegm syndrome of MS possibly by regulating the intestinal flora-bile acid axis to modulate the intestinal flora structure and maintain bile acid homeostasis via the FXR signaling pathway.
Animals ; Gastrointestinal Microbiome/drug effects* ; Metabolic Syndrome/microbiology* ; Bile Acids and Salts/metabolism* ; Rats, Wistar ; Drugs, Chinese Herbal/therapeutic use* ; Rats ; Male ; Fibroblast Growth Factors/metabolism* ; Liver/metabolism* ; Cholesterol 7-alpha-Hydroxylase/metabolism* ; Receptors, Cytoplasmic and Nuclear/metabolism*

Objective To analyze the predictive value of patient-reported outcomes(PRO)com-bined with hematological indicators for moderate-to-severe endoscopic activity in patients with ulcera-tive colitis(UC).Methods Clinical data of UC patients were retrospectively collected,including PRO,hematological parameters and endoscopic findings.Based on the Mayo endoscopic score,pa-tients were divided into remission and mild activity group(＜2 points)and moderate-to-severe activity group(≥ 2 points).Independent influencing factors for moderate-to-severe endoscopic activity were screened through multivariate Logistic regression analysis,and a binary Logistic regression model was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the discriminato-ry ability of the predictive model.The calibration of the model was assessed using calibration curves and the Spiegelhalter Z-test,and the model's performance was further validated in an external valida-tion cohort.Results Rectal bleeding(RB),C-reactive protein/albumin(CAR)and erythrocyte sed-imentation rate(ESR)were independent influencing factors for moderate-to-severe endoscopic activity(P＜0.05).The area under the curve(AUC)of the nomogram predictive model constructed based on the logistic regression analysis results was 0.848(95％CI,0.798 to 0.900),with sensitivity of 76.6％and specificity of 79.6％.In the external validation cohort,the model's AUC was 0.778(95％CI,0.699 to 0.857),and there was no statistically significant difference compared with the AUC of the training cohort model(P＞0.05).In both the training and validation cohorts,the Spiegelhalter Z-test results indicated that the model had good goodness-of-fit(P＞0.05).Conclu-sion RB,CAR and ESR are independent influencing factors for moderate-to-severe endoscopic ac-tivity in UC patients.The combination of RB,CAR and ESR has high predictive value for moderate-to-severe endoscopic activity in UC patients,with good discriminatory and calibration abilities.

Objective To investigate the therapeutic mechanism of Wendan Decoction for phlegm syndrome in rats with metabolic syndrome(MS).Methods Forty Wistar rats were randomly divided into normal control group(n=8)and 3 phlegm syndrome model groups(induced by high-fat,high-sugar,and high-salt feeding and a single-dose intraperitoneal STZ injection;n=24)treated with daily gavage of saline,Wendan Decoction(3.6 g/kg),or metformin(0.1 g/kg)for 4 weeks.General conditions and glucose and lipid metabolism parameters of the rats were monitored,and serum LPS,liver histopathology,hepatic expressions of FXR,CYP7A1 and FGFR4 and ileal expressions of FXR and FGF15 were examined.Gut microbiota structure was analyzed using 16S rDNA sequencing,and serum bile acids were quantified with UHPLC-MS/MS.Results The rat models of phlegm syndrome exhibited severe hepatic steatosis and necrosis,increased body weight,abdominal circumference,Lee's index,FBG,FINS,HOMA-IR,TG,TC,LDL and LPS,and decreased HDL level.The abundance of Bacteroidetes,Megamonas,and Bacteroides in gut microbiota increased while Firmicutes,Lachnospiraceae_NK4A136_group,isohyodeoxycholic acid,and glycohyodeoxycholic acid decreased significantly;hepatic FXR and FGFR4 expressions and ileal FXR and FGF15 expressions decreased while hepatic CYP7A1 expression increased significantly in the rat models.Treatment with Wendan Decoction effectively alleviated hepatic pathology,reduced body weight and abdominal circumference,improved glucose and lipid metabolic profiles and gut microbiota structure,and reversed the changes in hepatic and ileal protein expressions.Correlation analysis revealed that Firmicutes and Lachnospiraceae_NK4A136_group were positively correlated while Bacteroidetes,Megamonas and Bacteroides were negative correlated with the levels of isohyodeoxycholic acid and hyodeoxycholic acid.Conclusion Wendan Decoction can significantly improve metabolic profiles in rats with phlegm syndrome of MS possibly by regulating the intestinal flora-bile acid axis to modulate the intestinal flora structure and maintain bile acid homeostasis via the FXR signaling pathway.

Hepatic encephalopathy(HE)is a common complication of severe liver disease in the end stage,and it is urgently needed to improve the rate of effective treatment and clarify the pathogenesis of HE.The liver is a crucial hub for immune regulation,and disruption of immune homeostasis is a key factor in the pathological mechanisms of HE.As the main metabolites of intestinal flora,short-chain fatty acids(SCFAs)play a vital role in the biological processes of both innate and adaptive immunity and can regulate the proliferation and differentiation of immune cells maintain the homeostasis of intestinal microenvironment and the integrity of barrier function.Studies have shown that SCFAs participate in bidirectional and dynamic interactions with the liver-gut-brain axis through immunomodulatory pathways,thereby playing an important role in the diagnosis,treatment,and prognostic evaluation of HE.Starting from the immunoregulatory effect of SCFAs,this article summarizes and analyzes the crosstalk relationship between SCFAs and the liver-gut-brain axis and the significance of SCFAs in the diagnosis and treatment of HE,in order to provide new ideas for optimizing clinical prevention and treatment strategies.

In vivo confocal microscopy of the cornea is a non-invasive, rapid, and comprehensive technique for real-time, dynamic observation of all layers of the cornea. Confocal microscopy allows the examination of the morphology and cell density in the different layers of the cornea through direct visualization. With the increasing prevalence of diabetes, ocular complications have become common and have garnered more interest and in-depth research from clinical and scientific communities. This paper provides a comprehensive review of research progress made using in vivo confocal microscopy to observe various layers of cornea tissue in diabetic patients.

Objective To study the mechanism of Sanhuang Decotion in the treatment of ulcerative colitis(UC)under Candida albicans colonization in mice based on Dectin-1-Syk-CARD9 signaling pathway.Methods Mice model of UC with fungal colonization were established with dextran sodium sulfate free drinking and C.albicans intragastric administration.Mice were divided into normal control group,model group,sulfasalazine group,fluconazole group,and Sanhuang Decotion low-and high-dosage groups,and receive corresponding drug interventions.General state of mice were observed,and the disease activity index(DAI)score of mice were calculated.The load of C.albicans in intestine was detected,the length of the colon was measured,and pathological scoring of the colon tissue was performed.The ultrastructural changes of colon epithelium were observed under transmission electron microscopy.The contents of TNF-α,IL-6 and IL-12 in serum and colon tissues were detected by ELISA.The mRNA and protein expression of Dectin-1,Syk,CARD9,NF-κBp65 and inflammation factors in intestinal epithelial cells and colon tissues were detected by qPCR,Western blot and immunohistochemistry.Results Compared with the normal control group,the model group mice showed reduced activity,decreased food intake,accompanied by loose stools,significantly increased DAI score,increased load of C.albicans in the intestine,shortened colon length,and increased histopathological score,with widening of gap between colon epithelial cells,cytoplasmic dissolution,mitochondrial swelling;TNF-α,IL-6 and IL-12 in serum and colon tissue increased,the expressions of Dectin-1 and CARD9 mRNA and protein in colon epithelial cells increased,p-Syk,p-NF-κBp65,CARD9,TNF-α,IL-1β,IL-6 protein expression in colon tissue increased(P<0.01,P<0.05).Compared with the model group,the Sanhuang Decotion high-dosage group mice showed a significant decrease in DAI score,decreased intestinal C.albicans load,increased colon length,decreased histopathological score,more complete and orderly arrangement of microvilli in colon epithelial cells,mild mitochondrial swelling,TNF-α,IL-6 and IL-12 in serum and colon tissue decreased,and the mRNA and protein expression of Dectin-1 and CARD9 in colon tissue increased,the expression of p-Syk,p-NF-κBp65,CARD9,TNF-α,IL-1β,IL-6 protein in colon tissue decreased(P<0.01,P<0.05).Conclusion Sanhuang Decotion may exert an anti C.albicans colonization UC effect by inhibiting the Dectin-1-Syk-CARD9 signaling pathway and reducing the release of inflammatory factors.