Hepatic fibrosis is a chronic pathological condition characterized by hepatic stellate cell activation and excessive deposition of extracellular matrix， which would progress to liver cirrhosis and even hepatocellular carcinoma. Therefore， reversal of hepatic fibrosis is of great importance for improving quality of life and prolonging survival time. Currently， various therapeutic drugs for hepatic fibrosis have entered the stage of clinical trial. This article reviews the research advances in therapeutic drugs for hepatic fibrosis in the recent years， in order to provide insights into the treatment of hepatic fibrosis and future research directions for drugs.

OBJECTIVE To extract and isolate the four chemical components of Yao medicine Ventilago leiocarpa， and to conduct identification and content determination for them. METHODS The chemical components of V. leiocarpa were separated and purified by solvent extraction， extraction， silica gel column chromatography and preparative liquid chromatography； then the chemical structures of four isolated compounds were identified based on their spectral data. The contents of four components were determined by high performance liquid chromatography（HPLC）-quantitative analysis of multi-components by single-marker （QAMS） method， with the following chromatographic conditions： chromatographic column was Echway GowonTM C18 （250 mm× 4.6 mm， 5 μm）. The mobile phase was acetonitrile-0.1% phosphoric acid for gradient elution； the detection wavelength was 269 nm， and the column temperature was 25 ℃ . Using emodin as internal reference， the relative correction factors （fi/s） between emodin and the other 3 components were established and used to calculate the content. At the same time， the content of each component was calculated with the external standard method （ESM）， and the differences between these two methods were compared. RESULTS Four compounds were isolated from V. leiocarpa， and they were identified as emodin， frangulin A， pleuropyrone A， emodin-8-O-β-D-glucoside. The result of HPLC-QAMS showed that the fi/s of pleuropyrone A， emodin-8-O-β-D- glucoside and frangulin A were 1.147 2， 0.874 7 and 0.644 4， respectively. The content of these four components was measured as a good linearity （r≥0.999 6）； relative standard deviation （RSD） of precision， stability and reproducibility tests were all lower than 2.00%， and average recoveries were E-mail：dearhuangjianyou@126.com 99.41%-100.46%（RSD≤2.05%）. There was no significant difference between QAMS method and ESM （RSD＜3.00%）. CONCLUSIONS Emodin， frangulin A， pleuropyrone A and emodin- 8-O-β-D-glucoside are isolated from V. leiocarpa； among them， the last three components are all isolated from for the first time. The established HPLC-QAMS method is accurate and reliable for the determination of 4 components in V. leiocarpa， and can used for quality control of V. leiocarpa.

Objective:To investigate the efficacy and value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy.Methods:A total of 150 older adult patients with liver cancer, who underwent laparoscopic hepatectomy at The 2 nd Affiliated Hospital of Wenzhou Medical University between July 2019 and April 2020, were randomly assigned to two groups: a control group ( n = 75) and an observation group ( n = 75) using the random number table method. The control group received postoperative analgesia with parecoxib sodium, while the observation group received preemptive analgesia with parecoxib sodium. A comparative analysis was conducted between the control and observation groups in terms of the Numerical Rating Scale (NRS) scores at 8, 12, and 24 hours postoperatively, postoperative recovery, length of hospital stay, and overall cost. Results:There were no statistically significant differences in operation time, dosage of Sufentanil 24 hours postoperatively, or the total and effective usage counts of patient-controlled intravenous analgesia with Sufentanil between the control and observation groups (both P > 0.05). However, the NRS scores of the observation group were significantly lower than those of the control group at 8, 12, and 24 hours postoperatively. Specifically, the NRS scores of the observation group were (4.38 ± 1.24) points, (3.41 ± 0.19) points, and (2.90 ± 0.17) points, respectively, while those of the control group were (5.24 ± 1.01) points, (4.65 ± 1.24) points, and (3.32 ± 1.00) points, respectively ( t = 4.66, 8.56, 3.59, all P < 0.001). Patients in the observation group exhibited significantly more frequent off-bed activities [(2.62 ± 1.24) times], a notably longer cumulative duration of off-bed activities [(1.36 ± 0.20) hours], and a significantly shorter duration of first anal exhaust [(13.50 ± 1.27) hours] compared with those in the control group [(1.06 ± 0.12) times, (0.36 ± 0.09) hours, (20.10 ± 2.16) hours, t = -10.84, -39.49, 22.81, all P < 0.001]. Furthermore, the observation group demonstrated a shorter postoperative hospital stay [(8.90 ± 1.34) days], lower hospitalization costs [(55.8 ± 2.1) thousand yuan], and higher patient satisfaction scores [(88.98 ± 5.64) points] compared with the control group [(11.15 ± 1.29) days, (59.4 ± 6.2) thousand yuan, (72.16 ± 3.26) points, t = 10.48, 4.76, -22.36, all P < 0.001]. Conclusion:The implementation of preemptive analgesia intervention among older adult patients undergoing laparoscopic hepatectomy effectively enhances analgesic outcomes, accelerates postoperative recovery, reduces hospitalization duration, and markedly decreases hospitalization costs.

Objective The tissue motion mitral annular displacement(TMAD)technique was used to evaluate left ventricular longitudinal systolic function in patients with hyperthyroidism,and its correlation with myocardial damage was analyzed.Methods Sixty-nine cases of hyperthyroidism diagnosed in Affiliated Hospital of Youjiang Medical University for Nationalities from July 2021 to November 2022 were selected as the study objects.According to whether the patients were combined with hyperthyroidism heart disease,they were divided into simple hyperthyroidism group(n=43)and thyrotoxic heart group(n=26).35 healthy people who underwent physical examination in our hospital during the same period were selected as normal control group.Three-dimensional echocardiography was used to obtain the left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF)and TMAD parameters.The differences of above parameters among all groups were compared,and the correlations of TMAD parameters with creatine kinase isoenzymes(CK-MB)and high-sensitivity cardiac troponin T(hs-cTnT)were analyzed.Results The LVEDV,LVESV,LVEF,TMAD parameters,CK-MB and hs-cTnT of three groups were statistically significant(P<0.001),and LVEDV,LVESV,CK-MB and hs-cTnT of normal control groupsimple hyperthyroidism group>thyrotoxic heart group.All parameters of TMAD were positively correlated with LVEF(P<0.001),and some parameters of TMAD were negatively correlated with CK-MB(P<0.05).Conclusion TMAD technology can early evaluate left ventricular longitudinal systolic function in patients with hyperthyroidism,and is related to CK-MB and hs-cTnT.

Objective:Peritoneal free cancer cells can negatively impact disease progression and patient outcomes in gastric cancer.This study aimed to investigate the feasibility of using golden-angle radial sampling dynamic contrast-enhanced magnetic resonance imaging(GRASP DCE-MRI)to predict the presence of peritoneal free cancer cells in gastric cancer patients.Methods:All enrolled patients were consecutively divided into analysis and validation groups.Preoperative magnetic resonance imaging(MRI)scans and perfusion were performed in patients with gastric cancer undergoing surgery,and peritoneal lavage specimens were collected for examination.Based on the peritoneal lavage cytology(PLC)results,patients were divided into negative and positive lavage fluid groups.The data collected included clinical and MR information.A nomogram prediction model was constructed to predict the positive rate of peritoneal lavage fluid,and the validity of the model was verified based on data from the verification group.Results:There was no statistical difference between the proportion of PLC-positive cases predicted by GRASP DCE-MR and the actual PLC test.MR tumor stage,tumor thickness,and perfusion parameter Tofts-Ketty model volume transfer constant(Ktrans)were independent predictors of positive peritoneal lavage fluid.The nomogram model featured a concordance index(C-index)of 0.785 and 0.742 for the modeling and validation groups,respectively.Conclusions:GRASP DCE-MR could effectively predict peritoneal free cancer cells in gastric cancer patients.The nomogram model constructed using these predictors may help clinicians to better predict the risk of peritoneal free cancer cells being present in gastric cancer patients.

Objective To explore the nutritional status and immune function of hospitalized patients with decompensated cirrhosis.Methods A total of 132 patients with decompensated cirrhosis who were hospi-talized in this hospital from January 2020 to June 2022 were selected.According to Nutritional Risk Screening 2002 (NRS2002) score,the patients were divided into the high-nutritional-risk group,the low-nutritional-risk group,and the non-nutritional-risk group.Comparative analysis was conducted on nutritional status indica-tors,cellular immune indicators,Child-Pugh classification of liver function,and complications among the three groups.Results BMI,TSF,AMC,Hb,ALB,PA,RBP and TG in the high-nutritional-risk group and low-nu-tritional-risk group were lower than those in the non-nutritional-risk group.BMI,TSF,and AMC in the low-nutritional-risk group were lower than those in the non-nutritional-risk group.ALB and TG in the high-nutri-tional-risk group were lower than those in the low-nutritional-risk group,with statistically significant differ-ences (P<0.05).The immune indexes IgG and IgA in the high-nutritional-risk group and the low-nutritional-risk group were higher than those in the non-nutritional-risk group,with statistically significant differences (P<0.05).The percentage of CD4+T cells and the ratio of CD4+T cells to CD8+T cells (CD4+T/CD8+T) in the high-nutritional-risk group and the low-nutritional-risk group were lower than those in the non-nutrition-al-risk group,with statistically significant differences (P<0.05).The NRS2002 score was negatively correla-ted with BMI,TSF,AMC,Hb,ALB,PA,RBP,TC,TG,CD4+T,CD4+T/CD8+T (P<0.05).It was positive-ly correlated with IgG,IgA,IgM (P<0.001).Multivariate stepwise regression analysis showed that there was a linear regression relationship between Hb,TSF,AMC,ALB,RBP,and NRS2002 score.Conclusion The nu-tritional status and immune function of patients with high nutritional risk decompensated cirrhosis are poor.It is necessary to carry out nutritional intervention in patients with high nutritional risk decompensated cirrhosis in time.

Objective:To evaluate the clinical efficacy and safety of endoscopic ultrasound (EUS)-guided coil implantation combined with glue injection for preventing rebleeding of tumorous gastric fundal varices.Methods:A retrospective analysis was performed on the clinical data of patients who underwent EUS-guided coil implantation combined with glue injection due to tumorous gastric fundal variceal bleeding from September 2017 to December 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The basic characteristics and endoscopic manifestations of patients treated with this technique were analyzed, and the success rate of this technique, the usage of tissue glue and coil, the variceal obliteration rate and the incidence of complications such as pulmonary embolism were analyzed. Patients were followed up over a long period of time to obtain data on rebleeding. At the same time, patients were divided into complete obliteration group and incomplete obliteration group according to the endoscopic performance after the treatment, and the rebleeding rate in the two groups was compared.Results:Among the 41 patients included in this study, 18 cases (43.90%) had single isolated gastric varices type 1, and 23 cases (56.10%) had gastroesophageal varices combined. Fourteen cases had signs of recent bleeding such as thrombi and ulcers under endoscopy, and 13 cases had combined portal hypertensive gastropathy. All patients successfully completed the operation of EUS-guided coil implantation combined with glue injection. The technical success rate for the first attempt was 92.68% (38/41). The one-time pre-installation success rate of coils was 95.12% (39/41). The success rate of target vessel aspiration under EUS guidance was 100.00% (41/41). The release success rate of coil was 97.56% (40/41). The number of coils used was 1.12±0.33, and the amount of tissue glue used after inserting the coils was 1.54±0.46 mL. The target vessel obliteration rate after operation was 97.56% (40/41), and the complete gastric fundal variceal obliteration rate was 51.22% (21/41). There were 2 cases (4.88%) of intraoperative bleeding, 1 case stopped spontaneously, and 1 case successfully stopped bleeding after additional injection of tissue glue under direct endoscopic vision. No patient had symptoms of pulmonary embolism such as decreased oxygen saturation during the operation. Postoperative computed tomography angiography of pulmonary artery or lung computed tomography was performed in 24 cases, of which 1 case (4.17%) showed distal pulmonary artery embolism, but there were no relevant clinical manifestations. The patients were followed up for 21.64±16.86 months (1-50 months) after the surgery. There were 13 cases (31.71%) of recurrent gastrointestinal bleeding after the surgery, no rebleeding within 5 days, 2 cases of rebleeding within 3 months, 5 cases from 3 to 12 months, and 6 cases more than 1 year. Among the 13 cases of recurrent bleeding after the surgery, the recurrence rate of bleeding after operation in the complete obliteration group was 23.81% (5/21), which was lower than that in the incomplete obliteration group with 40.00% (8/20), but there was no statistically significant difference ( χ2=1.240, P=0.265). Conclusion:EUS-guided coil implantation combined with glue injection has good secondary prevention value and safety for tumorous gastric fundal variceal bleeding, and is worthy of clinical promotion and application.

Objective:To explore the effect of Zhuyu Xiaozhong Decoction combined with warm acupuncture and moxibustion on rotator cuff injury of qi stagnation and blood stasis type.Methods:A total of 120 patients with rotator cuff injury of qi stagnation and blood stasis type treated at the First Hospital of Hunan University of Chinese Medicine from October 2021 to October 2023 were randomly divided into a control group ( n=60) and an observation group ( n=60) according to the random drawing method. The control group received routine treatment, while the observation group received Zhuyu Xiaozhong Decoction combined with warming acupuncture and moxibustion on this basis. Two groups of treatment effects were compared, including total effective rate, inflammation indicators, pain status, shoulder joint function and range of motion, and quality of life. Visual Analog Scale (VAS), Shoulder Joint Function Rating Scale (CMS), and Quality of Life Comprehensive Assessment Questionnaire (GQOLI-74) were used to evaluate patients′ pain status, shoulder joint function, and quality of life, respectively. Results:After treatment, the total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05); Before treatment, there was no statistically significant difference in the levels of serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) between the two groups (all P>0.05); After treatment, the levels of serum CRP, IL-6, and TNF-α in both groups were lower than before treatment, and the levels of serum CRP, IL-6, and TNF-α in the observation group were lower than those in the control group after treatment (all P<0.05). Before treatment, there was no statistically significant difference in VAS scores and GQOLI-74 total scores between the two groups (all P>0.05); After treatment, the VAS scores of both groups were lower than before treatment, and the total GQOLI-74 score was higher than before treatment. In addition, the VAS score of the observation group was lower than that of the control group after treatment, and the total GQOLI-74 score was higher than that of the control group, with statistical significance (all P<0.05). Before treatment, there was no statistically significant difference in CMS scores, abduction, flexion, and extension angles between the two groups (all P>0.05); After treatment, the CMS scores of both groups were higher than before treatment, and the angles of abduction, flexion, and extension were greater than before treatment. The CMS scores of the observation group were higher than those of the control group after treatment, and the angles of abduction, flexion, and extension were greater than those of the control group, with statistical significance (all P<0.05). Conclusions:Zhuyu Xiaozhong Decoction combined with warm acupuncture and moxibustion can achieve a better clinical effect in the treatment of rotator cuff injury of qi stagnation and blood stasis type, which can control the inflammatory reaction of the body, alleviate pain symptoms, improve shoulder joint function and mobility, and optimize the quality of life.

Objective:Exploring the performance characteristics of spontaneous nystagmus（SN） in video-head impulse test（vHIT） and its possible effects on saccade. Methods:Vestibular function tests such as vHIT and SN were conducted in 48 patients with acute unilateral vestibulopathy（AUVP）. The saccade characteristics of vHIT in patients without SN and those with SN were analyzed, as well as the expression characteristics of SN in vHIT. Results:Among the 48 AUVP patients, there were 34 cases with SN, including 31 cases with saccade on the healthy side, 11 cases with both the same and opposite directions of eye movement, 19 with the opposite only, 1 with same direction only, and 3 cases without saccade. There were 14 patients without SN, of whom 10 showed saccade on the healthy side, including 4 with both eye movements in the same and opposite direction, 2 in the opposite direction only, 4 in the same direction only, and 4 without saccade. There is a correlation between reverse saccade on the healthy side and the presence of SN in patients. SN in vHIT can appear opposite to the direction of eye movement on the healthy side, while on the affected side it can appear the same as the direction of eye movement and may cause more discrete overt saccade. 32 patients in the acute phase（≤2 w）, 29 patients with SN, SN intensity of（6.7 ± 3.2） °/s, and 3 patients without SN. 16 cases in non acute phase（>2 w）, 5 cases with SN, SN intensity of（3.7 ± 2.1） °/s, and 11 cases without SN. In the acute phase there were 30 cases of saccade on the healthy side, 10 cases with both the same and opposite direction of eye movement, 18 cases with only the opposite direction, 2 cases with only the same direction and 2 cases without saccade. There is a correlation between the duration of the disease and the occurrence of reverse saccade on the healthy side. The intensity cut off point of SN for reverse saccade is 2.1 °/s in the healthy lateral semicircular canal vHIT. Conclusion:Compensatory saccades and SN waves with similar waveforms are mostly present in vHIT in AUVP patients. SN wave is in the opposite direction of the normal side and eye movement wave, and the affected side and dominant saccade direction are in the same direction and mixed together, which can affect the dispersion and amplitude of overt saccade in vHIT. Accurate identification of SN in vHIT of AUVP patients is not only the key factor to identify compensatory saccade, but also can provide help for the diagnosis and compensatory assessment of AUVP.
Humans ; Head Impulse Test/methods* ; Nystagmus, Pathologic/physiopathology* ; Saccades/physiology* ; Male ; Female ; Vestibular Diseases/physiopathology* ; Middle Aged ; Adult ; Eye Movements/physiology* ; Aged

The aim of this study was to compare the immune responses of C57BL/6 mice immunized with two pathogens, foot-and-mouth disease virus (FMDV) and Senecavirus A (SVA), and to provide clues for revealing the regulatory mechanisms of acquired immunity. Inactivated and purified FMDV and SVA antigens were used to immunize C57BL/6 mice respectively, and the mice immunized with PBS were taken as the control. The percentages of Th1 and Th2 cells in the spleen lymphocytes of mice in each group were analyzed by flow cytometry at 14 and 28 days after immunization. RNA-Seq was performed for the spleen. Mouse macrophages were stimulated with the antigens in vitro to examine the expression of the differentially expressed genes (DEGs) screened out. The results showed that 14 days after immunization, there was no significant difference in the magnitude of the Th1/Th2 immune response elicited by the FMDV and SVA antigens. After 28 days, the magnitudes of the Th1 and Th2 immune responses elicited by the SVA antigen were higher than those elicited by the FMDV antigen. RNA-Seq revealed two common DEGs, Rsad2 and Tspan8, between the two immunization groups, which indicated that the two genes may be involved in the activation of the Th1/Th2 immune responses by FMDV and SVA antigens. FMDV and SVA antigens stimulated macrophages to secrete interleukin (IL)-12 and IL-33 in vitro, and the expression of Tspan8 and Rsad2 was consistent with the RNA-Seq results. The expression of Rsad2 was regulated by type I interferons (IFNα, IFNβ). In this study, we obtained the DEGs involved in the immune responses to the two antigens in mouse spleen, which provides a molecular basis for investigating the immune response mechanisms induced by FMDV and SVA.
Animals ; Foot-and-Mouth Disease Virus/genetics* ; Mice ; Spleen/cytology* ; Mice, Inbred C57BL ; Antigens, Viral/genetics* ; Transcriptome ; Th1 Cells/immunology* ; Immunization ; Viral Vaccines/immunology* ; Th2 Cells/immunology* ; Foot-and-Mouth Disease/immunology* ; Interleukin-33/genetics* ; Female ; Macrophages/immunology* ; Picornaviridae