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.

OBJECTIVE To evaluate the efficacy， safety， and cost-effectiveness of posaconazole for the prevention of invasive fungal infections （IFIs）. METHODS PubMed， Embase， CNKI， Wanfang data and other Chinese and English databases were searched， as well as the official websites of related health technology assessment （HTA）. Systematic review （SR）/meta-analysis， pharmacoeconomic studies， and HTA reports of posaconazole for the prevention of IFIs were collected. The retrieval time limit was from the establishment of the database to November 1， 2025. After screening the literature， extracting the data， and evaluating the quality of the literature， the results of the included studies were descriptively analyzed. RESULTS A total of 45 studies were included， involving 17 SR/meta-analyses， 26 pharmacoeconomic studies， 1 SR/meta-analysis combined with a pharmacoeconomic study， and 1 HTA report. In terms of effectiveness， posaconazole was significantly superior to other antifungal drugs （eg.， fluconazole， itraconazole） in reducing the incidence of IFIs， the incidence of invasive aspergillosis， all-cause mortality， and IFI-related mortality （ P ＜0.05）. In terms of safety， posaconazole was significantly superior to other antifungal drugs in the incidence of total adverse reactions （ P ＜0.05）， but there was no significant difference in the incidence of serious adverse reactions， the incidence of gastrointestinal advers e reactions， drug-induced liver injury， and the withdrawal rate due to adverse drug reactions （ P ＞0.05）. In terms of cost-effectiveness， most studies have shown that posaconazole possesses more cost-effectiveness advantages. CONCLUSIONS Posaconazole demonstrates favorable efficacy， safety， and cost-effectiveness in preventing IFIs.

OBJECTIVE To evaluate the efficacy and safety of cholesterol absorption inhibitors （ezetimibe and hybutimibe） combined with statins for the treatment of dyslipidemia. METHODS Randomized controlled trials （RCTs） about above-mentioned drug combination in patients with dyslipidemia were retrieved from CNKI，PubMed and other Chinese and English databases. The retrieval time limit was from the establishment of the database to October 2025. After screening the literature，extracting the data，and evaluating the quality of the literature，network meta-analysis was performed using R software. RESULTS A total of 36 RCTs were included. Results showed that in reducing low-density lipoprotein cholesterol （LDL-C） and total cholesterol （TC）， ezetimibe+statins and hybutimibe+statins were significantly superior to statins+placebo and placebo alone （ P ＜0.05）. The top two interventions according to surface under the cumulative ranking curve （SUCRA） rankings were both ezetimibe+statins and hybutimibe+statins. In terms of triglyceride （TG） lowering， both hybutimibe+statins and ezetimibe+statins were significantly better than statins alone， statins+placebo and placebo alone （ P ＜0.05）， with hybutimibe+statins and ezetimibe+statins ranking top two by SUCRA. For apolipoprotein B （ApoB） reduction， ezetimibe+statins was significantly superior to statins alone and placebo alone （ P ＜0.05）， and the top two SUCRA rankings were ezetim ibe+statins and statins+placebo. In terms of high-density lipoprotein cholesterol （HDL-C） increase， placebo was significantly better than statins alone， hybutimibe+statins， statins+placebo， and ezetimibe+statins （ P ＜0.05）， and the top two SUCRA rankings were placebo alone and statins alone.There was no statistically significant difference in the overall incidence of adverse reactions among the interventions （ P ＞0.05）. CONCLUSIONS Ezetimibe combined with statins shows significant advantages in reducing LDL-C， TC and ApoB， while the hybutimibe combined with statins may have potential advantages in lowering TG； both combination regimens have good safety.

OBJECTIVE To explore the potential mechanism of Cigu Xiaozhi Prescription(CGXP)in the treatment of non-alco-holic steatohepatitis(NASH)liver fibrosis.METHODS A NASH mouse model was established.The degree of liver enlargement was evaluated by calculating the liver index.Hematoxylin-eosin(HE)and Masson staining were used to observe the degree of liver fibro-sis.In addition,immunohistochemistry was employed to detect the expression of liver fibrosis-related proteins,including α-SMA,Collagen 1,MMP2,and MMP9.Western blot and qPCR techniques were used to detect the expression levels of HIF-1α,E-cadher-in,N-cadherin,Shh,Smo,Gli1,and Gli2 in the mouse liver.The alkaline hydrolysis method was used to measure the content of liv-er hydroxyproline.RESULTS CGXP could effectively reduce the liver index(P<0.001),alleviate liver enlargement and inflamma-tion,and significantly improve the pathological damage of liver tissue in mice with liver fibrosis.CGXP significantly decreased the ex-pression levels of liver fibrosis-related proteins α-SMA,Collagen 1,MMP2 and MMP9(P<0.01,P<0.000 1);reduced the levels of HIF-1α,E-cadherin,N-cadherin,Shh,Smo,Gli1,and Gli2,and the therapeutic effect of high-dose CGXP was particularly significant(P<0.05,P<0.01,P<0.001,P<0.000 1).CONCLUSION CGXP can relieve NASH liver fibrosis in mice by reducing the liver index,alleviating inflammation,and improving tissue pathological damage.The mechanism may be related to the inhibition of the Hedgehog signaling pathway,which alters the activation and proliferation of hepatic stellate cells and reduces the synthesis and dep-osition of extracellular matrix.

Objective:To analyze the clinical characteristics of acute leukemia complicated with arterial ischemic stroke (AIS) in children, and to provide a reference for its diagnosis, treatment, and prognosis.Methods:Case summary.This report presents three children with acute leukemia complicated with AIS admitted to the First Affiliated Hospital of Zhengzhou University from April 2015 to August 2024, and reviews the relevant literature at home and abroad to analyze the clinical characteristics, pathogenesis, and treatment of the disease.Results:All three cases were female, aged 4-14 years; two had acute lymphoblastic leukemia (ALL) and one had acute myeloid leukemia (AML). Hemiparesis was the main presenting symptom in all cases, occurring during induction therapy.Symptoms resolved completely after anticoagulant and symptomatic treatment, with no sequelae and good prognoses.A literature search identified 8 reported cases of pediatric acute leukemia complicated with AIS.Combining these with our 3 cases yielded a total of 11 cases: 5 males and 6 females; median age 7 years (range 2-15 years); 8 with ALL and 3 with AML.Clinically, all presented with hemiparesis.Vascular imaging in 6 patients showed involvement of the middle cerebral artery.In 8 cases of ALL complicated with AIS, the event occurred during induction therapy, which was considered associated with the use of Asparaginase and intrathecal Cytarabine.Anticoagulation was the main treatment.Symptoms resolved in 10 cases, 3 had neurologic sequelae, and 1 died.Conclusions:AIS complicating acute leukemia in children is often the first clinical manifestation of hemiparesis, which mainly occurs in the process of induction therapy, and may be related to the adverse reactions of chemotherapy drugs such as hypercoagulable state of the blood caused by mendonuclease and insufficient cerebral perfusion caused by intrathecal injection of Cytarabine, etc.; once hemiplegic neurological symptoms appear in the process of induction therapy of children′s acute leukemia, it is highly suspicious of the concomitant AIS, and earlycranial magnetic resonance examination can help to clarify the diagnosis.Although most symptoms resolve with treatment, some patients may develop neurological sequelae.

Out-of-hospital cardiac arrest is one of the leading causes of death in China.The elderly are currently at high risk of cardiac arrest,and the most effective first aid measure is out-of-hospital cardiopulmonary resuscitation before the arrival of emergency medical services.The first witnesses outside the hospital are usually the spouses of elderly people who have not received cardiopulmonary resuscitation training.The survey shows that the knowledge and behaviors related to cardiopulmonary resuscitation of the elderly are at a medium and low level.How to improve the knowledge level and effective implementation rate of cardiopulmonary resuscitation among the elderly is an urgent problem to be solved.The theory of knowledge,attitudeand practice is widely used in health intervention of diseases and is also a commonly used theoretical model in disease education.Only by mastering scientific disease-related knowledge,establishing a positive attitude and enhancing the willingness to perform cardiopulmonary resuscitation,can the rescue rate be effectively improved.Therefore,this paper analyzes and summarizes the current situation and influencing factors of cardiopulmonary resuscitation among the elderly at home and abroad in recent years,and provides intervention measures.This article aims to provide a reference for the formulation of cardiopulmonary resuscitation health education and intervention programs for the elderly,so as to improve the level of cardiopulmonary resuscitation among the elderly.

Objective:To analyze the iodine nutrition status and its related factors among adults aged 18 years and above in Zhejiang Province in 2022.Methods:A multistage stratified sampling method was used to select 4 320 adults aged 18 years and above from 16 on-site survey sites in Zhejiang Province for the study. A questionnaire was used to investigate the general demographic information and personal dietary characteristics of the study participants. Household edible salt and urine samples were collected to detect salt iodine content and urinary iodine level by using direct titration and cerium arsenate-catalyzed spectrophotometry, respectively, to evaluate the iodine nutritional status according to the standard. The multiple-ordered logistic regression model was used to analyze the factors influencing the urinary iodine concentration.Results:The age of the 4 320 study participants was (51.19±15.33) years, with males accounting for 44.44% (1 920). About 40.16% of adults (1 735) were from coastal areas and 56.37% (2 435) from urban areas. The salt iodine content, M ( Q1, Q3), of the 4 320 household edible salt samples was 21.10 (0.00, 24.16) mg/kg, including 1 662 non-iodized salt samples, 182 unqualified iodized salt samples and 2 476 qualified iodized salt samples. The rate of iodized salt coverage was 61.53%, and the rate of qualified iodized salt consumption was 57.31%. There was a statistically significant difference in the proportion of qualified iodized salt in adult households among different regions ( P<0.001), with the proportion of non-iodized salt gradually decreasing from coastal to inland areas ( χ 2trend=618.458, P<0.001). The urinary iodine concentration M ( Q1, Q3) was 137.60 (86.85, 210.60) μg/L in 4 320 adult urine samples, with the urinary iodine levels of<100, 100-199, 200-299, and≥300 μg/L accounting for 31.64% (1 367), 40.56% (1 752), 17.66% (763), and 10.14% (438), respectively. There was a nonlinear positive correlation between household salt iodine content and urinary iodine level in adults aged 18 years and above by using the χ 2 test for trend ( χ 2regression=231.10, P<0.001 and χ 2skew=28.81, P<0.001). Urinary iodine concentrations were higher in men than in women ( P=0.029) and higher in adults in rural areas than in urban areas ( P<0.001). There were statistically significant differences in the distribution of iodine nutritional status among adults of different ages, regions, and urban and rural areas (all P<0.001). The proportion of those with urinary iodine levels<100 μg/L gradually increased with age ( χ 2trend=37.493, P<0.001), and gradually decreased from coastal areas to inland areas ( χ 2trend=71.381, P<0.001). The results of the multiple-ordered logistic regression model analysis showed that compared with adults aged 18 to 44 years and male adults, those aged 45 to 59 years and female adults had lower urinary iodine levels, with OR (95% CI) of 0.75 (0.68-0.83) and 0.85 (0.76-0.95), respectively. Compared with adults in coastal and urban adults, those in sub-coastal, inland and rural adults had higher levels of urinary iodine, with OR (95% CI) of 1.89 (1.63-2.19), 2.02 (1.72-2.37) and 1.46 (1.28-1.66), respectively. Conclusion:The overall iodine nutrition level of adults aged 18 years and above in Zhejiang Province in 2022 is generally appropriate. However, there is a potential risk of iodine deficiency among adults in coastal areas.

Objective:To investigate the iodine nutrition status of pregnant women in Zhejiang Province, explore the impact of salt industry system reform on iodine nutrition level of pregnant women, and provide scientific basis for prevention and treatment of iodine deficiency disorders.Methods:From 2016 to 2021, a multi-stage stratified sampling method was used to select 100 pregnant women from 90 counties (cities, districts) in Zhejiang Province each year as survey subjects. Salt samples were collected from pregnant women's families, and one random urine sample was taken for salt iodine and urinary iodine level testing, respectively.Results:A total of 56 581 samples of household edible salt were collected from pregnant women, with a median salt iodine level of 23.20 mg/kg. Among them, 7 961 were non iodized salt, 45 803 were qualified iodized salt, and 2 817 were unqualified iodized salt. The iodized salt coverage rate was 85.93% (48 620/56 581), and the qualified iodized salt consumption rate was 80.95% (45 803/56 581). The proportion of non iodized salt increased from 10.05% (897/8 928) in 2016 to 15.09% (1 461/9 679) in 2021 (χ 2trend = 95.16, P < 0.001). A total of 56 581 urine samples were collected from pregnant women, with a median urinary iodine level of 130.50 μg/L. Among them, the proportions of urinary iodine levels < 150, 150 - 249, 250 - 499, and ≥500 μg/L were 58.32% (32 996/56 581), 27.24% (15 410/56 581), 12.24% (6 926/56 581), and 2.21% (1 249/56 581), respectively. The median urinary iodine level of pregnant women in inland areas was significantly higher than that in coastal areas ( Z = 19.15, P < 0.001). Furthermore, urinary iodine levels exhibited a non-linear decline as age increased (χ 2regression = 12.65, P < 0.001; χ 2partial = 22.65, P < 0.001) and as pregnancy progressed (χ 2regression = 37.28, P < 0.001; χ 2partial = 18.89, P < 0.001). Conclusions:The overall iodine nutrition status of pregnant women in Zhejiang Province is in a state of iodine deficiency (< 150 μg/L), and there is a greater risk in coastal areas compared to inland areas. However, in the context of the reform of the salt industry system, it is still necessary to strengthen the quality supervision of iodized salt, provide scientific iodine supplementation education, promote specialized iodized salt for pregnant women, and strengthen interventions for prevention and control of iodine deficiency disorders.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

Objective:To measure the radial artery (RA) diameter and explore its related factors by using optical coherence tomography (OCT).Methods:This was a cross-sectional study conducted in Cardiac Care Unit of Beijing Luhe Hospital, Capital Medical University. Patients who underwent first-ever right forearm access and OCT guided coronary intervention via right distal RA, and measurement of the whole portion of RA diameter with OCT in our center between January 2021 to December 2021 were enrolled. Following the coronary intervention, OCT was used to assess the entire RA. The RA diameter was measured from the RA ostium to 2 cm above the radial styloid process, with a 1 mm interval. Multiple linear regression analysis was performed to determine the factors related the RA diameter.Results:The study enrolled 124 patients with an age of (61.6±12.6) years, of whom 98 (79%) were male. The total length of the RA was (19.5±1.8) cm, for males (20.2±1.3) cm and females (17.2±1.2) cm. The average RA diameter was (3.13±0.50) mm, and the RA diameter at 2 to 5 cm above the radial styloid process was (2.98±0.53) mm. The average RA diameter was significantly larger for male patients than for female patients ((3.21±0.50) mm vs. (2.84±0.37) mm, P<0.001). Multiple linear regression analysis indicated that gender was significantly associated with RA diameter ( P=0.019). Conclusions:The average RA diameter measured by OCT is (3.13±0.50) mm, (2.98±0.53) mm at 2 to 5 cm above the radial styloid process. Gender is identified as a factor related to the RA diameter.