In traditional Chinese medicine,jaundice is a liver and gallbladder disorder,primarily characterized by yellowing of the eyes,skin,and urine,with ocular yellowing being the most prominent feature.The understanding of jaundice pathogenesis in traditional Chinese medicine can be traced back to the Inner Canon of Huangdi.Despite the continuous development and improvement of successive generations of medical practitioners and a rich theoretical understanding of its pathogenesis being formed by the end of the Qing Dynasty,no unified view exists on whether the core pathological factor was dampness or blood stasis,nor on whether the primary disease location lay in the spleen and stomach or the liver and gallbladder.This article re-examines historical perspectives on jaundice pathogenesis within the context of traditional Chinese medicine theory,focusing on two key issues:pathological factors and the location of Zang and Fu.By integrating modern research approaches based on compound pathogenesis theory,and considering pathological factors,disease location according to Zang and Fu,and disease progression,a theoretical model is reconstructed,centered on the intermingling of dampness and blood stasis and integration of liver and spleen.Additionally,the insights and therapeutic strategies of multiple renowned clinical hepatology experts are incorporated to enrich the theoretical framework for jaundice treatment in traditional Chinese medicine and to enhance clinical efficacy.

In traditional Chinese medicine,jaundice is a liver and gallbladder disorder,primarily characterized by yellowing of the eyes,skin,and urine,with ocular yellowing being the most prominent feature.The understanding of jaundice pathogenesis in traditional Chinese medicine can be traced back to the Inner Canon of Huangdi.Despite the continuous development and improvement of successive generations of medical practitioners and a rich theoretical understanding of its pathogenesis being formed by the end of the Qing Dynasty,no unified view exists on whether the core pathological factor was dampness or blood stasis,nor on whether the primary disease location lay in the spleen and stomach or the liver and gallbladder.This article re-examines historical perspectives on jaundice pathogenesis within the context of traditional Chinese medicine theory,focusing on two key issues:pathological factors and the location of Zang and Fu.By integrating modern research approaches based on compound pathogenesis theory,and considering pathological factors,disease location according to Zang and Fu,and disease progression,a theoretical model is reconstructed,centered on the intermingling of dampness and blood stasis and integration of liver and spleen.Additionally,the insights and therapeutic strategies of multiple renowned clinical hepatology experts are incorporated to enrich the theoretical framework for jaundice treatment in traditional Chinese medicine and to enhance clinical efficacy.

Objective To investigate the effect of oxaliplatin on the activation of hepatic stellate cells(HSCs),as well as the association of oxaliplatin with microRNA-30a-5p and autophagy.Methods HSC-LX2 cells were cultured and divided into groups according to the following three protocols:control group,PDGF treatment group,oxaliplatin treatment group,oxaliplatin+PDGF treatment group;control group,microRNA-30a-5p transfection group,PDGF treatment group,microRNA-30a-5p transfection+PDGF treatment group;control group,3-MA group,microRNA-30a-5p inhibitor group,microRNA-30a-5p inhibitor+3-MA group.Western Blot was used to measure the expression of HSC activation-related proteins(Collagen-I and alpha-smooth muscle actin[α-SMA])and HSC autophagy-related proteins(Beclin-1,P62,and LC3B);LysoTracker staining and immunofluorescence assay were used to measure the expression of LC3B autophagosomes;RT-PCR was used to measure the expression level of microRNA-30a-5p;bioinformatics techniques were used to predict the potential targets of microRNA-30a-5p in HSCs.The independent-samples t test was used for comparison of normally distributed continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups.Results After the cells were treated with oxaliplatin,RT-PCR results showed that the oxaliplatin treatment group had a significantly higher expression level of microRNA-30a-5p than the control group(P＜0.01);Western Blot showed that the oxaliplatin treatment group had significant reductions in the expression levels of the HSC activation-related proteins α-SMA and Collagen-Ⅰ and the autophagy-related proteins Beclin 1 and LC3BⅡ/Ⅰ(all P＜0.001);immunofluorescence assay showed that the oxaliplatin treatment group had a significantly lower number of autophagosomes than the control group(P＜0.05).After HSC-LX2 cells were transfected with microRNA-30a-5p mimic,compared with the control group,the microRNA-30a-5p mimic group had significant reductions in the expression levels of the autophagy-related proteins Beclin 1 and LC3BⅡ/Ⅰ(P＜0.05)and the HSC activation-related protein Collagen-Ⅰ(P＜0.001);after HSC-LX2 cells were transfected with microRNA-30a-5p inhibitor,Western Blot showed that compared with the control group,the microRNA-30a-5p inhibitor group had significant increases in the expression levels of the HSC activation-related proteins Collagen-Ⅰ and α-SMA and the autophagy-related protein Beclin 1(t=2.41,2.32,and 4.57,all P＜0.05).Western Blot showed that compared with the control group,the microRNA-30a-5p inhibitor group had significant increases in the expression levels of the HSC autophagy-related protein Beclin 1 and the HSC activation-related protein α-SMA(both P＜0.05),and after the treatment with the autophagy inhibitor 3-MA,there were no significant differences in the expression of these proteins between the two groups(P＞0.05).The bioinformatics analysis using TargetScan,PicTar,and miRanda databases showed that the autophagy-related protein Beclin-1 might be a potential target of miRNA-30a-5p.Conclusion Oxaliplatin can inhibit the activation of HSCs by upregulating the expression of microRNA-30a-5p,which provides new ideas and a new target for the treatment of liver fibrosis.

Objective To investigate the temporal properties of dynamic functional connectivity of brain networks and the variability of network topology in patients with end-stage renal disease(ESRD).Methods Data of 30 ESRD patients(ESRD group)and 33 healthy subjects(control group)were retrospectively analyzed.Based on cranial resting-state functional MRI(rs-fMRI),dynamic functional connectivity(dFC)and graph theory analysis were employed,and the abnormalities in network topology and dFC in ESRD patients were assessed through comparison of groups.Pearson correlation analysis was used to observe the correlation between abnormal dFC indicators and clinical variables.Results Compared with control group,temporal scores and the mean residence time in ESRD group were significantly higher under state Ⅱ but significantly lower under state Ⅲ(both P＜0.05).The abnormal functional connectivity in ESRD patients under states Ⅱ and Ⅲ distributed mainly within and between default mode network,sensorimotor network,subcortical nuclei,execution and attention network,visual network and cerebellum networks.Network density and bilateral superior temporal gyrus nodal degrees in ESRD group were all significantly lower than those in control group(all P＜0.05).No significant correlation was found between the abnormal parameters of functional connectivity and graph theory attributes in ESRD group and clinical indicators under states Ⅱ nor Ⅲ(all P＞0.05).Conclusion ESRD patients had abnormal temporal attributes and network topology of brain dynamic networks related to cognitive impairments.

Objective To investigate the risk factors for spontaneous bacterial peritonitis (SBP) in patients with cirrhotic ascites, and to establish a new model for predicting the development of SBP. Methods A total of 215 patients who were diagnosed with cirrhotic ascites in Hebei General Hospital from September 2016 to September 2020 were enrolled, and according to the presence or absence of SBP, they were divided into SBP group with 55 patients and non-SBP group with 160 patients. Related clinical data were collected and albumin-bilirubin (ALBI) score, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and Child-Pugh score were calculated. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to screen out independent risk factors, and the receiver operating characteristic (ROC) curve was plotted to evaluate the performance of ALBI score, procalcitonin (PCT), polymorphonuclear neutrophil (PMN) count in ascites, and the ALBI-PMN-PCT combined model in the diagnosis of SBP. Results Compared with the SBP group, the non-SBP group had a significantly higher concentration of Na + ( Z =-3.414, P =0.001) and significantly lower total bilirubin ( Z =-2.720, P =0.007), creatinine ( Z =-1.994, P =0.046), urea nitrogen ( Z =-2.440, P =0.015), C-reactive protein ( Z =-9.137, P < 0.001), PCT ( Z =-8.096, P < 0.001), prothrombin time ( Z =-1.969, P =0.049), international normalized ratio ( Z =-2.073, P =0.038), PMN ( Z =-8.292, P < 0.001), MELD score ( Z =-2.736, P =0.006), MELD-Na score ( Z =-3.188, P =0.001), Child-Pugh score ( Z =-3.419, P =0.001), and ALBI score ( t =-5.010, P < 0.001), and there were also significant differences between the two groups in the presence or absence of gastrointestinal bleeding or hepatic encephalopathy ( χ 2 =16.551 and 8.142, P < 0.001 and P =0.004). The multivariate logistic regression analysis showed that ALBI score (odds ratio [ OR ]=3.460, 95% confidence interval [ CI ]: 1.296-9.240, P =0.013), PMN ( OR =1.012, 95% CI : 1.007-1.017, P < 0.001), and PCT ( OR =6.019, 95% CI : 2.821-12.843, P < 0.001) were independent risk factors for SBP in patients with cirrhotic ascites. The ROC curve showed that ALBI, PCT, PMN, and ALBI-PMN-PCT had areas under the ROC curve of 0.711, 0.866, 0.875, and 0.934, respectively, in the diagnosis of SBP, with sensitivities of 50.91%, 73.36%, 72.73%, and 89.09%, respectively, and specificities of 86.87%, 81.25%, 100.00%, and 91.87%, respectively. The patients with ALBI-PMN-PCT > 0.272 had an increased risk of developing SBP. Conclusion The ALBI-PMN-PCT combined model has a high value in predicting the onset of SBP in patients with cirrhotic ascites.

Objective To explore the value of dynamic contrast-enhanced (DCE).MRI in the early diagnosis of brucellosis spondylitis.Methods Fifty-six patients (24 female and 32 male) with Brucellosis with average age of (49± 3)years were retrospectively analyzed.Inclusion criteria:The patients with clinically diagnosed brinell coli spondylitis,drops of serum agglutination test degree 1:100＞(++),Hu＞red plate agglutination test (+ +),enzyme-linked immunosorbent assay to detect specific antibody IgG/IgM (+).Exclusion criteria:Pregnant and lactating women,patients with MRI examination contraindications and spinal tuberculosis,myeloma or other spinal disease,patients with the cervical,thoracic and lumbar 5 vertebral body involvement.The patients were classified into early lesion group and lesion group.Early lesion group was defined as low back pain less than a month,enzyme-linked immunosorbent assay positive IgM and negative IgG results,and no abnormality in conventional MR imaging,while lesion group was defined as low back pain for longer than 3 months,enzyme-linked immunosorbent assay positive IgG and negative IgM and marked lesion in conventional MR imaging.All the patients conducted with conventional MRI and DCE-MRI scan.The differences of the Ktrans,Kep,Ve and Vp between the vertebral lesions,early lesions of vertebral body and normal tissues were measured and compared.Results The values of Ktrans,Kep,Ve and Vp were significantly different between the vertebral lesions [(0.856±0.539) ml/min,(1.482±0.711) ml/min,0.542±0.267,0.034±0.017] and normal tissues [(0.315±0.298) ml/min,(0.713±0.548) ml/min,0.358±0.259,0.056±0.03](all P＜0.05).The values of Ktrans,Kep and Vp were significantly different between the early lesions of vertebral body and normal tissues (all P＜0.05),while no difference was found for Ve between the two groups (P＞0.05).Conclusion DCE-MRI quantitative analysis plays a role in the early diagnosis of the brucella spondylitis.

Objective To quantitatively analyze brucellar spondylitis, tuberculous spondylitis and spinal metastatic tumors by dynamic contrast-enhanced (DCE)-MRI, and to evaluate the quantitative DCE-MRI in the differential diagnosis of brucellar spondylitis, tuberculous spondylitis and spinal metastatic tumors. Methods This was a retrospective study including 30 patients with brucellar spondylitis, 30 with tuberculous spondylitis, and 30 with spinal metastatic tumors. The clinical and demographic data were collected. All patients received routine MRI and DCE-MRI examinations. Volume transfer constant(Ktrans), rate constant(Kep), extravascular extracellular volume fraction(Ve) and plasma volume fraction(Vp) of diseased vertebral bodies of the patients with brucellar spondylitis, tuberculous spondylitis and spinal metastatic tumors were measured on perfusion parameter maps. All indexes showed non-normal distribution. Differences of all indexes were compared and analyzed statistically with rank-sum test among the above diseases. Results For brucellosis spondylitis, spinal tuberculosis, and vertebrae metastasis, the values of Ktrans were(0.716 ± 0.017),(0.316 ± 0.004),(0.986 ± 0.012)min-1, the values of Kep were(1.326 ± 0.018), (0.747 ± 0.005),(2.899 ± 0.054)min-1, the values of Ve were 0.541 ± 0.011, 0.427 ± 0.017, 0.338 ± 0.007 and the values of Vp were 0.034 ± 0.003, 0.029 ± 0.003, 0.049 ± 0.007. The differences suggested statistical significance(H=50.24, 52.49, 48.31, 46.54, P<0.01) among the three diseases. Conclusion DCE-MRI quantitative analysis is helpful in the differential diagnosis of brucellar spondylitis, tuberculous spondylitis and spinal metastatic tumors.

Here we reported a research project based on Black-board to integrate medical curriculum .The key points of this research is application of clinical cases as teaching data and facilitate learning of knowledge following the principle of learning by doing and , input the concept of precision medicine and informatics in learning process with an individually designed framework of learning .The learning outcome is evaluated with big data tech-nology and thus creates a student-centered pathway of medical education .

BACKGROUND:Low power microwave irradiation has been shown to promote the healing of fractures with internal fixation;however, its action mechanisms on the skeletal muscle around the fracture site are unclear. OBJECTIVE:To study the effects of low power microwave irradiation (20 W) on the proliferation ability of skeletal muscle satel ite cel s in a rabbit model of femoral fracture with internal fixation. METHODS:Forty male New Zealand rabbits were used to establish femoral fracture fol owed by internal fixation models, and then were equal y randomized into spontaneous recovery and microwave treatment groups. Low power microwave irradiation (20 W) was given for 30 consecutive days in the microwave treatment group on day 4 after modeling, while no microwave irradiation was given in the spontaneous recovery group. Rabbit thigh muscles adjacent to the implant were obtained to isolate skeletal muscle satel ite cel s. Immunohistochemical staining, hematoxylin-eosin staining and quantitative RT-PCR were used to evaluate the ability of the proliferation and differentiation of skeletal muscle satel ite cel s. RESULTS AND CONCLUSON:Hematoxylin-eosin staining showed that there was no significant difference in the morphology and histology of skeletal muscle tissues between the spontaneous recovery and microwave treatment groups. However, the relative mRNA expression of MyoG in the cultured skeletal muscle satel ite cel s in vitro and the number ofα-sarcometric actin-postive cel s in the microwave treatment group were significantly increased compared with the spontaneous recovery group (P<0.05). The proliferative ability of skeletal muscle satel ite cel s was inhibited at the early stage, but not at the later stage. Our results suggest that low power microwave irradiation (20 W) can promote the proliferation and differentiation of skeletal muscle satel ite cel s around the implant in a rabbit model of femoral fracture with internal fixation, and thereby confirm the efficacy and safety of low power microwave irradiation for the internal fixation of fractures.

Objective To clarify the relationship between tumor necrosis factor alpha (TNF-α) and leptin in nonalcoholic fatty liver disease.Methods The real-time quantitative PCR (q-PCR) and enzymelinked immunosorbent adsorption experiment(ELISA) were used to detect the expression and correlation of TNFα and leptin in blood cells and serum from the normal group, non-alcoholic simple fatty liver(NAFL) group, nonalcoholic steatohepatitis (NASH) group and cirrhosis group.Results At the level of mRNA, the transcription of TNF-α in cirrhosis group was 14.03 times, 12.07 times and 11.05 times of the normal group, NAFL group and NASH group,and the difference was significant(P＜0.05).Leptin transcription of cirrhosis group was 1.95 times,0.79 times and 1.45 times of normal group, NAFL group and of NASH group(P＞0.05).And in the cirrhosis group, the expression of TNF-α was 7.52 times higher than Leptin (P＜ 0.01).In expression level of protein,TNF-α and leptin in cirrhosis group was 1.98 times and 2.39 times higher than the normal group, 1.24 times and 1.30 times higher than the NAFL group, 1.27 times and 1.37 times higher than NASH, and the difference was significant(P＜0.05).Moreover the expression of TNF-α was significantly higher than that of Leptinin groups above(P＜0.01).Conclusion TNF-α and Leptin are less expression in lymphocytes, but more expression in serum.And TNF-α and Leptin affect the evolution of NAFLD, and present a positive correlation, which lead to the occurrence of NAFLD.Comparing the two methods, detection of serum is more sensitive and more suitable for clinical study than lymphocyte.