Hepatic fibrosis is a reversible pathological process in various chronic liver diseases and is closely associated with the development and progression of severe liver diseases such as liver cirrhosis and hepatocellular carcinoma， and it has emerged as a significant global health challenge. In recent years， studies have shown that histone lactylation， a newly discovered epigenetic modification， actively participates in regulating the progression of hepatic fibrosis. This article systematically reviews the core regulatory effect of histone lactylation modification in the interaction between inflammatory microenvironment and hepatic fibrosis， in order to clarify the cascade regulatory mechanism of “inflammation-hepatic fibrosis” and provide new insights for early diagnosis， targeted intervention， and prevention of malignant transformation in hepatic fibrosis.

To investigate the drug-resistance mutations and treatment of hospitalized children with Mycoplasma pneumoniae pneumonia (MPP) in Hunan Province. Children with pneumonia, who were hospitalized in the pediatric ward of the Second Xiangya Hospital of Central South University from January 1, 2023, to December 31, 2023, were enrolled in this study, and their clinical data was also collected. The targeted next-generation sequencing (tNGS) was used to detect Mycoplasma pneumoniae (MP) infection and drug-resistance mutations, and the drug-resistance and treatment in children with MPP were also analyzed. A total of 125 children with pneumonia were involved in this study, including 70 children in the MPP group and 55 children in the bacterial pneumonia group. The results showed that there were 41 boys and 29 girls with an average age of (6.50±3.45) years, with the most common group being the school-age group (age≥6 years). The clinical symptoms were characterized by fever and cough. Laboratory examination showed that the white blood cell and neutrophil counts in the MPP group were lower than those in the bacterial pneumonia group, while the lymphocyte ratio and hemoglobin levels in the MPP group were higher than those in the bacterial pneumonia group, with statistically significant differences (all P<0.05). Twelve children (17.14%) in the MPP group had severe pneumonia, and all children with severe pneumonia had 23Sr RNA A2063G and/or A2064G mutations. The tNGS detected 60 cases of MPP resistance gene mutations, including 59 cases (98.33%) of A2063G mutation in 23Sr RNA and one case (1.67%) of A2064G mutation in 23Sr RNA. There was a significant difference in the positive rate of drug-resistance mutations among patients of different age groups (χ 2=7.991, P=0.021). A total of 63 children (90.00%) with MPP were treated according to the results of drug-resistance mutations, and seven children (70.00%) with MPP without drug-resistance mutations were treated according to the tNGS results. In children with the drug resistance of MPP, 46 cases (95.83%) of non-severe pneumonia and 10 cases (83.33%) of severe pneumonia were treated according to the tNGS results. All patients had a good prognosis, with no deaths reported and a median hospital stay M ( Q1, Q3) of 9 (7, 11) days. In conclusion, MPP is more common in children aged≥6 years old in Hunan Province, and the detection of drug-resistant mutations includes A2063G and A2064G, with A2063G being the main one. The positive rate of drug-resistant mutations is related to age.

Objective To observe the effects of electroacupuncture on intestinal flora and serum inflammatory factors in rabbit model with rheumatoid arthritis(RA);To explore the mechanism of its therapeutic effect on RA.Methods RA model rabbits were established by ovalbumin induction combined with Freund's complete adjuvant,and the rabbits after successful modeling were randomly divided into model group,probiotic group and electroacupuncture group,with 6 rabbits in each group.Another 6 rabbits were set as the normal group.The electroacupuncture group received electroacupuncture at the bilateral"Zusanli"and"Dubi"for 30 minutes,the probiotic group was given probiotic capsules solution(14.5 mg/kg)by gavage,once a day,for two consecutive weeks.The knee joint circumference and pain threshold of rabbits were measured,histopathological morphological changes of colonic tissue and synovial tissue ws observed by HE staining,16S rDNA sequencing was used to analyze structural changes of intestinal flora,the contents of TNF-α,IL-1β and IL-6 in serum were detected by ELISA.Results Compared with the normal group,the circumference of knee joint of rabbits in the model group increased significantly,the pain threshold was significantly decreased(P<0.01);the colonic mucosal damage was serious,the goblet cells were missing,a large number of inflammatory cells were infiltrate;the joint capsule synovial surface was rough,the synovial cell layer was hyperplasia and thickening,the synovial tissue inflammatory cell infiltration was obvious;the number and evenness of gut microbiota species decreased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes decreased(P<0.05,P<0.01),the relative abundance of Desulfobacteria increased(P<0.01),while the relative abundance of Campylobacter,Lawsonella,and Pseudomonas increased(P<0.01),while the relative abundance of Heshanomonas and Herbaspirillum decreased(P<0.01);the contents of serum TNF-α,IL-1β and IL-6 increased(P<0.01).Compared with the model group,the knee joint circumference of the probiotic group and the electroacupuncture group decreased,the pain threshold increased(P<0.01,P<0.05);the degree of intestinal mucosal damage was reduced,the goblet cells were basically arranged neatly,the inflammatory cell infiltration was reduced;synovial cells proliferation and thickening decreased,with a small amount of inflammatory cell infiltration;the number and evenness of gut microbiota species increased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes increased(P<0.05,P<0.01),the relative abundance of Desulfobacteria decreased(P<0.01),while the relative abundance of Campylobacter,Lawsonella and Pseudomonas decreased(P<0.01),the relative abundance of Heshanomonas and Herbaspirillum increased(P<0.05,P<0.01);the contents of serum TNF-α,IL-1β and IL-6 significantly decreased(P<0.01).Conclusion Electroacupuncture can significantly improve the symptoms of RA rabbits and reduce the inflammatory reaction in synovial tissue of joint,and the mechanism may be related to the regulation of intestinal flora structure.

To investigate the drug-resistance mutations and treatment of hospitalized children with Mycoplasma pneumoniae pneumonia (MPP) in Hunan Province. Children with pneumonia, who were hospitalized in the pediatric ward of the Second Xiangya Hospital of Central South University from January 1, 2023, to December 31, 2023, were enrolled in this study, and their clinical data was also collected. The targeted next-generation sequencing (tNGS) was used to detect Mycoplasma pneumoniae (MP) infection and drug-resistance mutations, and the drug-resistance and treatment in children with MPP were also analyzed. A total of 125 children with pneumonia were involved in this study, including 70 children in the MPP group and 55 children in the bacterial pneumonia group. The results showed that there were 41 boys and 29 girls with an average age of (6.50±3.45) years, with the most common group being the school-age group (age≥6 years). The clinical symptoms were characterized by fever and cough. Laboratory examination showed that the white blood cell and neutrophil counts in the MPP group were lower than those in the bacterial pneumonia group, while the lymphocyte ratio and hemoglobin levels in the MPP group were higher than those in the bacterial pneumonia group, with statistically significant differences (all P<0.05). Twelve children (17.14%) in the MPP group had severe pneumonia, and all children with severe pneumonia had 23Sr RNA A2063G and/or A2064G mutations. The tNGS detected 60 cases of MPP resistance gene mutations, including 59 cases (98.33%) of A2063G mutation in 23Sr RNA and one case (1.67%) of A2064G mutation in 23Sr RNA. There was a significant difference in the positive rate of drug-resistance mutations among patients of different age groups (χ 2=7.991, P=0.021). A total of 63 children (90.00%) with MPP were treated according to the results of drug-resistance mutations, and seven children (70.00%) with MPP without drug-resistance mutations were treated according to the tNGS results. In children with the drug resistance of MPP, 46 cases (95.83%) of non-severe pneumonia and 10 cases (83.33%) of severe pneumonia were treated according to the tNGS results. All patients had a good prognosis, with no deaths reported and a median hospital stay M ( Q1, Q3) of 9 (7, 11) days. In conclusion, MPP is more common in children aged≥6 years old in Hunan Province, and the detection of drug-resistant mutations includes A2063G and A2064G, with A2063G being the main one. The positive rate of drug-resistant mutations is related to age.

Objective:To evaluate high resolution esophageal manometry (HREM) in peroral endoscopic myotomy (POEM) for pediatric achalasia of cardia (AC).Methods:Data of 30 AC children who received POEM in Xi′an Children′s Hospital from January 2013 to September 2019 were reviewed. HREM was performed before and 6 months after POEM. Preoperative and postoperative lower esophageal sphincter pressure (LESP), 4-second integrated relaxation pressure (4sIRP), Eckardt scores and nutritional status were compared.Results:Children with AC aged between 4-14 years. Postoperative LESP was 5.50±1.13 mmHg (1 mmHg=0.133 kPa), which was significantly lower than that before operation (26.23±4.47 mmHg) with significant difference ( t=-24.623, P<0.001). Postoperative median 4sIRP was 5 mmHg, which was 20 mmHg lower than that before operation (25 mmHg) with significant difference ( Z=-4.786, P<0.001). Postoperative median Eckardt symptom score decreased significantly compared with that before (1 VS 8, Z=-4.796, P<0.001). Severe malnutrition of the AC children improved evidently to normal( Z=-5.166, P<0.001). Conclusion:POEM can significantly improve the characteristics of esophageal dynamics in children with AC, and HREM can be an important indicator for follow-up evaluation of POEM.

OBJECTIVETo compare the differences in the clinical therapeutic effects on juvenile myopia between's stunt needling technique and traditional even needling technique.

METHODSA total of 166 cases of mild juvenile myopia (diopter <-3.00D) were randomized into an observation group ('s stunt needling technique) and a control group (traditional even needling technique), 83 cases in each one (166 affected eyes). Taiyang (EX-HN 5), Fengchi (GB 20), Cuanzhu (BL 2), Hegu (LI 4) and Guangming (GB 37) were used in the two groups. In the observation group, theneedling technique was adopted at Taiyang (EX-HN 5), theneedling technique at Fengchi (GB 20) andneedling technique at Cuanzhu (BL 2). The traditional needling technique was used at Hegu (LI 4) and Guangming (GB 37). In the control group, traditional even needling technique was applied at all the acupoints. The treatment was given once every day, continuously for 6 times as one course. There was 1 day at interval. After treatment for 4 courses, the changes in visual acuity, diopter and axial length were observed before and after treatment. The therapeutic effects were evaluated.

RESULTSAfter treatment, the visual acuity of the naked eyes, and diopter were remarkably improved in the patients of the two groups (all<0.05). The improvements in the observation group were better than those in the control group (both<0.05). The axial length did not change in the two groups (both>0.05). The total effective rate was 78.3% (130/166) in the observation group, which was better than 57.8% (96/166) in the control group (<0.05). .

CONCLUSION 's stunt needling technique effectively improves the vision, rectifies the refractive error and delays the progression of myopia. The therapeutic effects of it are better than traditional even needling technique.

OBJECTIVETo explore heat-reinforcing needling for the metabolite profiling changes in serum of rheumatoid arthritis (RA) rabbits with liquid chromatograph-mass spectrometer (LC-MS) technique, and to investigate its mechanisms.

METHODSForty clean purple blue rabbits were randomized into a normal group, a model group, a reinforcing-reducing needling (RRN) group, a twirling-reinforcing needling (TRN) group, and a heat-reinforcing needling (HRN) group, 8 cases in each group. RA rabbits with cold syndrome were made with ovalbumin and freezing except those in the normal group. No treatment was given in the normal and model groups. The corresponding manipulations for 7 days were applied at "Zusanli" (ST 36) in the three acupuncture groups, 30 min a time, once a day. After intervention the pain threshold and the local skin temperature of each group were observed. Fresh serum from heart was collected for metabonomics detection. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were adopted. Several metabolites were screened by the variable importance in the projection values (VIP>1) andvalue (<0.05).

RESULTSThe pain threshold and the local skin temperature in the model group were lower than those in the normal group (both<0.05). The pain threshold and the local skin temperature in the three acupuncture groups were higher than those in the model group after intervention (all<0.05), which were better in the HRN group than those in the RRN and TRN groups (all<0.05). The serum metabolites of carnitine, LysoPC (14∶0), LysoPC (18∶3), LysoPE (0∶0/20∶5), LysoPE (0∶0/22∶1), decylic acid, stearic acid and lactic acid in the model group increased compared with those in the normal group, and other metabolites decreased, including leucine, valine, glutamine, pyroglutamic acid, α-ketoglutaric acid, succinic acid, fumaric acid, malic acid, galactose, mannose. Those metabolites were correlated fatty acid, amino acid, citric acid cycle, and glucose metabolism. The metabolites above-mentioned in the three acupuncture groups were regulated in various degrees (all<0.05). Lactic acid decreased and succinic acid, fumaric acid, malic acid, galactose, mannose increased more obviously in the HRN group than those in the RRN and TRN groups.

CONCLUSIONThe specificity of heat-reinforcing needling for RA presents the regulation for citric acid cycle and glucose metabolism.

Objective To investigate the clinical efficacy of shoulder-three-points warm needling moxibustion plus conventional rehabilitation in recovery from arthroscopic rotator cuff repair.Method Seventy patients who had undergone arthroscopic rotator cuff repair for rotator cuff injury were enrolled and randomly allocated to groups A and B, 35 cases each. Group A received conventional rehabilitation and group B, shoulder-three-points warm needling moxibustion in addition. Functional activity and pain in the affected shoulder were scored using the American Shoulder Elbow Scale (ASES), the University of California at Los Angeles (UCLA) Shoulder Scale and the Constant-Murley Shoulder Outcome Score in the two groups before and after treatment.Result There were statistically significant pre-/post-treatment differences in the ASES, UCLA and Constant-Murley scores in the two groups (P<0.01). After treatment, the scores were higher in group B than in group A, but there was no significant difference in the UCLA function subscore (P>0.05) and a significant difference in the UCLA pain subscore (P<0.01) between groups A and B. Conclusion shoulder-three-points warm needling moxibustion plus conventional rehabilitation training can markedly promote postoperative rehabilitation and especially relieve postoperative pain in patients with rotator cuff injury. It provides a new idea for clinical shoulder rehabilitation in the future.

A discussion of the connotation and key issues of the new normal in the healthcare sector,with an introduction to the new normal.The furthering reform is unveiling roadblocks in the healthcare system.For example,human resources available can hardly support development of the sector, and revenue growth of tertiary hospitals in the cities will decline,while county hospitals will be further challenged by debt crisis.In the meantime of steady elevation of medical capabilities in both urban and rural areas,the gap between the two will be maintained for a while.The authors predict that the sector will be faced with restructuring essential medicine system,grading diagnosis and treatment practice,rising risks for health insurance,and growing market shares of commercial health insurance and private capital, as well as fiercer competitions to challenge public hospitals.

Based on the concept of hospital corporate governance,this article proposed to clarify the property ownership by the corporate governance,making it the cornerstone of building hospitals of mixed ownership.Furthermore,the authors also recommended the roadmap and policy support for such hospitals,policy analysis and suggestions to the construction of the mixed ownership hospitals,aiming at providing theoretical basis and reference to public hospital reform and the medical and health system reform.