1.Risk assessment analysis of infectious disease prevention and control in schools of Shangcheng District, Hangzhou
YAO Ying, YU Kuangming, SUN Jiayi, JIANG Siqing, WANG Hui
Chinese Journal of School Health 2025;46(6):868-872
Objective:
To establish a risk assessment system for infectious disease prevention and control in schools in Shangcheng District, Hangzhou and determine risk levels for each school, and propose corresponding risk management measures, so as to provide a scientific reference for infectious disease prevention and control in primary and secondary schools.
Methods:
Based on the Failure Mode and Effects Analysis (FMEA) method, potential failure analysis and current situation investigation of infectious disease prevention and control risks were conducted in 110 primary and secondary schools from 2022 to 2024 in Shangcheng District, Hangzhou. Risk levels were classified using K-Means cluster analysis.
Results:
Through expert panel discussions using FMEA, 6 first level indicators and 28 second level indicators were identified. The top three risk priority numbers were implementation of required prevention and control measures for clustered infectious disease outbreaks in schools in the past three years ( 189.00 ), student morning/afternoon health checks (168.00), and reporting status of clustered infectious disease outbreaks in schools in the past three years (144.00). The comprehensive prevention scores of schools ranged from 61.00 to 98.00 (mean: 87.40 ). There were no statistically significant differences in the average scores(primary school: 88.17±7.39, nine year consistent education: 86.26±7.68, junior high school: 85.55±8.20, and high school: 88.72±4.91) and risk level distribution of schools with different educational stages( F/H=0.95,1.47, P >0.05).K-Means cluster analysis divided the schools into 5 risk levels with cluster centers at 93.25, 85.78, 79.69, 70.29, 61.00 ( F=309.21, P <0.05), with 80% of schools classified as low risk or below.
Conclusion
The infectious disease prevention and control risk assessment system for primary and secondary schools can be established, and hierarchical management can be conducted according to school risk levels, thereby improving the efficiency and effectiveness of school infectious disease prevention and control, and enhancing the precision and sustainability of prevention efforts.
2.Role and Mechanism of Glucocorticoid-induced Transcription Factor 1 in Cognitive Dysfunction in Diabetic Mice
Yingrui LIU ; Jiayi WANG ; Yefeng WANG ; Jiahui LUAN ; Yun GU ; Zhongfu ZUO ; Hongdan YU
Journal of Sun Yat-sen University(Medical Sciences) 2025;46(5):826-835
ObjectiveTo explore the protective effect of glucocorticoid-induced transcription factor 1 (GLCCI1) on cognitive dysfunction in diabetic mice and its mechanism. MethodsTwenty-four C57BL/6J mice were randomly divided into 4 groups, namely Control, DM, DM+AAV-Glcci1, and DM+AAV-NC. The Control group was intraperitoneally injected with saline, while the other groups were all injected with streptozotocin (STZ). Two weeks after successful modeling, the DM+AAV-Glcci1 group was brain stereotactic injected with Glcci1 overexpressing adeno-associated virus, and the DM+AAV-NC group was stereoscopically injected with the control virus. After 12 weeks, the Morris water maze test was used to evaluate the learning and memory abilities of mice in each group. Subsequently, the localized expression of GLCCI1 in the hippocampus were determined by immunofluorescence and immunohistochemistry experiments. The myelin morphology in the hippocampus was observed by LFB staining, the neuronal morphology was observed by Nissl staining, and the myelin-related proteins MBP and CNPase were stained by immunohistochemistry. Molecular docking was used to predict the interaction between GLCCI1 and HSPA5. The expression of endoplasmic reticulum stress-related proteins was detected by Western blot. ResultsThe results of the behavioral experiment showed that compared with the mice in the Control group, DM mice exhibited obvious cognitive dysfunction behaviors (P<0.000 1), and the learning and memory abilities of mice improved after overexpression of Glcci1 (P=0.000 7). The results of immunofluorescence and immunohistochemistry showed that GLCCI1 was expressed in hippocampal neuron cells. Compared with Control mice, the expression level of GLCCI1 in DM mice was significantly downregulated (P<0.000 1). The molecular docking results revealed that GLCCI1 interacts with HSPA5. The Western blot results indicated that, compared with the Control group, the expression levels of endoplasmic reticulum stress-related proteins HSPA5 (P<0.000 1), ATF4 (P<0.000 1), ATF6 (P=0.001 1), and p-ELF2α/elF2α (P=0.000 1) in the DM group were significantly increased; Compared with the DM group, the expression of the corresponding protein HSPA5 (P<0.000 1), ATF4 (P<0.000 1), ATF6 (P=0.000 2), and p-ELF2α/elF2α (P=0.000 1) was significantly down-regulated after overexpression of Glcci1. LFB staining showed that compared with the Control group, the myelin integrity of DM mice decreased significantly (P=0.010 3), the expressions of myelin-related proteins MBP and CNPase decreased significantly (P=0.000 4, P=0.000 2), and Nissl staining observed disordered neuronal arrangement. Compared with the mice in the DM group, the myelin integrity in the hippocampal region significantly increased after overexpression of Glcci1 (P=0.000 3), the expressions of myelin-related proteins MBP and CNPase significantly increased (P=0.001 4, P=0.000 1), and the ordered arrangement of neurons was observed by Nissl staining. ConclusionThe down-regulation of GLCCI1 expression in hippocampal neurons promotes demyelination of hippocampal neurons and thereby induces diabetic cognitive dysfunction. The specific mechanism may be related to endoplasmic reticulum stress.
3.Antisense oligonucleotides targeting IRF4 alleviate psoriasis.
Yanxia YU ; Yirui WANG ; Weiwei CHEN ; Chang ZHANG ; Zhuo LI ; Jing YU ; Minhao WANG ; Can SONG ; Sihao YAN ; Jiayi LU ; Liangdan SUN
Acta Pharmaceutica Sinica B 2025;15(7):3575-3590
Interferon regulatory factor 4 (IRF4) is a critical transcription factor that governs the differentiation of cluster of differentiation 4+ (CD4+) T cells. The pathogenesis and progression of psoriasis are primarily attributed to an immune imbalance stemming from the overproduction of interleukin-17A (IL-17A) by T lymphocytes. However, the role of IRF4 in psoriasis remains unexplored. In this study, we found that IRF4 activity is increased in the cutaneous lesions of patients with psoriasis in response to stimulation by IL-23A and IL-1β. This IRF4 elevation heightens its binding to the E1A binding protein p300 (EP300) promoter, triggering the transcription of downstream retinoic acid receptor-related orphan receptor-γt (RORγt) and increasing the secretion of IL-17A, thereby establishing the IL-1β/IL-23A-IRF4-EP300-RORC-IL-17A inflammatory cascade in psoriasis. The alleviation of imiquimod (IMQ)-induced psoriatic-like symptoms was achieved through the creation of a Irf4 -/- gene deletion mouse model and pharmacological inhibition using antisense oligonucleotides targeted for Irf4. This amelioration was accompanied by a decreased number of IL-17A-producing CD4+ T cells in the skin. The findings of this study suggest that IRF4 plays a crucial role in the promotion of inflammation and exacerbation of IMQ-induced psoriasiform dermatitis. Consequently, IRF4 targeting could be a promising therapeutic strategy.
4.Puerarin alleviates rheumatoid arthritis in rats by modulating TAK1-mediated TLR4/NF-κB signaling pathway.
Maiyuan XU ; Ni LI ; Jiayi LI ; Tao ZHANG ; Liwen MA ; Tao LIN ; Haonan YU ; Ning WU ; Zunqiu WU ; Li HUANG
Journal of Southern Medical University 2025;45(10):2231-2239
OBJECTIVES:
To explore the therapeutic mechanism of puerarin for alleviating synovitis in rats with collagen-induced arthritis (CIA).
METHODS:
In a SD rat model of CIA, we tested the effects of daily gavage of puerarin at low, moderate and high doses (10, 30, and 100 mg/kg, respectively) for 3 weeks, with tripterygium glycosides (GTW, 10 mg/kg) as the positive control, on swelling in the hind limb joints regions evaluated by arthritis index scoring. Mass fraction of the liver of the rats was calculated, and pathologies in joint synovial membrane were observed with HE staining. The expressions of transforming growth factor β‑activated kinase-1 (TAK1), Toll-like receptor 4 (TLR4), and nuclear factor kappa-Bp65 (NF‑κB p65) at the mRNA and protein levels in the synovial tissues were detected using Real-time PCR and Western blotting.
RESULTS:
Compared with those in the model group, the rats in GTW group and high-dose puerarin group showed significantly reduced mass fraction of the liver. Treatment with GTW and puerarin at the 3 doses all significantly alleviated plantar swelling, lowered arthritis index scores, and improved synovitis in CIA rats (P<0.05), and the effects of puerarin showed an obvious dose dependence. Both GTW and puerarin treatments significantly lowered TAK1, TLR4, and NF‑κB p65 mRNA and protein expressions in the synovium of CIA rats.
CONCLUSIONS
Puerarin alleviates synovium damages in CIA rats possibly by suppressing the TLR4/NF‑κB signaling pathway via downregulating TAK1 expression.
Animals
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Toll-Like Receptor 4/metabolism*
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Rats, Sprague-Dawley
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Rats
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MAP Kinase Kinase Kinases/metabolism*
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Signal Transduction/drug effects*
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Arthritis, Rheumatoid/drug therapy*
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NF-kappa B/metabolism*
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Isoflavones/therapeutic use*
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Male
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Arthritis, Experimental/drug therapy*
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Transcription Factor RelA/metabolism*
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Synovial Membrane/metabolism*
5.NUP62 alleviates senescence and promotes the stemness of human dental pulp stem cells via NSD2-dependent epigenetic reprogramming.
Xiping WANG ; Li WANG ; Linxi ZHOU ; Lu CHEN ; Jiayi SHI ; Jing GE ; Sha TIAN ; Zihan YANG ; Yuqiong ZHOU ; Qihao YU ; Jiacheng JIN ; Chen DING ; Yihuai PAN ; Duohong ZOU
International Journal of Oral Science 2025;17(1):34-34
Stem cells play a crucial role in maintaining tissue regenerative capacity and homeostasis. However, mechanisms associated with stem cell senescence require further investigation. In this study, we conducted a proteomic analysis of human dental pulp stem cells (HDPSCs) obtained from individuals of various ages. Our findings showed that the expression of NUP62 was decreased in aged HDPSCs. We discovered that NUP62 alleviated senescence-associated phenotypes and enhanced differentiation potential both in vitro and in vivo. Conversely, the knocking down of NUP62 expression aggravated the senescence-associated phenotypes and impaired the proliferation and migration capacity of HDPSCs. Through RNA-sequence and decoding the epigenomic landscapes remodeled induced by NUP62 overexpression, we found that NUP62 helps alleviate senescence in HDPSCs by enhancing the nuclear transport of the transcription factor E2F1. This, in turn, stimulates the transcription of the epigenetic enzyme NSD2. Finally, the overexpression of NUP62 influences the H3K36me2 and H3K36me3 modifications of anti-aging genes (HMGA1, HMGA2, and SIRT6). Our results demonstrated that NUP62 regulates the fate of HDPSCs via NSD2-dependent epigenetic reprogramming.
Humans
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Dental Pulp/cytology*
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Nuclear Pore Complex Proteins/genetics*
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Cellular Senescence/genetics*
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Stem Cells/metabolism*
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Epigenesis, Genetic
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Cell Proliferation
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Cell Differentiation
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Histone-Lysine N-Methyltransferase/metabolism*
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Cells, Cultured
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Cellular Reprogramming
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Cell Movement
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Proteomics
6.(+)-Strebloside induces Non-Hodgkin lymphoma cell death through the STEAP3-Mediated Ferroptosis and MAPK pathway.
Yu ZHAO ; Jing CAI ; Ying YANG ; Dongmei ZHANG ; Jiayi REN ; Shuyun XIAO ; Jian XU ; Feng FENG ; Rong WU ; Jie ZHANG
Chinese Journal of Natural Medicines (English Ed.) 2025;23(10):1221-1231
(+)-Strebloside, a significant bioactive compound isolated from the roots of Streblus asper Lour., demonstrates inhibitory effects against multiple malignancies. However, its specific function and underlying mechanistic pathways in Non-Hodgkin lymphoma (NHL) remain unexplored. This investigation sought to elucidate the role and potential mechanisms of (+)-strebloside-induced NHL cell death. The results demonstrated that (+)-strebloside significantly induced apoptosis and ferroptosis in NHL cells, including those from Raji cell-derived xenograft models. Mechanistic analyses revealed that (+)-strebloside enhanced six-transmembrane epithelial antigen of prostate 3 (STEAP3)-induced ferroptosis in NHL, and STEAP3 inhibition reduced the proliferation-inhibitory effects of (+)-strebloside. Furthermore, (+)-strebloside suppressed NHL proliferation through the mitogen-activated protein kinase (MAPK) pathway, and extracellular signal-regulated kinase (ERK) inhibition diminished the proliferation-inhibitory activity induced by (+)-strebloside. These findings indicate that (+)-strebloside presents promising therapeutic potential for NHL treatment.
Humans
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Ferroptosis/drug effects*
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Lymphoma, Non-Hodgkin/physiopathology*
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Cell Line, Tumor
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MAP Kinase Signaling System/drug effects*
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Animals
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Cell Proliferation/drug effects*
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Mice
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Apoptosis/drug effects*
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Membrane Proteins/genetics*
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Xenograft Model Antitumor Assays
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Male
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Mice, Nude
7.Cloning and functional analysis of the phenylalanine ammonia-lyase gene from Anthoceros angustus.
Haina YU ; Jian MO ; Jiayi YANG ; Xiaochun QIN
Chinese Journal of Biotechnology 2025;41(7):2855-2870
Anthoceros angustus Steph. is rich in phenolic acids such as rosmarinic acid (RA). Phenylalanine ammonia-lyase (PAL) is an entry enzyme in the phenylpropanoid pathway of plants, playing an important role in the biosynthesis of RA. To investigate the important role of PAL in rosmarinic acid synthesis, two PAL genes (designated as AanPAL1 and AanPAL2) were cloned from A. angustus, encoding 755 and 753 amino acid residues, respectively. The AanPAL deduced amino acid sequences contain the conserved domains of PAL and the core active amino acid residues Ala-Ser-Gly. The phylogenetic analysis indicated that AanPAL1 and AanPAL2 were clustered with PALs from bryophytes and ferns and had the shortest evolutionary distance with the PALs from Physcomitrella patens. Quantitative real-time PCR results showed that the expression of AanPAL1 and AanPAL2 was induced by exogenous methyl jasmonate (MeJA). HPLC results showed that the MeJA treatment significantly increased the accumulation of RA. AanPAL1 and AanPAL2 were expressed in Escherichia coli and purified by histidine-tag affinity chromatography. The recombinant proteins catalyzed the conversion of L-phenylalanine to generate trans-cinnamic acid with high efficiency, with the best performance at 50 ℃ and pH 8.0. The Km and kcat of AanPAL1 were 0.062 mmol/L and 4.35 s-1, and those of AanPAL2 were 0.198 mmol/L and 14.48 s-1, respectively. The specific activities of AanPAL1 and AanPAL2 were 2.61 U/mg and 8.76 U/mg, respectively. The two enzymes had relatively poor thermostability but good pH stability. The high activity of AanPAL2 was further confirmed via whole-cell catalysis with recombinant E. coli, which could convert 1 g/L L-phenylalanine into trans-cinnamic acid with a yield of 100% within 10 h. These results give insights into the regulatory role of AanPAL in the biosynthesis of RA in A. angustus and provide candidate enzymes for the biosynthesis of cinnamic acid.
Phenylalanine Ammonia-Lyase/metabolism*
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Cloning, Molecular
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Cinnamates/metabolism*
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Recombinant Proteins/metabolism*
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Rosmarinic Acid
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Depsides/metabolism*
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Escherichia coli/metabolism*
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Amino Acid Sequence
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Plant Proteins/metabolism*
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Phylogeny
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Acetates/pharmacology*
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Cyclopentanes
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Oxylipins
8.Yunkang Oral Liquid Promotes Restoration of Mice from Postpartum Kidney Deficiency via TGF-β/Smads Signaling Pathway
Jiayi ZHENG ; Jie SU ; Meiqiu YAN ; Jingjing YU ; Yigong CHEN ; Meng FU ; Xueling HU ; Mengxi CHANG ; Guiyuan LYU ; Liqin JIANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(6):83-90
ObjectiveTo investigate the effect of Yunkang oral liquid on postpartum kidney deficiency in mice. MethodPostpartum mice were randomized into model and low-dose (6 mL·kg-1), medium-dose (9 mL·kg-1), and high-dose (12 mL·kg-1) Yunkang oral liquid groups. The mouse model of postpartum kidney deficiency was established by sleep deprivation combined with forced swimming. Another 9 female ICR mice were selected as the normal control group. The mice were administrated with Yunkang oral liquid during the period of modeling. The levels of estradiol (E2), progesterone (P), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) in the serum were measured by the enzyme-linked immunosorbent assay. The morphological changes of ovaries and uterus were observed by hematoxylin-eosin (HE) staining, and the expression of transforming growth factor (TGF)-β and Smad2/3 was determined by immunohistochemistry and Western blotting. ResultThe mice in the model group showed prolonged estrous cycle, reduced voluntary activity, dorsal temperature, grip strength, and bone strength, and whitening tongue coating. Compared with the model group, Yunkang oral liquid shortened the estrous cycle, increased the voluntary activity, dorsal temperature, grip strength, and bone strength, and alleviated the whitening of tongue coating. Moreover, it elevated the E2 and P levels and lowered the FSH and LH levels in the serum, decreased ovarian follicular atresia rate, promoted uterine repair, and down-regulated the expression of TGF-β and Smad2/3 in the ovarian and uterine tissues. ConclusionYunkang oral liquid can ameliorate postpartum kidney deficiency in mice by regulating the TGF-β/Smads signaling pathway.
9.TCM constitution distribution and clinical features of patients with hepatitis B cirrhosis and dysplastic nodules
Mengbing FANG ; Cheng LIU ; Yu ZHANG ; Jiayi ZENG ; Zhiheng CHEN ; Sheng LI ; Xiaoling CHI ; Huanming XIAO
Journal of Clinical Hepatology 2024;40(5):961-967
Objective To investigate the characteristics of TCM constitution distribution in hepatitis B cirrhosis patients with dysplastic nodules(DN),and to provide a basis for the prevention and treatment of precancerous lesions of liver cancer.Methods This study was conducted among 113 hepatitis B cirrhosis patients with DN,105 hepatitis B cirrhosis patients with regenerative nodules(RN),and 70 hepatitis B cirrhosis patients with small hepatocellular carcinoma(sHCC)who were hospitalized in Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2015 to March 2023.Related data were collected,including age,sex,liver function Child-Pugh class,TCM constitution type,and laboratory markers.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups;the chi-square test was used for comparison of categorical data between groups,and the Bonferroni correction method was used for further comparison between two groups.Results The main TCM constitution types of hepatitis B cirrhosis patients with DN were Qi-deficiency constitution(27 patients,23.89%),blood-stasis constitution(26 patients,23.01%),and phlegm-dampness constitution(23 patients,20.35%).There were significant differences between the three groups in the proportion of patients with phlegm-dampness constitution or damp-heat constitution(χ2=6.822 and 6.383,both P<0.05);the hepatitis B cirrhosis patients with RN had the highest proportion of patients with phlegm-dampness constitution(30.48%),followed by those with DN(20.35%)and those with sHCC(14.29%),while the hepatitis B cirrhosis patients with sHCC had the highest proportion of patients with damp-heat constitution(27.14%),followed by those with DN(16.81%)and those with RN(12.38%).There were significant differences between the hepatitis B cirrhosis DN patients with different TCM constitution types in sex,age,Child-Pugh class,prealbumin,albumin(Alb),aspartate aminotransferase,total bilirubin(TBil),total bile acid,and alpha-fetoprotein(all P<0.05).Compared with the male hepatitis B cirrhosis DN patients,female patients showed a significantly higher proportion of patients with Qi-deficiency constitution(χ2=4.895,P=0.027).Among the patients with Qi-deficiency constitution,the patients with Child-Pugh class A liver function accounted for a significantly lower proportion than those with Child-Pugh class B liver function(χ2=6.380,P=0.012),while among the patients with phlegm-dampness constitution,the patients with Child-Pugh class A liver function accounted for a significantly higher proportion than those with Child-Pugh class B liver function(χ2=8.515,P=0.004).The patients with phlegm-dampness constitution had significantly higher levels of prealbumin and Alb than those with the other four constitutions(all P<0.05),as well as significantly lower levels of TBil and total bile acid than those with damp-heat constitution(P<0.05);the patients with Yin-deficiency constitution had a significantly lower level of Alb than those with qi-deficiency constitution,blood-stasis constitution,or phlegm-dampness constitution(all P<0.05);the patients with Yin-deficiency constitution had a significantly lower proportion of patients with abnormal alpha-fetoprotein than those with non-Yin-deficiency constitutions(χ2=4.448,P=0.035).Conclusion Hepatitis B cirrhosis patients with DN mainly have the TCM constitution types of Qi deficiency,blood stasis,and phlegm dampness.The patients with phlegm-dampness constitution seem to have a low probability of carcinogenesis,while those with damp-heat constitution and Yin-deficiency constitution have a relatively high risk of carcinogenesis.
10.Mechanism of bis(2-ethylhexyl)phthalate in inducing cholestasis and liver injury in mice
Jiayi ZHANG ; Yun YU ; Fan ZHAO ; Lu YE ; Jianqing WANG
Journal of Clinical Hepatology 2024;40(5):1003-1008
Objective To investigate the mechanism of bis(2-ethylhexyl)phthalate(DEHP)in inducing cholestasis and liver injury in mice.Methods In the in vivo experiment,adult female ICR mice were randomly divided into control group(corn oil)and DEHP group(200 mg/kg/d),and a model of cholestasis was established by intragastric administration for 4 weeks.After blood and liver tissue samples were collected from all mice,a biochemical analyzer was used to measure the level of total bile acid(TBA)in serum and the liver,and a microplate reader was used to measure alkaline phosphatase(ALP)and gamma-glutamyl transpeptidase(GGT);HE staining was used to observe the pathological changes of the liver;RT-PCR was used to measure the mRNA expression levels of the inflammatory factors interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the liver;liquid chromatography/triple quadrupole mass spectrometry was used to measure the bile acid profile in the liver of mice.In the in vitro experiment,AML-12 mouse hepatocytes were cultured and treated with DEHP(250 μmol/L),DCA(125 μmol/L),and CDCA(125 μmol/L)for 24 hours,and RT-PCR was used to measure the mRNA expression levels of the inflammatory cytokines IL-1β,IL-6,and TNF-α.The independent-samples t test was used for comparison of continuous data between two groups;a one-way analysis of variance was used for comparison between multiple groups,and the LSD-t test was used for further comparison between two groups.Results The in vivo experiment showed that compared with the control group,the DEHP group had significant increases in the serum levels of TBA,ALP,and GGT and the level of TBA in the liver(the t values are respectively-4.396,-5.109,-8.504,-3.792 and-7.974,all P<0.05,).Compared with the control group,the DEHP group had significant increases in cholic acid,chenodeoxycholic acid,taurocholic acid,deoxycholic acid,and ursodeoxycholic acid(the t values are respectively-2.802,-3.177,-2.633,-2.874 and-2.311,all P<0.05).HE staining of the liver showed that the mice in the DEHP group had enlargement of the portal area,bile duct deformation,inflammatory cell infiltration around the bile duct,and significant increases in the mRNA expression levels of the inflammatory factors IL-1β,IL-6,and TNF-α in the liver(the t values are respectively-2.539,-2.823 and-4.636,all P<0.05).The in vitro experiment showed that the actual difference in hepatocyte viability after 0-1 000 μmol/L DEHP treatment does not exceed 15%,but there were significant increases in the mRNA expression levels of the inflammatory cytokines IL-1β,IL-6,and TNF-α after treatment with DEHP at different concentrations of 125 μmol/L,250 μmol/L,and 500 μmol/L(all P<0.05).Compared with DEHP stimulation alone,the combined stimulation of CDCA and DEHP upregulates the cytokine in hepatocyte IL-1β mRNA levels(P<0.01);the combined stimulation of DCA and DEHP can significantly increase the cytokine in hepatocyte IL-1β and IL-6 mRNA levels(all P<0.01).Conclusion DEHP exposure can cause cholestasis and induce liver inflammation in mice,possibly by promoting the production of toxic bile acids and the secretion of inflammatory factors.


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