OBJECTIVE To investigate the improvement effects and mechanism of Xiangsha yiwei tang on gastric mucosal injury in rats with chronic atrophic gastritis （CAG）. METHODS Rats were randomly assigned into normal control group， model group， Xiangsha yiwei tang low-， medium- and high-dose groups （6， 12， 18 g/kg， calculated by crude drug）， and high-dose group of Xiangsha yiwei tang+740 Y-P [Xiangsha yiwei tang 18 g/kg+transforming growth factor β1/phosphatidyl inositol 3 kinase/ protein kinase B（TGF-β1/PI3K/Akt） pathway activator group 740 Y-P 10 mg/kg]， with 18 rats in each group. Rats in each group were administered the corresponding drugs via oral gavage or injection， once daily， for 4 consecutive weeks. Gastric mucosal blood flow， the levels of serum gastrointestinal hormones [including motilin （MTL）， gastrin （GAS）， and pepsinogen （PP）]， as well as inflammatory cytokines [including tumor necrosis factor- α （TNF- α）， interleukin-1β （IL-1β）， IL-6] in rats were measured. Pathological damage to gastric mucosal tissue was observed in rats； the apoptotic rate of gastric mucosal cells was detected. The expressions of TGF-β1/PI3K/Akt signaling pathway-related proteins and apoptosis-related proteins [including B-cell lymphoma-2 （Bcl-2） and Bcl-2-associated X protein （Bax）] in the gastric mucosal tissues of rats were assessed. RESULTS Compared with normal control group， model group had abnormal gastric mucosal tissue structure， with shedding of gastric mucosal epithelial cells， and prominent infiltration of inflammatory cells. Gastric mucosal blood flow， the serum levels of MTL， GAS， PP， and Bcl-2 protein expression were lowered significantly， while serum levels of TNF-α， IL-1β and IL-6， apoptosis rate， protein expressions of Bax and TGF-β1， the phosphorylations of PI3K and Akt were increased significantly （P＜0.05）. Compared with model group， Xiangsha yiwei decoction groups exhibited attenuated histopathological injuries in gastric mucosal tissues， reduced inflammatory cell infiltration， and significant improvements in the aforementioned quantitative parameters （P＜0.05）. Compared with high-dose group of Xiangsha yiwei tang， high-dose group of Xiangsha yiwei decoction combined with 740 Y-P exhibited significantly aggravated histopathological injuries in gastric mucosal tissues， and the aforementioned quantitative parameters were markedly reversed （P＜0.05）. CONCLUSIONS Xiangsha yiwei tang can alleviate gastric mucosal damage in CAG rats， and its mechanism of action is related to the inhibition of TGF-β1/PI3K/Akt signaling pathway.

OBJECTIVE To investigate the effect and mechanism of asperuloside on liver fibrosis in non-alcoholic fatty liver disease （NAFLD） rats by regulating the sphingosine kinase 1 （SphK1）/sphingosine-1-phosphate （S1P） signaling pathway. METHODS SD rats were fed with a high-fat diet to establish a NAFLD model. They were randomly separated into model group， asperuloside low-dose group （14 mg/kg， i.g.， similarly hereinafter）， asperuloside high-dose group （28 mg/kg）， high dose of asperuloside （28 mg/kg）+pc-NC （empty plasmid， 50 µg， via tail vein， similarly hereinafter） group， and high dose of asperuloside （28 mg/kg）+pc-SphK1 （SphK1 overexpression plasmid， 50 µg） group， with 12 rats in each group. Another 12 rats were fed with a normal diet as control group. Each group was given relevant medicine or plasmid intragastrically once a day or via tail vein twice a week， for 3 consecutive weeks. After the last medication， the levels of blood lipid indexes [total cholesterol （TC）， triglyceride （TG）， and free fatty acid （FFA）] and liver function indexes [aspartate transaminase （AST） and alanine transaminase （ALT）] were detected in each group. The pathological changes of liver tissue and liver fibrosis in rats were also observed in each group. The levels of serum fibrosis-related factors [procollagen type Ⅲ （PCⅢ）， collagen type Ⅳ （Ⅳ-Col）， laminin （LN）]， pro-fibrotic factor [transforming growth factor-β1 （TGF-β1）]， and pro-inflammatory factors [interleukin-1β （IL-1β）， inducible nitric oxide synthase （iNOS）， IL-6] of rats were determined in each group. The expressions of collagen formation-related proteins （Ⅰ-Col， Ⅳ-Col） and SphK1/S1P pathway-related proteins in the liver tissues of rats were detected in each group. RESULTS Compared with control group， the liver tissue of rats in model group showed significant pathological damage； the NAFLD activity score， liver tissue collagen volume fraction， serum levels of TC，TG， FFA， AST， ALT， PCⅢ， Ⅳ-Col， LN， TGF-β1， IL-1β， iNOS and IL-6， and protein expressions of Ⅰ-Col， Ⅳ-Col， SphK1 and S1P in liver tissue were greatly increased （P＜0.05）. Compared with the model group， the liver tissue pathological damage symptoms of rats in asperuloside low-dose and high-dose groups were improved， and the above indexes were all reduced significantly （P＜0.05）； moreover， the high-dose group had a better effect （P＜0.05）. Compared to asperuloside high-dose group， high dose of asperuloside+pc-NC group， the pathological damage of liver tissue symptoms in rats were aggravated in high dose of asperuloside+pc-SphK1 group， and the above indexes were all increased significantly （P＜0.05）. CONCLUSIONS Asperuloside can reduce the expressions of pro-fibrotic factor， pro-inflammatory factors and collagen formation-related proteins by inhibiting the activity of SphK1/S1P signaling pathway， thus alleviating liver fibrosis in NAFLD rats.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Metformin is one of the commonly used hypoglycemic drugs in clinical practice. In addition to hypoglycemia, there are a variety of medical biological values that have been constantly discovered and attracted much attention. In recent years, studies have shown that metformin through activation of AMPK inhibition of sterols regulating element binding protein 1 (SREBP-1) reduce lipid synthesis, in the treatment of liver steatosis, improve insulin sensitivity, prevention Metformin is one of the commonly used hypoglycemic drugs in clinical practice. In addition to hypoglycemia, there are a variety of medical biological values that have been constantly discovered and attracted much attention. In recent years, studies have shown that metformin through activation of AMPK inhibition of sterols regulating element binding protein 1 (SREBP-1) reduce lipid synthesis, in the treatment of liver steatosis, improve insulin sensitivity, prevention of atherosclerosis and cardiovascular dysfunction, tumor, polycystic ovary syndrome and adjuvant therapy of COVID-19 aspects play a role. Therefore, this article reviews the possible mechanism and clinical application of metformin in regulating glucose and lipid metabolism by inhibiting SREBP-1 through activating AMPK.

Objective To evaluate the efficacy of Bupi-Qingchang recipe combined with traditional Chinese medicine enema on the patients with radiation proctitis.Methods Eighty patients with radioactive proctitis who met the inclusion criteria were randomly divided into two groups,40 in each group.The control group was treated with western medicine combined with enema,and the observation group was treated with oral spleen and clearing spleen combined with traditional Chinese medicine enema.Symptoms were scored before and after treatment from abnormal sensation of bowel movement,blood in stool,stool traits and frequency,abdominal pain;TNF-α,IL-8,IL-6,IL-10 levels were detected by ELISA.The intestinal mucosal healing and recurrence were observed by microscopy.Results After treatment,the serum TNF-α (1.18 ± 0.61 ng/ml vs.1.78 ± 0.66 ng/ml,t=4.860),IL-6 (2.52 ± 0.75 ng/ml vs.3.02 ± 0.81 ng/ml,t=3.297),IL-8 (2.51 ± 0.68 ng/ml vs.3.01 ± 0.82 ng/ml,t=3.417),IL-10 (0.56 ± 0.25 ng/ml vs.0.89 ± 0.29 ng/ml,t=6.275) in the observation group were significantly lower than those in the control group (P＜0.01).The total scores of abdominal pain,blood in the stool,stool characteristics and frequency,abnormal feeling of defecation and symptoms were significantly lower in the observation group than in the control group (t values were 8.108,2.085,4.965,7.865,9.586,P＜0.01 or P＜0.05).The total effective rate was 92.5％ (37/40) in the observation group and 67.5％ (27/40) in the control group.The difference between the two groups was statistically significant (x2=7.813,P＜0.01).The intestinal mucosa of the observation group was treated.The healing rate was significantly better than that of the control group (x2=15.535,P＜0.01),and the recurrence rate was significantly lower than that of the control group (x2=10.912,P＜0.01).Conclusions The Bupi-Qingchang recipe combined with traditional Chinese medicine enema can improve the clinical symptoms of patients with radiation proctitis,reduce inflammation,reduce recurrence and improve curative effect.

Objective To investigate the role and mechanism of oncogene spindle and kinetochore associated complex subunit 3 (SKA3) in the proliferation regulation of hepatocellular carcinoma (HCC) cells. Methods The expression of SKA3 in HCC tissues and cells was detected by Western blot and RT-PCR. SKA3 overexpression group (Huh7-SKA3) and control group (Huh7-Vector) were constructed using lentivirus transfection. Cell models of SKA3 interference group (Huh7-shSKA3) and control group (Huh7-Scramble) were constructed as well. The ability of cell proliferation was detected by MTT assay and cell clony formation assay. The cell cycle was detected by flow cytometry, and the expression of cyclin related proteins was detected by Western blot and RT-PCR. The experimental data were compared byt test.Results The expression of SKA3 protein in HCC tissues and Huh7 HCC cells increased significantly, and the expression level of mRNA was respectively 15.46±2.10 and 9.26±0.80, significantly higher than 1.48±0.17 and 1.11±0.07 of normal liver tissues and normal liver cells LO2 (t=6.58, 10.08; P<0.05). The cell growth curve showed that the proliferation ability of cells in overexpression group was significantly better than those in control group, and the proliferation ability of cells in interference group was lower than those in control group. The number of cell clones in the overexpression group was 259±20, significantly higher than 97±11 in control group (t=9.12, P<0.05), and the number of cell clones in interference group was 11±2, significantly lower than 97±11 in control group (t=-8.13, P<0.05). The ratio of phase G2/M and phase S in overexpression group was respectively (5.5±0.6)％ and (41.9±3.6)％, and was correspondingly (15.8±1.5)％ and (31.9±3.3)％ in control group, and significant differences were observed (t=-10.89, 6.39; P<0.05). The ratio of phase G1/G0 and phase S in interference group was respectively (71.7±6.1)％ and (20.2±2.9)％, and was correspondingly (53.4±5.4)％ and (31.3±4.2)％ in control group, and significant differences were observed (t=8.59,-5.17;P<0.05).Conclusions SKA3 is highly expressed in HCC and can promote the proliferation of HCC cells, which may be related to its promotion of cell cycle from phase G1 to phase S.

Objective:To understand the spatial distribution of mushroom poisoning in Hunan Province and its influential factors,and to provide the evidence for control of the mushroom poisoning.Methods:The surveillance data for mushroom poisoning cases from 122 counties in Hunan Province in 2015 were collected.Based on geographical information system database,spatial autocorrelation analysis and spatial regression analysis (via OpenGeoDa) was conducted.Results:The incidence of mushroom poisoning in Hunan Province in 2015 was 2.94/100 000.Global Moran's I values was 0.315 (P＜0.05).Local spatial autocorrelation analysis indicated that Ningxiang,Xiangtan,Shaoyang,Lingling,Jiahe,and Linwu districts et al were "positive hotspot" regions.Guzhang,Hecheng,Dingcheng,Yueyang districts et al were "negative hotspot" regions.Spatial regression analysis revealed that the reported incidence of mushroom poisoning was positively correlated with the annual average temperate (Z=2.145,P=0.032),the number of health care institutions per capita (Z=2.352,P=0.019),and the number of students enrollment in secondary schools (Z=4.309,P＜0.001).It was negatively associated with the number of school staff and workers of secondary schools (Z=-2.626,P=0.009).Conclusion:The spatial distribution of mushroom poisoning cases in Hunan Province in 2015 is highly clustered.Mushroom poisoning cases are more prevalent in the middle and southern regions and less prevalent in the northern areas of the province.The annual average temperate and the number of students enrollment in secondary schools demonstrate a certain positive influence on the distribution of mushroom poisoning in Hunan.

Objective To report the treatment of type A3 distal tibiofibular fractures with the fibular posterolateral approach and minimally invasive percutaneous plate osteosynthesis (MIPPO).Methods We reviewed 61 patients with type A3 distal tibiofibular fracture (observation group) who had been treated with MIPPO and the fibular posterolateral approach from June 2011 to May 2015.Our control group included 78 patients with type A3 distal tibiofibular fracture who had been treated by traditional open reduction and internal fixation from April 2009 to September 2013.Interval between injury and surgery,surgical time,intraoperative bleeding,hospital stay,postoperative complications,X-ray Lane-Sandhu osteotylus score and limb weight-bearing score one year after operation were compared between the 2 groups.Results All the 139 patients were followed up for more than one year.There were significant differences between the 2 groups in terms of interval between injury and surgery (8.0 ± 3.5 h versus 140.7 ± 52.4 h),surgical time (66.2 ± 7.2 min versus 92.1 ±6.6 min),intraoperative bleeding (59.8 ± 12.8 mL versus 209.5 ±50.4 mL),hospital stay (9.4 ± 1.9 d versus 26.1 ± 15.7 d),postoperative complications,X-ray Lane-Sandhu osteotylus score (3.9 ±0.2 points versus 3.0 ±0.6 points) and limb weight-bearing score (3.9 ±0.1 points versus 3.0 ±0.7 points) one year after operation,favoring the observation group(P ＜ 0.001).Conclusions In the treatment of type A3 tibiofibular fractures,MIPPO plus the fibular posterolateral approach is superior to the traditional open reduction and internal fixation because it can benefit fracture healing by shortening the time for preoperative preparation,surgery and hospitalization,and decreasing the amount of intraoperative bleeding and the incidence of postoperative complications.

Hospital entrustment will incur cultural conflicts,which calls for cultural integration as the best means to ease such frictions and conflicts between two hospitals of cultural difference.Renmin Hospital of Wuhan University (Hubei general hospital)directly hosted Hanchuan people's hospital,and implemented the president responsibility system under the leadership of the management committee.By means of cultural integration to reshape Hanchuan hospital culture,Hubei general hospital has rebuilt the latter's culture.Such reshaping features the following:development as the core,scientific management as the breakthrough,employees as the center,technology upgrade as the basis,and patients service as the direction.Cultural integration has furthered development of the hospital entrusted,and turned frictions and conflicts into infiltration and integration.As a result,Hanchuan hospital is upgraded in general in terms of management and service quality.

Aim To study the protection and possible mechanism of 5-hydroxy-1 H-indazole against 1-methyl-4-phenylpyridinium iodide ( MPP+)-induced SH-SY5 Y cell apoptosis. Methods An apoptotic model was es-tablished in human neuroblastoma SH-SY5 Y by MPP+in vitro. MTT analysis was used to evaluate the protec-tive effect of 5-hydroxy-1H-indazole. Immunochemistry and Hoechst33258 nuclear staining were used to ob-serve the neuroprotection and anti-apoptosis of 5-hy-droxy-1H-indazole. Western blot was used to detect the levels of P-tau ( Ser396 ) closely related to neuronal apoptosis and its upstream kinases:P-GSK-3β and CDK5 . Results MPP+ induced activation of GSK-3β, increase of activity of CDK5 , tau hyperphosphory-lation and neuronal cell apoptosis. However,5-hydrox-y-1 H-indazole reduced the activities of GSK-3β and CDK5,then decreased the level of tau hyperphosphory-lation and inhibited MPP+-induced SH-SY5 Y cells ap-optosis. Conclusions 5-hydroxy-1H-indazole could attenuate MPP+-induced SH-SY5 Y neuronal cell apop-tosis. Possible mechanism is that 5-hydroxy-1H-in-dazole inhibits GSK-3βand CDK5 two signal transduc-tion pathways to lower the level of tau phosphorylation, then plays a role of neuroprotection.