ObjectiveTo develop a scale for evaluating the syndrome of internal retention of dampness and turbidity in nonalcoholic fatty liver disease （NAFLD） that combines disease and syndrome and has the characteristics of traditional Chinese medicine （TCM）. MethodsAn item pool was established for evaluating the syndrome of internal retention of dampness and turbidity in nonalcoholic fatty liver disease （NAFLD） with reference to the guideline for developing international scales. A clinical survey was conducted among the outpatients and inpatients who were diagnosed with NAFLD and had the syndrome of internal retention of dampness and turbidity in Department of Hepatology and Spleen-Stomach， The First Affiliated Hospital of Henan University of Chinese Medicine， from June to August， 2023， and the items were screened based on the classical test theory and the item response theory. An expert questionnaire was developed， and expert discussions were conducted using the Delphi method to identify the items for evaluating the syndrome of internal retention of dampness and turbidity in NAFLD. Finally， the scale was given scientific scores. ResultsA preliminary item pool was established， with 16 primary items and 22 secondary items， and it was divided into the two dimensions of disease and syndrome type. Clinical pre-survey suggested to retain 9 primary items and 14 secondary items， while the Delphi expert questionnaire recommended to retain 11 primary items and 15 secondary items， and tongue manifestation and pulse manifestation were no longer used for assessing the severity of syndrome. After hierarchical analysis and scientific assignment of scores， the scale for evaluating the syndrome of internal retention of dampness and turbidity in NAFLD had a total score of 123 points and 9 important items， i.e.， discomfort in the hypochondrium， abdominal fullness and distension， obesity， heaviness of the head and body， loose stool， anorexia， coughing up phlegm， nausea with a tendency to vomit， and lethargy. ConclusionA preliminary scale is established for evaluating the syndrome of internal retention of dampness and turbidity in NAFLD， which fills the gap in this research field and provides a basis for further clinical application.

Biliary fibrosis (BF) is the result of pathological repair of bile tract injury, characterized by thickening and sclerosis of the bile duct wall and progressive stricture of the lumen, which may ultimately lead to serious adverse outcomes such as biliary obstruction, biliary cirrhosis, liver failure, and hepatobiliary malignancies. Current research describes BF as a pathological feature of certain bile tract diseases, lacking a systematic summary of its etiology, pathophysiology, molecular mechanisms, and treatment. BF is a common but easily neglected disease state in biliary system, which may promote the development and progression of hepatobiliary diseases through abnormal repair mechanism after pathological biliary tract injury. Based on the latest research progress from both domestic and international perspectives, the authors review the concept, clinical manifestation, etiology, pathogenesis, and therapeutic strategies of BF to provide a reference for clinical physicians.

Objective To investigate the risk factors for the development of advanced liver fibrosis by analyzing the clinical features of patients with in nonalcoholic fatty liver disease(NAFLD)and advanced liver fibrosis,and to establish a nomogram model for predicting the risk of advanced liver fibrosis.Methods A retrospective analysis was performed for the clinical data of 406 NAFLD patients who attended The First Affiliated Hospital of Henan University of Chinese Medicine from January 2022 to October 2023,and according to whether liver stiffness measurement(LSM)measured by FibroScan was≥11.0 kPa,the patients were divided into advanced liver fibrosis group with 65 patients and non-advanced liver fibrosis group with 341 patients.Related data were collected,including general information,laboratory markers,and medical history.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.A multivariate Logistic regression analysis was used to identify independent risk factors,and a nomogram model was established based on these factors.The receiver operating characteristic(ROC)curve was used to evaluate the discriminatory ability of the nomogram model,and the calibration curve was used to evaluate its effectiveness.Results The univariate analysis showed that there were significant differences between the advanced liver fibrosis group and the non-advanced liver fibrosis group in age,controlled attenuation parameter(CAP),total bilirubin,direct bilirubin(DBil),indirect bilirubin,globin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase(ALP),gamma-glutamyl transpeptidase(GGT),glucose,body mass index(BMI),and history of diabetes(all P<0.05).The multivariate Logistic regression analysis showed that CAP(odds ratio[OR]=1.015,95%confidence interval[CI]:1.006-1.024,P=0.010),DBil(OR=1.345,95%CI:1.139-1.590,P=0.001),ALP(OR=1.019,95%CI:1.008-1.029,P=0.001),GGT(OR=1.004,95%CI:1.000-1.008,P=0.035)and BMI(OR=1.240,95%CI:1.137-1.353,P=0.001)were independent risk factors for the development of advanced liver fibrosis in NAFLD.A nomogram model was established based on the results of the multivariate Logistic regression analysis.The ROC curve analysis showed that this nomogram model had an area under the ROC curve of 0.841(95%CI:0.791-0.891)in predicting the development of advanced liver fibrosis in the NAFLD population,and the calibration curve showed a good degree of fitting between the observed and predicted values for the development of advanced liver fibrosis.Conclusion Elevated levels of CAP,BMI,DBil,ALP,and GGT are independent risk factors for advanced liver fibrosis in NAFLD.The nomogram model established based on these factors has good predictive performance and a certain value in predicting advanced liver fibrosis.

BACKGROUND: Hip arthroplasty is now an effective method of effectively solving the problem of femoral neck fracture in the elderly, but there is a risk of big trauma, high joint dislocation and postoperative complications. OBJECTIVE: To explore the application value of 3D printing guide plate in hip arthroplasty in the elderly by retrospective study and literature retrieval. METHODS: (1) Clinical data of 25 elderly patients with femoral neck fracture undergoing hip arthroplasty from February 2017 to October 2018 in Liaoning Jinqiu Hospital were retrospectively analyzed. In the guide plate group, 13 patients received hip arthroplasty using 3D printing guide plate. In the non-guide plate group, printing guide plate was not used in 12 cases. The application value of SuperPATH technique with 3D printing guide plate in hip arthroplasty in the elderly was observed. (2) Wanfang database was retrieved by the first author for studies published from 2000 to 2019. The key words were “3D, hip”. According to the inclusion criteria, 31 articles were selected to analyze the application value of 3D printing guide plate in hip arthroplasty in the elderly. RESULTS AND CONCLUSION: (1) The results of retrospective analysis showed that the operation time and the times of X-ray fluoroscopy were less in the guide plate group than those in the non-guide plate group (P < 0.05). Intraoperative blood loss and Harris score of hip function at the final follow-up were not significantly different between the two groups (P > 0.05). (2) Literature search results showed that 3D guide plates could be used to compensate for some defects of surgery in hip arthroplasty. There are many approaches to implement joint arthroplasty. Both conventional and minimally invasive approaches have direct anterior approach and posterolateral approach. According to several literature analysis, direct anterolateral approach can reduce trauma, and minimally invasive approach can reduce the risk of surgery. The above results show that the use of 3D printing guide plate in elderly hip arthroplasty can reduce the operation time and the times of intraoperative X-ray fluoroscopy, and the effect is better. 3D guide plate has application value in hip arthroplasty, and it has advantages in combination with minimally invasive techniques.

Objective To evaluate the satisfaction and current situation of advanced health assessment course for postgraduates. So that it can provide the evidence for the development of teaching reform. Methods Facilitating the convenient sampling of 69 nursing master′s degree authorized schools in China. And a further survey using self-designed questionnaires was conducted in the teacher who in charge of this course and 73 postgraduates in 17 schools offering Advanced Health Assessment. The data were analyzed using reliability, validity, frequency and percentage. Results There were 45 schools responded effectively, of which only 17 schools set up this course. There were no uniform norms of the teaching materials, hours and credits. 73 postgraduates were satisfied with the teaching methods, training practical abilities, meeting academic development needs, practicality, and commonality of the advanced health assessment course. However, 54.8％ of the students said the course is too difficult to handle. Conclusion All the schools should pay more attention to Advanced Health Assessment Course and improve the professional level of postgraduates.

Objective: To examine the regulatory effect of ginsenoside Rg1 (G-Rg1) on endoplasmic reticulum stress and its effect on hepatocellular apoptosis in carbon tetrachloride (CCl₄)-induced acute liver failure (ALF). Methods: Forty healthy, adult male C57/BL mice were randomly divided into normal saline control (NS) group, G-Rg1 blank control (G-Rg1) group, CCl₄ model (CCl₄) group, and G-Rg1 preventive treatment (CCl₄+G-Rg1) group, and an ALF mouse model was established by CCl₄ induction. Blood and liver specimens were collected from all mice upon sacrifice at 12 hours post-intraperitoneal injection. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST) and total bilirubin (TBil) levels were determined using commercial test kits. The mRNA expression of glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP) was measured using real-time PCR. The protein expression of GRP78, CHOP, caspase12, and caspase3 were measured by Western blot. Histological changes in the liver were assessed by hematoxylin-eosin staining, and the expression of GRP78 and caspase3 was detected by immunohistochemistry. Hepatocyte apoptosis was determined using terminal transferase dUTP nick end labeling. Quantitative data were analyzed using one-way ANOVA, and subsequent pairwise comparisons were performed using the LSD-t method. Results: Serum ALT, AST, and TBil levels in the CCl₄+G-Rg1 group were significantly reduced compared with those in the CCl₄ group (ALT: 691.30 ± 108.06 U/L vs 980.66 ± 110.29 U/L, F = 365.07, P < 0.05; AST: 195.40 ± 15.41 U/L vs 319.44 ± 89.32 U/L, F = 115.64, P < 0.05; TBil: 1.09 ± 0.11 mg/dl vs 1.56 ± 0.12 mg/dl, F = 211.29, P < 0.05). The relative mRNA expression of GRP78 and CHOP was significantly lower in the CCl₄ + G-Rg1 group than in the CCl₄ group (P < 0.05). The relative protein expression of caspase3, GRP78, caspase12, and CHOP was significantly reduced to different extents in the CCl₄+G-Rg1 group compared with those in the CCl4 group (P < 0.05). The CCl₄ + G-Rg1 group showed reduced liver tissue degeneration and necrosis compared with the CCl₄ group. Furthermore, the CCl₄+G-Rg1 group showed significantly fewer brown granules in the liver than the CCl4 group (P < 0.05), indicating that G-Rg1 preventive treatment reduced CCl₄-induced hepatocyte apoptosis. Conclusion G-Rg1 prophylaxis can inhibit inflammation and reduce hepatocyte necrosis and apoptosis during CCl₄-induced ALF. Its mechanism may involve the suppression of endoplasmic reticulum stress-related signaling molecules to alleviate hepatocyte endoplasmic reticulum stress and apoptosis. The results of this study suggest that G-Rg1 may inhibit liver inflammation and hepatocyte apoptosis through multiple targets to protect liver function.

Purpose To study of predictive value for detection of high-grade cervical intraepithelial neoplasia (CIN2 +) by p16/Ki-67 dual-stained liquid-based cytology.Methods Random collection of 123 women including 103 samples of atypical squamous cell of undetermined significance (ASC-US) and above with results of high-risk human papillomavirus (HR-HPV)testing and cervical biopsy,20 samples of negative for intraepithelial lesion or malignancy (NILM) by using immunocytochemical p16/Ki-67 dual-stained and the morphology assessment.Results In normal control group,the expression of p16/Ki-67 dual-stained in squamous epithelial cells were negative.Sensitivity of p16/Ki-67 dual-staind cytology for biopsy-confirmed CIN2 + was 66.67％ (ASC-US),91.67％ (LSIL) and 92.86％ (HSIL),specificity rates were 95.92％ (ASC-US),95.00％ (LSIL) and 0 (HSIL),positive predictive value were 50.00％ (ASC-US),91.67％ (LSIL) and 92.86％ (HSIL),negative predictive value were 97.92％ (ASC-US),95.00％(LSIL) and 0 (HSIL),respectively.Condusion p16/Ki-67 dual-stained cytology are improved obviously the predictive value for detection of CIN2 +,p16/Ki-67 dual-stained cytology may efficiently complement HPV-based screening programs to prevent cervical cancer.

Objective To investigate the diagnostic value of DNA ploidy analysis combined with immunocytochemistry p16/ki-67 double staining in cervical high grade squamous intraepithelial neoplasia(HSIL) and cervical squamous cell carcinoma(SCC).Methods A total of 73 cases of cytological tests were randomly collected.Among them,53 cases were small DNA ploidy abnormal cells and 20 cases were DNA ploidy negative.The p16/Ki-67 results were detected by immunocytochemistry double staining.With the pathological results as the golden standard,the diagnostic values of DNA ploidy analysis and DNA ploidy analysis combined with p16/Ki-67 double staining in HSIL + was contrastively analyzed by pathologic results.Results Among 20 samples of DNA ploidy negative,the p16/Ki-67 double staining results all were negative.The positive predictive value of DNA ploidy analysis for HSIL + was 34.62％.The sensitivity of DNA ploidy analysis combined with p16/Ki-67 double staining for HSIL + was 84.62％,and its specificity was 92.31％,the positive predictive value was 78.57％ and the negative predictive value was 94.74％,which were significantly higher than those of DNA ploidy analysis(P＜0.05).Conclusion p16/Ki-67 double staining can significantly im prove the prediction value of HSIL.The DNA ploidy analysis combined with p16/Ki-67 double staining is an effective method for predicting HSIL +,which is suitable for the implementation in the areas with lack of medical resources.

DNA End-Joining Repair ; Humans ; Immunologic Deficiency Syndromes ; genetics