Discussion on treatment of liver fibrosis with traditional Chinese medicine from the perspective of gut microbiota

Liver fibrosis is the key stage of various chronic liver diseases, and its occurrence and development are closely related to the imbalance of the gut microbiota. In terms of treatment, there is still a lack of ideal chemical drugs, but traditional Chinese medicine has shown unique clinical efficacy in the treatment of hepatic fibrosis. In recent years, research on the regulation of the gut microbiota by traditional Chinese medicine has attracted widespread attention in the academic community. The primary target of the active ingredients of traditional Chinese medicine compound in hepatic fibrosis may be the gut microbiota, or they exert biological effects through the intestinal flora medium and the characteristic reconstruction of the gut microbiota. From the perspective of the "gut-liver axis", the therapetuic effect of traditional Chinese medicine on liver fibrosis is closely connected with regulating the intestinal flora and "treating the liver and spleen together". Based on the viewpoint of the gut-liver axis, this paper discusses the anti-hepatic fibrosis effects of traditional Chinese medicine and its active ingredients by regulating the gut microbiota, with an aim to provide a new research perspective for the therapetuic effect of traditional Chinese medicine on hepatic fibrosis.

[Predictive value of plasma exosomal miR-124-3p for the risk of chronic cerebral hypoperfusion]

Objective: To investigate the predictive value of plasma exosomal microRNA (miR)-124-3p in the risk of chronic cerebral hypoperfusion (CCH). Methods: A case-control study. Thirty patients who were diagnosed with CCH (CCH group) based on cranial artery spin labeling (ASL) in the neurology outpatient clinic of Sichuan Provincial People's Hospital from March 2022 to June 2022 and 30 healthy volunteers (control group) were included. Age, gender, smoking history, alcohol consumption history, diabetes history, hypertension, hyperlipidemia history, uric acid, fasting blood glucose, homocysteine and plasma exosomal miR-124-3p expression level were compared between the two groups. Comparisons of categorical variables were analyzed by either χ2 test or Fisher's exact test. If the data of continuous variables followed a normal distribution, they were expressed as mean±standard deviation (SD) and compared by t-test for two independent samples; otherwise, the data were expressed as M(Q1, Q3), and analyzed by Mann-Whitney U test for comparison between two groups. The correlation between cerebral blood flow and exosomal miR-124-3p levels was analyzed by Pearson's correlation. Binary multifactorial logistic regression analysis was used to determine the risk factors associated with CCH, and corresponding odds ratios (OR) and 95% confidence intervals (CI) were calculated. P<0.05 was considered significant. Results: There was no significant difference in age (64±8 vs. 60±8 years old), gender (33.3% vs. 30.0%), history of smoking (20.0% vs. 3.3%), alcohol consumption (20.0% vs. 6.7%), diabetes mellitus (13.3% vs. 13.3%), hypertension (53.3% vs. 30.0%), history of hyperlipidemia (46.7% vs. 36.7%), uric acid (288±60 vs.319±67 μmol/L), and fasting glucose [4.99(4.63, 5.91) vs. 5.28(5.09, 6.05) mmol/L] and homocysteine [11.35(10.18, 13.08) vs.11.00(9.78, 13.03) μmol/L] between the CCH and control groups (P>0.05). Plasma exosomal miR-124-3p expression was significantly higher in the CCH group than in the control group [13.08 (8.59, 21.55) vs. 2.85 (1.44, 5.10), respectively; U=169.50, P<0.001]. Pearson's correlation test showed that the level of exosomal miR-124-3p was negatively correlated with cerebral blood flow in the hypoperfused region in patients with CCH (r=-0.932, P<0.001). Multi-factor logistic regression analysis showed that plasma exosomal miR-124-3p was independently associated with the risk of CCH (OR=1.169,95%CI 1.063-1.286,P=0.001). Conclusions: The expression of plasma exosomal miR-124-3p is negatively correlated with cerebral blood flow in areas of low perfusion and is an independent risk factor for CCH. Plasma exosomal miR-124-3p may thus serve as a valid biomarker for CCH risk prediction.

[Clinicopathological features of verrucous hemangioma]

Objective: To investigate the clinicopathological features, and differential diagnosis of verrucous hemangioma (VH). Methods: Twenty-eight VH cases diagnosed from 2005 to 2020 in Henan Provincial People's Hospital, Zhengzhou, China were analyzed retrospectively. Immunohistochemical studies were used to detect diagnostic markers. The mutation status of PIK3CA (exons 9 and 20) was detected using fluorescence PCR. Results: There were 13 males and 15 females in 28 cases, with the male to female ratio of 1.0∶1.2. There were 25 patients under the age of 18 years. The age range was from 10 months to 56 years (mean, 9.7 years; median, 4.5 years). There were 17 cases occurred in the lower extremities, 7 in the upper extremities and 4 in the trunk. All 28 cases were irregular red patches on the skin, which grew slowly. Some of them were thickened with uneven surface, which was light pink or red-white. Skin lesions of the 7 cases ranged from dark red and reddish brown, with a rough and hard surface. Satellite foci were present. Microscopically, 28 cases had a wide range of pathological features. Dilated, malformed vessels were observed from dermal papilla to deep soft tissue. Among them, the dermal papillary layer was mainly composed of many proliferating and expanding thin-walled capillaries and cavernous blood vessels. Thin-walled small vessels were found in the dermal reticular layer and subcutaneous fascia layer, with no obvious endothelial cell proliferation, occasional papillary hyperplasia, and lobular distribution of the malformed vessels in the fascia layer mixed with the fibroadipose tissue. There was epidermal papillary hyperplasia with hyperkeratosis and parakeratosis, lengthening and mutual fusion of epithelial horns. Immunohistochemistry showed that CD31, CD34, ERG and WT-1 were diffusely and strongly positive. The expression of GLUT-1 was present in superficial dermal vascular endothelial cells, but undetectable in the deep layer. The PIK3CA tests of 13 cases showed that no somatic mutations were found in exons 9 and 20. Twenty-five patients were followed up for 5 months to 10 years. Seven patients underwent multiple surgical resections and plastic surgeries due to the large size, and 8 patients had recurrence. Conclusions: VH is a rare congenital vascular malformation and more commonly occurs in infants and children. It tends to appear in limbs, especially lower limbs and distal limbs. Its morphology and immunophenotype are characteristic and should be distinguished from other vascular malformations and the resolution phase of infant hemangiomas. In about one third of the cases, postoperative recurrence may occur and long-term follow-up is often required.

[Application of pump-controlled retrograde trial off in weaning from veno-arterial extracorporeal membrane oxygenation in adult patients]

Objective: To Summarize the experience of pump-controlled retrograde trial off (PCRTO) in the process of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) withdrawal in adult patients. Methods: Adult patients who received ECMO assistance in Intensive Care Unit for Cardiac Surgery from March to July 2019 were collected. According to our strategies, PCRTO was used if the patients can wean from VA-ECMO and hemodynamic indexes were recorded during the process. The statistics data was collected, including the 48 hours survival rate, ECMO re-assistance rate, thrombus complications, Intensive Care Unit (ICU) stay time and hospital stay time after weaning from VA-ECMO. The patients who failed in the test were continued to be assisted by ECMO. Results: There were 46 patients assisted by VA-ECMO in our center. In total, 21 adults who met the offline test standard underwent 26 PCRTOs, including 10 male adults (47.6%), with an age of 65 (55, 68) years old. Eighteen adults passed the withdrawal test. No new thrombus was found in the arteriovenous ultrasound of the lower extremity after weaning from ECMO, and no pulmonary embolism was found in the chest X-ray. The success rate of weaning from ECMO was 69.23%(18/26). The D-dimer decreased [584(348,2 107)μg/L vs 1 440(631,2 916)μg/L, P=0.014] and the left ventricular ejection fraction (LVEF) increased (51.4%±8.5% vs 46.9%±10.6%, P=0.013) on the next day after weaning. There were significant differences in heart rate (HR), central venous pressure (CVP), oxygenation index and lactate (Lac) during the PCRTO in the group which involved the cases of the 8 failed experiments (all P<0.05). Compared with the failure group, there were significant differences in age, blood flow rate, CVP before the test, HR, pulse oxygen saturation(SpO(2)), CVP, Lac and oxygenation index after the test, and the variations of SpO(2), CVP and Lac. Conclusion: PCRTO is a simple, reversible, safe and effective weaning method. It can be used in the process of VA-ECMO withdrawal in adult patients.

Environmental Exposure-Associated Human Health Risk of Dioxin Compounds in the Vicinity of a Municipal Solid Waste Incinerator in Shanghai, China

In order to assess environmental exposure-associated human health risk of dioxin compounds for the population in the vicinity of a municipal solid waste incinerator (MSWI) in Shanghai, the atmospheric samples (n = 24) and soils samples (n = 96) were collected and analyzed to obtain the concentration level, pollution characteristics and seasonal changes of dioxin compounds in environmental medias. The toxicity equivalent concentration range of 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) was 30.9-409 fg WHO-TEQ·m^-3 in atmosphere and 0.362-8.55 ng WHO-TEQ·kg^-1 in soil. The non-carcinogenic health risk and carcinogenic health risk from PCDD/Fs environmental exposure of people living in the vicinity of the MSWI in Shanghai were all within the allowable range of the US Environmental Protection Agency, which implied that the MSWI in Shanghai did not produce additional risk for the population living in its vicinity.

Molecular Detection of Theileria species in Cattle from Jilin Province, China

Bovine theileriosis is a tick-borne disease that is hampering the development of the domestic cattle industry in northern China. This study involved a molecular survey of bovine Theileria species in 137 blood samples from cattle in the Jilin province of China. The DNA samples were screened by species-specific 18S rRNA PCR. Results revealed that 19.7% (27/137), 17.5% (24/137) and 10.9% (15/137) were found to be infected with Theileria sinensis, Theileria orientalis, respectively. Mixed infection was found in 8.8% (12/137). The overall detection rates of Baishan, Yanji, Jilin and Liaoyuan districts was 60.0%, 17.5%, 5.3% and 0%, respectively. There is little information on the detection and distribution of bovine Theileria species in northern China. Therefore, this study provides important data for understanding the epidemiology of Theileria species and designing appropriate approaches for the diagnosis and control of bovine theileriosis in northern China.

[Preventive effects of ulinastatin on acute respiratory distress syndrome]

OBJECTIVE

To explore the effect of ulinastatin on prevention of acute respiratory distress syndrome (ARDS).

METHODS

A prospective multicentral cohort study was conducted. The patients from three intensive care units (ICUs) of grade A tertiary hospitals in Beijing and a ICU of grade A tertiary hospitals in Cangzhou from January 2012 to December 2014, included 77 ARDS at-risk patients with ulinastatin treatment and 108 ARDS at-risk patients without ulinastatin treatment (control) were eligible. Both groups received normal treatment; additionally, the intervention group received 600 000 units of ulinastatin via intravenous infusion for 5 days. The control group received the same amount of saline via intravenous infusion for 5 days. Venous blood human neutrophil elastase (HNE) and peptidase inhibitor 3 (PI3) levels were measured on days 1, 3, and 7, respectively. Other outcomes included acute physiology and chronic health evaluation scoring II (APACHE II), body temperature, respiratory rate, heart rate, mean arterial pressure, white blood cell counts, PaO₂/FiO₂, ARDS incident, mechanical ventilation time, ICU treatment and hospitalization duration, 28 days mortality.

RESULTS

The PI3 levels showed no statistical difference on day 1, but significant differences on day 3 and day 7 between the two groups (P<0.01). HNE/PI3 ratio showed no statistical difference on day 1, but significant differences on day 3 and day 7 (P<0.05). PaO₂/FiO₂ was significantly higher in ulinastatin group on day 3 and day 7 (P<0.05). The incident rate for ulinastatin group was 15.58%, lower than that for the control group (33.33%), and the difference was statistically significant (P<0.05). The mechanical ventilation time and ICU treatment time in ulinastatin group was shorter than that in the control group, and the difference was statistically significant (P<0.05). There were no significant effects in other factors.

CONCLUSION

Increased dose of ulinastatin can recover the balance of HNE and its antagonist, lower the HNE's damage to lungs, and further reduce the ARDS incident rate.

[Preventive effects of ulinastatin on acute respiratory distress syndrome]

OBJECTIVE

To explore the effect of ulinastatin on prevention of acute respiratory distress syndrome (ARDS).

METHODS

A prospective multicentral cohort study was conducted. The patients from three intensive care units (ICUs) of grade A tertiary hospitals in Beijing and a ICU of grade A tertiary hospitals in Cangzhou from January 2012 to December 2014, included 77 ARDS at-risk patients with ulinastatin treatment and 108 ARDS at-risk patients without ulinastatin treatment (control) were eligible. Both groups received normal treatment; additionally, the intervention group received 600 000 units of ulinastatin via intravenous infusion for 5 days. The control group received the same amount of saline via intravenous infusion for 5 days. Venous blood human neutrophil elastase (HNE) and peptidase inhibitor 3 (PI3) levels were measured on days 1, 3, and 7, respectively. Other outcomes included acute physiology and chronic health evaluation scoring II (APACHE II), body temperature, respiratory rate, heart rate, mean arterial pressure, white blood cell counts, PaO2/FiO2, ARDS incident, mechanical ventilation time, ICU treatment and hospitalization duration, 28 days mortality.

RESULTS

The PI3 levels showed no statistical difference on day 1, but significant differences on day 3 and day 7 between the two groups (P<0.01). HNE/PI3 ratio showed no statistical difference on day 1, but significant differences on day 3 and day 7 (P<0.05). PaO2/FiO2 was significantly higher in ulinastatin group on day 3 and day 7 (P<0.05). The incident rate for ulinastatin group was 15.58%, lower than that for the control group (33.33%), and the difference was statistically significant (P<0.05). The mechanical ventilation time and ICU treatment time in ulinastatin group was shorter than that in the control group, and the difference was statistically significant (P<0.05). There were no significant effects in other factors.

CONCLUSION

Increased dose of ulinastatin can recover the balance of HNE and its antagonist, lower the HNE's damage to lungs, and further reduce the ARDS incident rate.

Combinatorial biochemical and chemical analyses of polychlorinated dibenzo-p-dioxins and dibenzofurans in agricultural soils from Chongming Island, Shanghai, China

We compared polychlorinated dibenzo-p-dioxin and dibenzofuran (PCDD/F) concentrations [expressed as toxic equivalent quantities (TEQs)] in agricultural soil samples from Chongming Island (Shanghai, China) determined using two analytical approaches, an enzyme-linked immunoassay (EIA) method and a high resolution gas chromatography-high resolution mass spectrometry (HRGC/HRMS) method. The PCDD/F concentrations in all 31 soil samples were at background levels (7.30-16.7 pg EIA-TEQ/g from the EIA analysis and 0.526-1.99 pg WHO-TEQ/g from the HRGC/HRMS analysis). Although, the EIA method overestimated the PCDD/F concentrations compared with the concentrations determined using the HRGC/HRMS method. The absence of false-negatives showed by the EIA analysis verified that this method is useful for preliminary sample screening (prior to HRGC/HRMS analysis) and the preliminary characterization of potentially contaminated sites.

Levels of PCDD/Fs in agricultural soils near two municipal waste incinerators in Shanghai, China

A study was conducted on polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDD/F) in agricultural soils at 41 sites within a radius of 3 km from two municipal solid waste incinerators in Shanghai. The PCDD/F concentrations ranged from 71.32 to 3,881.44 pg g⁻¹ (0.64-61.15 pg I-TEQ g⁻¹). The highest PCDD/F concentrations were found approximately 1,000 m from the municipal solid waste incinerators. The PCDD/F homologue profiles of all soil samples were compared with the profiles from suspected PCDD/F sources by multivariate statistical analysis. The results showed that, the PCDD/F pollutions in some soil samples can be attributed to emissions from the municipal solid waste incinerators.

Polychlorinated dibenzo-p-dioxins, dibenzofurans and dioxinlike biphenyls in sediments from the Suzhou Creek, China

Polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and biphenyls (PCBs) were detected in sediments from Suzhou Creek with mean concentrations of 478.1, 245.1, and 4727.6 pg/g dw, respectively. WHO-TEQ concentrations of PCDD/Fs in sediments ranged from 2.90 to 13.96 pg/g dw, while TEQ concentrations of PCBs varied from 0.27 to 1.41 pg/g dw. OCDD or HpCDD were the dominant congeners but PeCDF or HpCDD was the major contributor to PCDD/Fs-TEQ in all the sites. For dioxinlike biphenyls, PCB 118 was the major congener while PCB-TEQ was attributable to PCB 126 in all the samples.