Type 1 diabetes mellitus is a chronic autoimmune disease, requiring glucose monitoring and intensive insulin therapy. Its therapeutic management aims to restore normal HbA1C and stabilize prandial and postprandial glucose levels. The burden of self-management of diabetes is high, and the growing requirement for blood glucose measuring devices presents a challenge. Such devices can continuously monitor glucose concentrations and automatically adjust insulin delivery rates, which in turn help to maintain blood glucose within a healthy range. The artificial pancreas system (so-called APS) technology has evolved rapidly over the past few years, capable of providing effective management of diabetes to improve quality of life of the type 1 diabetes mellitus patients. This review discusses the evolution of the APS technology and its progress in the various components: continuous subcutaneous insulin infusion, mathematical model, real-time continuous glucose monitoring, and control algorithms driving closed-loop control systems. The limitations and the proposed future directives are also discussed.

Hepatitis E virus (HEV) is a global health problem, affecting about 20 million people worldwide. There is significant overlap of hepatitis B virus (HBV) and HEV endemicity in many Asian countries where dual infections with HEV and HBV can occur. Though the clinical course of HEV is largely self-limited, HEV superinfection in patients with chronic hepatitis B (CHB) can result in acute exacerbation of underlying CHB. HEV superinfection in patients with CHB-related cirrhosis has been identified as a risk factor for decompensated cirrhosis and an independent predictor of mortality. Whereas acute HEV infection in pregnancy can cause fulminant liver failure, the few studies on pregnant patients with dual HBV and HEV infection have shown a subclinical course. Immunosuppression is a risk factor for the development of chronic HEV infection, which can be managed by decreasing the dose of immune-suppressants and administering ribavirin. Vaccination for HEV has been developed and is in use in China but its efficacy in patients with CHB has yet to be established in the USA. In this review, we appraise studies on dual infection with HEV and HBV, including the effect of HEV superinfection and coinfection in CHB, management strategies used and the role of active vaccination in the prevention of HEV.

The incidence rate and mortality of liver fibrosis caused by various etiologies are high throughout the world. Liver fibrosis, the subsequent cirrhosis and other serious related complications threaten the health of patients and represent a serious medical burden; yet, there is still a lack of approved methods to prevent or reverse liver fibrosis. Therefore, effective hepatic antifibrotic drugs are urgently needed. The activation and proliferation of hepatic stellate cells are still the mechanisms of fibrosis that remain the focus of therapeutic research. In recent years, significant progress has been made in the development and applicability of antifibrosis drugs. In this review, we summarize the effectiveness and safety of available antifibrosis drugs utilizing different targets. In addition, some characteristics of antifibrosis drugs in phase II and III trials are introduced in detail.

Microglia activation can cause degeneration of retinal ganglion cells (RGCs). This study aimed to investigate the potential therapeutic effect of minocycline on microglia activation-related degeneration of RGCs in both retinas after unilateral optic nerve crush (ONC) in the left eye of male adult C57BL/6 mice.

First, the primary degeneration of RGCs after unilateral ONC in the left eye and the secondary degeneration of RGCs in the contralateral eye were investigated. Second, microglia activation in both eyes was examined longitudinally at 1, 5 and 14 days post-ONC. Finally, the effects of minocycline treatment on the primary or/and secondary RGC degeneration as well as the function of both retinas (estimated by flash electroretinogram) at 5 days post-ONC were analyzed.

The results indicated that ONC induced the primary RGC degeneration, which was more severe than the secondary RGC degeneration and microglia activation in both eyes. Treatment with minocycline partially inhibited microglia activation, preserved the function of retinas in both eyes, and delayed the secondary degeneration of RGCs in the contralateral retina.

ONC caused RGC degeneration in both eyes of mice. Minocycline treatment delayed the secondary degeneration of RGCs and improved the function of both retinas post-ONC in mice, which were associated with inhibition of microglia activation.

To discuss the possible underlying mechanism of the effect of Pien Tze Huang capsules (PTHCs) against coronavirus disease 2019 (COVID-19) using network pharmacology research methods.

Through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), in this study, we searched for the active ingredients of PTHC, including Sanqi (Panax notoginseng), Shedan (snake's bile), Niu-huang (Calculus Bovis or ox bezoars), and musk, as well as information on the corresponding targets. The GeneCards database was used to obtain relevant information on COVID-19 targets. The search tool for the retrieval of interacting genes/proteins (STRING) database was used to draw the protein−protein interaction network, and the R Programming Language was used to carry out gene ontology functional enrichment analysis and the Kyoto encyclopedia of genes and genomes pathway enrichment analysis.

In PTHC, there were 12 compounds that met the conditions and 232 gene targets. Along with the 394 gene targets associated with COVID-19, there were 41 potential targets related to the PTHC ingredients against COVID-19. The key targets included RELA, interleukin (IL)-6, IL-1β, mitogen-activated protein kinase (MAPK) 1, and C-X-C motif chemokine ligand 8, whereas the potential signaling pathways were nuclear factor-κB, cytokine-cytokine receptor interaction, the hypoxia-inducible factor 1 signaling pathway, the chemokine signaling pathway, and the MAPK signaling pathway.

PTHCs have the potential to combat COVID-19 by modulating key targets and potential signaling pathways that regulate immune function, providing theoretical support for more TCM treatments against COVID-19.

Hepatic cirrhosis complicated by hypocalcemia is a common electrolyte disorder and a sign of severe disease. This article summarized the pathophysiological research progress of cirrhosis: systemic vasodilation, water balance and effect of antidiuretic hormone, non-osmotic stimulation of the renin-angiotensin-aldosterone system, sympathetic nervous system. At the same time, we discussed the mechanism and clinical symptoms of hyponatremia complicated with hepatorenal syndrome and hepatic encephalopathy. Finally, we summarized the treatment progress of cirrhosis complicated with hypocalcemia from the aspects of water restriction, hypertonic Saline, correction of hypokalemia, albumin infusion, drug therapies. In this way, we hope to provide a reference for the diagnosis and treatment of liver cirrhosis complicated by hypocalcemia.

With the development of clinical practice and transformation of the medical model, traditional Chinese medicine (TCM) research has attracted considerable attention. Randomized controlled trials of traditional Chinese medicine are unable to meet the need of clinical research, while the real-world studies are more in accordance with the characteristics of traditional Chinese medicine research. In this paper, the concept and characteristics of real-world studies, characteristics of traditional Chinese medicine research, and the advantages of and the application of real-world studies in the clinical research of traditional Chinese medicine, were reviewed to provide new ideas for TCM research.

Based on the concept of traditional Chinese medicine diet health, in the context of the COVID-19 epidemic, help people with wet constitution to identify their own constitutions, and preliminarily put forward guidance and Suggestions for people with wet constitution to improve their biased constitution by adjusting diet. Under the guidance of Wang Qi, the master of Chinese medicine, and Sun Guangrong, the master of Chinese medicine, "Health is achieved by going with nature", dietary Suggestions for different people with wet constitutions are put forward from the perspective of TCM health maintenance. Specifically including different physical conditions, different seasons and different regions, more comprehensive and systematic guidance for people with wet physical conditions to adjust their diet structure, to help them maintain a healthy state in this epidemic.

The heterogeneity of hepatocellular carcinoma (HCC) has become a scientific problem, which must be solved urgently. Formerly, HCC prevention mainly focused on the HCC cells themselves but in recent years, HCC prevention based on the HCC microenvironment is the new strategy. Focusing on the liver regeneration microenvironment of HCC rather than just HCC cells may be a breakthrough in the study of HCC tumor heterogeneity and the prevention and treatment of HCC.

With mortality rates of liver cancer doubling in the last 20 years, this disease is on the rise and has become the fifth most common cancer in men and the seventh most common cancer in women. Hepatocellular carcinoma (HCC) represents approximately 90% of all primary liver cancers and is a major global health concern. Patients with HCC can be managed curatively with surgical resection or with liver transplantation, if they are diagnosed at an early stage. Unfortunately, most patients with HCC present with advanced stages of the disease and have underlying liver dysfunction, which allows only 15% of patients to be eligible for curative treatment. Several different treatment modalities are available, including locoregional therapy radiofrequency ablation, microwave ablation, percutaneous ethanol injection, trans-arterial chemoembolization, transarterial radio-embolization, cryoablation, radiation therapy, stereotactic radiotherapy, systemic chemotherapy, molecularly targeted therapies, and immunotherapy. Immunotherapy has recently become a promising method for inhibiting HCC tumor progression, recurrence, and metastasis. The term “Immunotherapy” is a catch-all, encompassing a wide range of applications and targets, including HCC vaccines, adoptive cell therapy, immune checkpoint inhibitors, and use of oncolytic viruses to treat HCC. Immunotherapy in HCC is a relatively safe option for treating patients with advanced disease in the USA who are either unable to receive or failed sorafenib/lenvatinib therapy and thus may offer an additional survival benefit for these patients. The purpose of this review is to elaborate on some of the most recent advancements in immunotherapy.

The lineage of the erythroid cell has been revisited in recent years. Instead of being classified as simply inert oxygen carriers, emerging evidence has shown that they are a tightly regulated in immune potent population with potential developmental plasticity for lineage crossing. Erythroid cells have been reported to exert immune regulatory function through secreted cytokines, or cell-cell contact, depending on the conditions of the microenvironment and disease models. In this review, we explain the natural history of erythroid cells in the liver through a developmental lens, as it offers perspectives into newly recognized roles of this lineage in liver biology. Here, we review the known immune roles of erythroid cells and discuss the mechanisms in the context of disease models and stages. Then, we explore the capability of erythroid lineage as a cell source for regenerative medicine. We propose that the versatile lineage of erythroid cells provides an underappreciated and potentially promising area for basic and translational research in the field of liver disease.

This review discusses the efficiency and sensitivity of 68Ga-labelled prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) imaging in comparison to other radiotracers and imaging techniques. It also conveys its impact on the treatment or management of prostate cancer patients. PSMA, observed in almost all prostate cancer cells, is used for staging and treatment, due to its high multiplication in this cancer when compared to normal tissues. PSMA PET/magnetic resonance imaging (MRI) has applications in the management of prostate cancer. Though PSMA PET/MRI has yielded preliminary results, it is still studied as an imaging biomarker for tumor responses. PSMA-PET/CT is known for its highly sensitive resolution, as it lights up only the parts harboring prostate cancer or tumor cells and not any other kind of lesion. Therefore, 68Ga-PSMA-PET imaging is chosen over other variants of 68Ga-PSMA-11, such as 177Lu-PSMA or 225Ac-PSMA, and it is used for its greater ability to detect metastatic sites in patients with biochemical recurrence and low serum prostate-specific antigens values. The efficacy of 68Ga-PSMA PET/CT also allows for estimation of oligometastases, as it supports the design of therapeutic trials in measuring long-term effects in patients. Finally, 68Ga-PSMA PET/CT is effective in identifying recurrence localization and, hence, permits the ability to choose the best therapeutic strategy as early as possible.

In addition to liver injury, elevation of aminotransferases can be caused by strenuous exercise and use of muscle-building and weight-loss supplements. The purpose of this review is to discuss the various mechanisms of elevation of aminotransferases related to body building. A literature review was performed on clinical trials and case reports involving exercise or supplement use and their effects on aminotransferases. Normal aminotransferase levels varied according to gender, age, body mass index, and comorbidities. Strenuous exercise and weight lifting, especially in the unaccustomed, can cause elevated aminotransferases in the absence of liver damage. Supplements such as anabolic steroids, ephedra, and LipoKinetix, amongst others, have also been associated with aminotransferase elevations. The pattern of elevation of aminotransferases is not helpful in distinguishing liver from muscle injury. Other associated muscle enzymes can be useful in making that distinction. To prevent aminotransferase elevations, subjects not accustomed to moderate-high intensity workouts, are recommended to undertake gradual increase in intensity. When causes of liver injury have been ruled out, investigation into bodybuilding, extreme exercise, and supplement use is warranted.

Xia Sang Ju (XSJ) granule, a Chinese drug and herbal tea made up of Prunellae spica (Xia Ku Cao), Mori folium (Sang Ye), and Flos Chrysanthemi Indici (Ye Ju Hua), is commonly used for fever, headache, and sore throat. The underlying pharmacological mechanism of XSJ on hypertension treatment is described here, based on network pharmacology.

The compounds in XSJ were searched using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (commonly known as TCMSP), and the active components, according to oral bioavailability and drug likeness, were screened. Compounds targets were predicted by the SwissTargetPrediction web server, while hypertension targets were collected from the Online Mendelian Inheritance in Man (commonly known as OMIM) and GeneCards databases. The interaction of targets was analyzed by STRING. The compound-compound target network was constructed by Cytoscape. Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes (commonly known as KEGG) pathways were analyzed by the Database for Annotation, Visualization and Integrated Discovery (commonly known as DAVID).

Forty-five active compounds were obtained from 359 ingredients present in the XSJ decoction, corresponding to 237 targets. In addition, 189 genes were found to be related to hypertension, of which 11 overlapped with XSJ targeted by 28 compounds and were thus considered therapeutically-relevant. ESR2 was the most frequent gene targeted by the compounds, while NR3C1 showed the most interaction with other genes. These results revealed that the anti-hypertensive activity of XSJ may directly relate to the regulation of several hypertension-associated biological processes and pathways, such as cellular nitrogen compound biosynthetic process, positive regulation of the nitrogen compound metabolic process, steroid hormone biosynthesis, and aldosterone-regulated sodium reabsorption.

These findings provide a reference for further interpretation of the potential mode of action of XSJ against hypertension and serve as an example for elucidation of the Traditional Chinese Medicine concept of “multiple compounds-multiple targets-multiple effects”.

In recent years, there has been a significant increase in the incidence of peptic ulcer cases among military personnel. It is important for clinicians to identify the risk factors of peptic ulcer and then implement the appropriate prophylactic measures in a timely manner. This study aims to systematically review the risk factors of peptic ulcer in military personnel.

We searched literature from the PubMed, EMBASE, Wanfang, China National Knowledge Infrastructure, and VIP databases up to November 17, 2019. Eligible studies analyzed at least one risk factor of peptic ulcer in military personnel with descriptive or comparative data. The risk factors’ data were then extracted and tabulated.

Of the 1,008 studies initially identified, 11 were eligible for the present study. The total sample size was 29,925 (ranging from 203 to 10,046). The study population included military officers and soldiers, pilots, armed policemen, and firefighters. The most studied risk factor of peptic ulcer was history of smoking (n = 8), followed by high-intensity training (n = 5), mental stress (n = 5), family history of peptic ulcer (n = 4), history of alcohol drinking (n = 4), and use of non-steroidal anti-inflammatory drugs (n = 4).

Several major risk factors of peptic ulcer have been systematically identified, of which some are modifiable. In the future, proper intervention of these modifiable risk factors may be helpful in preventing military personnel from the development of peptic ulcer.

Acute kidney injury (AKI) occurs frequently in patients with cirrhosis, and hepatorenal syndrome (HRS) is second most common etiology of AKI after volume responsible pre-renal etiology. AKI in these patients negatively impacts pre- and post-transplant patient survival and healthcare burden. Reduced effective blood volume with consequent reduced renal blood flow, along with systemic inflammation in patients with decompensated cirrhosis, result in susceptibility to HRS. In this article, we will review updates over the last 5 years on the changing definition with diagnostic criteria and nomenclature of AKI and HRS, data on medical treatment with vasoconstrictors, and urinary biomarkers in diagnosis of etiology of AKI. We will also discuss the significance of liver transplantation evaluation once the diagnosis of HRS is established and the post-transplant immunosuppression management. We will also review one of the challenging issues that remains among transplant-eligible patients, that of allocation of simultaneous liver kidney transplant. Finally, we will review the new implemented policy from the Organ Procurement Transplant Network on simultaneous liver kidney allocation.

Background and Aims: Evaluation of significant liver fibrosis is important for treatment decision and treatment response evaluation in patients with chronic hepatitis B. Since liver biopsy is invasive and transient elastography (TE) has limited availability, various non-invasive blood parameters need evaluation for their capabilities for detection of significant fibrosis.

Methods: In this retrospective study, records of patients who had undergone liver biopsy for treatment-naïve chronic hepatitis B were evaluated to obtain various non-invasive blood parameters (aspartate aminotransferase-to-platelet ratio index [referred to as APRI], Fibrosis-4 score [referred to as FIB-4], gamma-glutamyl transpeptidase-to-platelet ratio [referred to as GPR], and gamma-glutamyl transpeptidase-to-albumin ratio [referred to as GAR]), in addition to TE, to assess significant liver fibrosis and compare these to fibrosis stage in liver biopsy.

Results: A total of 113 patients were included in the study (median age 33 [interquartile range: 11-82 years], 74% males). Most (75%) patients were HBeAg-negative. The liver biopsy revealed significant fibrosis (Ishak ≥3) in 13% of the patients and nil or mild fibrosis (Ishak <3) in 87% of the patients. TE findings were available for 85 patients, APRI and FIB-4 for 95 patients, GPR for 79 patients, and GAR for 78 patients. The median values of all the parameters were significantly higher in patients with significant fibrosis, as compared to patients with non-significant fibrosis, and all the blood parameters as well as TE were able to identify patients with significant fibrosis significantly well (p<0.05). All non-invasive parameters had low positive predictive value but negative predictive value above 92%. Compared to TE, all the non-invasive blood parameters had similar area under the curve for detecting significant fibrosis, with excellent negative predictive value (≥93%).

Conclusions: Non-invasive blood parameters (APRI, FIB-4, GPR, and GAR) with negative predictive values above 93% are excellent parameters for ruling-out significant fibrosis in patients with chronic hepatitis B. These can be used at bedside in place of TE.