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BACKGROUND Collision carcinoma is a rare histological pattern, and includes two or more different types of tumors coexisting in the same organ as one neoplasm. Different to the combined type, the two adjacent tumors of collision carcinoma are histologically distinct. Collision carcinoma may occur from any origin or organ, including the cecum, liver, cervix, thyroid, stomach, kidney, and esophagus. In the rectum, adenocarcinoma is the most common pathological type, the combined type is rare, and collision tumors are even rarer. To date, only a limited number of collision carcinoma cases originating from the rectum have been reported. Due to the scarcity of rectal collision carcinoma, more cases need to be reported to fully understand the clinico-pathological features and biological behavior of the tumor. CASE SUMMARY Here we report a 40-year-old female who presented with the chief complaints of persistent changes in bowel habits and hematochezia for 10 d. She underwent Miles' operation which revealed a collision carcinoma of the rectum, showing a “side by side” pattern, composed of a high grade neuroendocrine carcinoma, (small cell carcinoma) and moderately differentiated adenocarcinoma, based on its clinico-pathological features and biological behavior. The patient remained disease-free at 12 mo follow-up. We also focused on the related literature and expert opinion. CONCLUSION Collision carcinoma is a rare tumor with ambiguous biological behavior. Greater attention should be paid to its clinico-pathologic diagnosis. Regular and adequate follow-up is essential to help rule out metastasis and assess the prognosis.

Background Kashin-Beck disease (KBD) is an endemic osteoarthropathy, and its pathogenesis is still not entirely clear. Pathologically, many KBD changes are similar to those of osteoarthritis (OA). Therefore, this study aimed to identify changes in the levels of potential urinary biomarkers for OA, including C-telopeptide of type II collagen (uCTX-II), type II collagen cleavage neoepitope (uC2C), pyridinoline (uPYD), and uHelix-II, among adults with KBD. Methods Urinary samples of 83 external control (EC) subjects, 91 KBD patients, and 86 internal control (IC) subjects were tested by ELISA after the subjects completed a questionnaire and X-ray examination. Results The medians of the four markers in the KBD group were higher than those in the EC group and those in the IC group. The medians in the grade II KBD group were higher than those in the grade I group but were not statistically significant (P = 0.301, P = 0.408, P = 0.204, and P = 0.898 for uCTX-II, uC2C, uPYD, and uHelix-II, respectively). The area under the curve (AUC) of uCTX-II (0.775) was higher than that of the others (0.672, 0.639, and 0.628 for uC2C, uPYD, and uHelix-II, respectively). Conclusion The levels of uCTX-II, uC2C, uPYD, and uHelix-II were elevated in adults with KBD and showed an increasing trend as the severity of KBD increased. The prediction accuracy of uCTX-II was more useful than that of the others for assisting in the diagnosis of KBD.

Background and Objective: The role of (Human Papilloma Virus) HPV in cancer of certain anatomical location, such as cervix, has been widely recognized. The present study was conducted to explore the association between HPV 16-E6 protein and esophageal squamous cell carcinoma. Methods: SP immunohistochemical method was used to examine the expression of HPV 16-E6 in 50 cases of esophageal squamous cell carcinoma, 10 cases of normal esophageal squamous cell and 10 cases of adjacent tissue. Results: The expression of HPV 16-E6 was significantly higher in esophageal carcinoma than in normal esophageal mucosa and in adjacent tissue. The expressions of HPV 16-E6 had significant correlation with invasive depth (P0.05). Conclusion: HPV 16-E6 can promote the growth and metastasis of esophageal squamous cell carcinoma and can be a prognostic factor of esophageal squamous cell carcinoma.DOI: http://dx.doi.org/10.3126/jcmsn.v10i4.12970 JCMS Nepal 2014; 10(4):1-5&nbsp

Objective to examine the psychometric properties of a newly developed Postpartum Women's Health Quotient Scale (PWHQS) for Chinese post partum women. Design a cross-sectional survey of post partum women was conducted.Categorical confirmatory factor analysis (CCFA) models were applied to examine the factorial structure of the PWHQS; test information function (TIF) was used to examine reliability of PWHQS subscales; and measurement invariance was examined by testing differential item functioning (DIF) using a multiple indicators multiple causes (MIMIC) model. Setting two large hospitals with a level 3A designation in Suzhou, Jiangsu Province, China. Participants a convenience sample of 395 post partum women was recruited from April to September 2014. Measurement the PWHQS consists of 31 items with 5 subscales: health consciousness (HC, 6 items), maternal health knowledge (MHK, 8 items), infant health knowledge (IHK, 6 items), maternal health care ability (MHCA, 5 items), and infant health care ability (IHCA, 6 items). Findings PWHQS has a valid factorial structure with five dimensions as theoretically designed. Each of its subscales has adequate reliability that is particularly high over the lower-moderate range of the factor score scale. Measurement non-invariance in PWHQS is very limited as only two of the 31 items displayed DIF related to one grouping variable (Age). Key conclusion PWHQS is a valid and reliable instrument that can be readily used as a screening tool to assess health quotient (HQ) among Chinese post partum women. PWHQS will also be useful for the development of interventions to help post partum women maintain and improve maternal and infant health. Further research to confirm the findings of the present study is desirable.

Background and Objectives: Microtubules, the main components of spindles in the mitotic phase, can provide the suitable conditions for unlimited proliferation of tumor cells. Cytoskeleton microtubule-associated-Tau accelerates the progress of malignant tumor through microtubules. Currently, the expression of Cytoskeleton microtubule-associated-Tau in gastric cancer and the relationship between clinical pathological factors research has not yet been reported, so the report aims to elucidate the features of Cytoskeleton microtubule-associated-Tau expression in normal gastric tissue and gastric carcinoma tissue.Materials and Methods: The expressions of Cytoskeleton microtubule-associated protein-Tau protein and Cytoskeleton microtubule-associated protein-Tau mRNA were investigated in 60 cases of gastric carcinoma (cases) and 10 cases of normal gastric tissues (controls). Immunohistochemistry and RT-PCR were respectively used to detect the expression of Cytoskeleton microtubule-associated protein-Tau protein and Tau mRNA in the normal and carcinomatous gastric tissues.Results: The expressions of both cytoskeleton microtubule-associated protein-Tau protein and Tau mRNA in the carcinomatous gastric tissue were higher than in the normal gastric tissue (P). Likewise, both biomarkers were expressed significantly lower in the well-differentiated and moderately-differentiated gastric carcinoma was than in the poorly-differentiated one (P). Moreover, their expressions in the gastric carcinoma without lymph node metastasis was lower than in the gastric carcinoma with lymph node metastasis (P).Conclusion: The expressions of Cytoskeleton microtubule-associated-protein, Tau-protein and Cytoskeleton microtubule-associated-protein, Tau-mRNA were significantly different between the normal gastric tissue and the gastric carcinoma tissue, and were correlated with the degree differentiation and lymph node status.JCMS Nepal. 2015;11(3):6-11.

Aims and Objectives: To detect the protein expression level of Cx43, smad4 and PCNA in normal and gastric carcinoma tissue by immuno-histochemistry, western blotting and RT-PCR method. We intend to reveal the relationship between their expression in occurrence and development. Simultaneously through analyzing experimental data we have obtained the correlation among them. Materials and Methods: Immuno-histochemistry and western blotting were adopted to detect the expression of Cx43, smad4 and PCNA protein in normal and carcinomatous gastric tissue, expression levels mRNA of Cx43, smad4 and PCNA were detected by RT-PCR in normal and carcinomatous gastric tissue. Experimental data were analyzed by combining clinical pathology data using statistical approach. Results: The expression levels of Cx43, and smad4 in carcinomatous gastric tissue were lower than they were in normal gastric tissue. The expression level of PCNA in carcinomatous gastric tissue was higher than that in normal gastric tissue. The expression levels of Cx43, Smad4 and PCNA in groups of age and gender is not significant. The expression of Cx43, Smad4 and PCNA in different clinicopathologic features of carcinomatous gastric tissue including degrees of pathological differentiation, lymph node metastasis condition, depth of tumor invasion and TNM stages is statistically significant. With the progression of gastric carcinoma, the expression levels of Cx43 and Smad4 were decreased, conversely PCNA showed a high expression level. Based on the analysis Cx43 negatively correlated with PCNA, Cx43 positively correlated with Smad4, Smad4 negatively correlated with PCNA. Conclusions: The protein and mRNA expressions of Cx43, smad4 and PCNA were significant differences between normal gastric tissue and gastric carcinoma, also were concerned with differentiation degree, lymph node metastasis, TNM stages and depth of invasion, while not significant with age and gender. This suggests that they may play an important role in occurrence and development of gastric carcinoma, but also may have some interaction. Asian Journal of Medical Sciences Vol.7(1) 2015 6-13

Aims and Objectives: To provide theoretical basis for the gastric carcinoma pathogenesis and the clinical targeted therapy. Materials and Methods: We detected the expression of Tau protein and Tau mRNA in 60 cases of gastric carcinoma tissues (observation group) and 10 cases of normal gastric tissues (control group). Immunohistochemisty was adopted to detect the expression of Tau protein in normal and carcinomatous gastric tissue. Tau mRNA was detected by RT-PCR in normal and carcinomatous gastric tissue. To analyse the experimental data combined clinical pathology with statistics. Results: The expression of Tau protein in carcinomatous gastric tissue was higher than that in normal gastric tissue (P

Aim: To explore the association between HPV16-E6 protein and esophageal squamous cell carcinoma.Materials and Methods: SP immunohistochemical method was used to examine the expression of HPV 16-E6 in 50 cases of esophageal squamous cell carcinoma, 10 cases of normal esophageal squamous cell and 10 cases of adjacent tissue.Results: The expressions of HPV 16-E6 was significantly higher in esophageal carcinoma than in normal esophageal mucosa and in adjacent tissue. The expressions of HPV 16-E6 had correlation with invasive depth (P0.05).Conclusion: HPV 16-E6 can promote the growth and metastasis of esophageal squamous cell carcinoma and can be a prognostic factor of esophageal squamous cell carcinoma. DOI: http://dx.doi.org/10.3126/ajms.v6i6.12537 Asian Journal of Medical Sciences Vol.6(6) 2015 39-42

Background: To detect the Protein expression level of Cx43, Smad4 and PCNA in normal and gastric carcinoma tissue by immunohistochemistry, western blotting and RT-PCR method.Materials and Methods: Immunohistochemistry and western blotting were adopted to detect the expression and expression level of Cx43, Smad4 and PCNA protein in normal and carcinomatous gastric tissue. Experimental data were analyzed by combining clinical pathology data using statistical tools.Results: The expression levels of Cx43 and Smad4 in carcinomatous gastric tissue were lower than they were in normal gastric tissue. The expression level of PCNA in carcinomatous gastric tissue was higher than that in normal gastric tissue. The expression levels of Cx43, Smad4 and PCNA in groups of age and gender is not significant. The expression of Cx43, Smad4 and PCNA in different clinic pathologic features of carcinomatous gastric tissue which includes degrees of pathological differentiation, lymph node metastasis condition, depth of tumor invasion and TNM stages is statistically significant. With the progression of gastric carcinoma, the expression levels of Cx43 and Smad4 were decreased, conversely PCNA showed a high expression level.Conclusion: The protein and mRNA expressions of Cx43, Smad4 and PCNA were significantly different between normal gastric tissue and gastric carcinoma and also were concerned with degree of differentiation, lymph node metastasis, TNM stages and depth of invasion, though not significant with age and gender. This suggests that they may play an important role in occurrence and development of gastric carcinoma, but also may have some interaction.Journal of Pathology of Nepal (2015) Vol. 5, 696-704

Background?Gastrointestinal cancer is the most common malignant tumor in China. This research aims to explore the association between HPV16-E6 protein and esophageal squamous cell carcinoma.Materials and Methods: SP immunohistochemical method was used to examine the expression of HPV 16-E6 in 50 cases of esophageal squamous cell carcinoma, 10 cases of normal esophageal squamous cell and 10 cases of adjacent tissue.Results: The expressions of HPV 16-E6 was significantly higher in esophageal carcinoma than in normal esophageal mucosa and in adjacent tissue. The expressions of HPV 16-E6 had correlation with invasive depth (P0.05).Conclusion: HPV 16-E6 can promote the growth and metastasis of esophageal squamous cell carcinoma and can be a prognostic factor of esophageal squamous cell carcinoma.Journal of Pathology of Nepal (2015) Vol. 5, 752-755

Non-motor symptoms (NMS) occur commonly in PD patients. The NMS is associated with the deterioration of life quality in Parkinsons disease (PD), even exceeding the effects of the motor disorder. To determine the effects of cognitive behavior therapy (CBT) on NMS in PD, fifty-five PD individuals with CBT intervention were matched for forty-eight control PD participants. NMS of all PD patients including depressive symptoms, sleep quality, cognitive function and physical and mental health-related quality of life were respectively assessed. Results indicate that CBT ameliorates NMS of PD patients, and that is significantly related with the decreases of serum inflammatory cytokines levels.

The predictive value of cumulative blood pressure (BP) on all-cause mortality and cardiovascular and cerebrovascular events (CCE) has hardly been studied. In this prospective cohort study including 52,385 participants from the Kailuan Group who attended three medical examinations and without CCE, the impact of cumulative systolic BP (cumSBP) and cumulative diastolic BP (cumDBP) on all-cause mortality and CCEs was investigated. For the study population, the mean (standard deviation) age was 48.82 (11.77) years of which 40,141 (76.6%) were male. The follow-up for all-cause mortality and CCEs was 3.96 (0.48) and 2.98 (0.41) years, respectively. Multivariate Cox proportional hazards regression analysis showed that for every 10 mm Hg·year increase in cumSBP and 5 mm Hg·year increase in cumDBP, the hazard ratio for all-cause mortality were 1.013 (1.006, 1.021) and 1.012 (1.006, 1.018); for CCEs, 1.018 (1.010, 1.027) and 1.017 (1.010, 1.024); for stroke, 1.021 (1.011, 1.031) and 1.018 (1.010, 1.026); and for MI, 1.013 (0.996, 1.030) and 1.015 (1.000, 1.029). Using natural spline function analysis, cumSBP and cumDBP showed a J-curve relationship with CCEs; and a U-curve relationship with stroke (ischemic stroke and hemorrhagic stroke). Therefore, increases in cumSBP and cumDBP were predictive for all-cause mortality, CCEs, and stroke.

Relationship between atrial natriuretic peptide-immunoreactive cells and microvessels in rat gastric mucosa

Rationale: We reviewed 76 published cases of Doege–Potter syndrome, and non-islet cell tumor hypoglycemia (NICTH) secondary to a solitary fibrous tumor (SFT) between 1989 and 2016, to study disease pathogenesis, diagnosis, and treatment of this rare paraneoplastic disease. Further, we report 1 new case of a patient presenting with Doege–Potter syndrome. Patients concerns: The tumors originated from the pleural cavity, lung, pelvis, liver, retroperitoneum, kidney, mediastinal, the sella, uterus, bladder, intestine, mandibular, and the thigh. The most common location was the pleural cavity (left 12 cases and right 28 cases). Moreover, 28/71 (39.4%) were benign and 43/71 (60.6%) were malignant. SFTs with NICTH were more likely to be malignant and present at a higher rate than previously published (5%–10.4%). The malignancy rate of extrathoracic SFTs was higher than that of thoracic SFTs, 20 (66.7%) as compared with 23 (56.1%). Age of onset varied from 24 to 85 years (mean 59 years), with 47 males and 28 females, and gender unavailable for 1 case. When comparing clinical characteristics of patients with benign as compared malignant tumors, no significant differences in the age of onset, gender, or size of tumor were seen. Among 15/19 cases, the insulin-like growth factor II (IGF-II)/IGF-I ration was >10.0. Complete tumor resection remained the only definitive treatment. Outcomes and lessens: Glucocorticoids dose-dependently reduce the frequency and severity of hypoglycemic episodes. Low doses of prednisone were ineffective at relieving hypoglycemia. The effect of neoadjuvant treatment, consisting of chemoradiation, and consecutive selective embolization of vessels feeding the tumor were not identified.

Neuroendocrine tumor covers a wide range of neoplasms that originate in the neuroendocrine cells which spread throughout the body. Carcinoid tumor, and neuroendocrine tumor are low-grade malignant tumors, their growth is slow, and mainly in the gastrointestinal epithelium. Esophageal adenocarcinoma tumor is a big problem in esophageal cancer. Combined esophageal adenocarcinoma and carcinoid tumor both as primary tumors is very rare[1]. Neuroendocrine tumors of the esophagus are derived from the diffuse neuroendocrine system in the gastrointestinal tract. Neuroendocrine tumors in the esophagus can be distinguished from other mesenchymal tumors by immunostaining for synaptophysin and chromogranin-A. Both carcinoid of the esophagus and adenocarcinoma of the esophagus are malignant tumors and considered to have a specifi c molecular pathogenesis. This paper presents a rare case diagnosed as carcinoid of the esophagus concomitant with an adenocarcinoma of the esophagus, a review of the literature is also presented here.

Background: Is the timing of dosing for amlodipine and atorvastatin important with regard to therapeutic efficacy? To answer this question, we designed an outpatient, practice-based, case-control study lasting 8 weeks. Methods: Two hundred patients were divided into two groups: in Group I, patients were provided with a single pill containing amlodipine/atorvastatin (5⁄20 mg) to be taken each night at 10pm, and in Group II, patients were taking amlodipine (5 mg) and atorvastatin (20 mg) each morning at 7am. Results: Our results indicated that no obvious difference was found in blood pressure control between the two groups. Taking amlodipine at night not only lowered blood pressure, but it also provided better control during the peak blood pressure in the morning. Hypercholesterolemia control in the two groups was also not significantly different; taking atorvastatin in the morning was equally as effective as dosing at night in patients with hypercholesterolemia. While the carotid IMT, hs-CRP and LVMI were significantly lower after treatment, no differences were found between the two groups. Although no obvious difference was found in adverse drug reactions between the two groups, compliance was much better in the single-pill group than in patients taking the two medications separately. Conclusion: In conclusion, single-pill amlodipine - atorvastatin taken at night would not only lower the blood pressure but also could reduce the morning peak blood pressure levels the next day. Additionally, this dosing method could improve patients’ adherence to the therapy.

Natriuretic peptides (NPs) are a cyclic guanosine monophosphate (cGMP) generation system like nitric oxide (NO) and play an inhibitory regulation in gastrointestinal motility but the effect of NPs on muscarinic activity is still unclear. This study was designed to investigate effect of C-type natriuretic peptide (CNP) on muscarinic control of gastric motility and its ion channel mechanism. The spontaneous contraction of gastric smooth muscle strip was recorded by using physiograph in guinea-pig. Membrane currents and potential were recorded by using whole-cell patch-clamp technique. CNP significantly inhibited muscarinic M receptor agonist carbachol (Cch)-induced contractions of gastric smooth muscle strips and dramatically hyperpolarized Cch-induced depolarization of membrane potential in gastric single smooth muscle cell. Muscarinic currents induced by both Cch and GTPγS, a G-protein agonist were significantly suppressed by CNP. 8-Br-cGMP mimicked the effect of CNP on Cch-induced muscarinic currents, and the peak holding current was decreased from − 200.66 ± 54.35 pA of control to − 67.35 ± 24.82 pA. LY83583, a guanylate cyclase nonspecific inhibitor, significantly weakened the inhibitory effect of CNP on muscarinic current while zaprinast, a cGMP sensitive phosphoesterase inhibitor, potentiated the inhibitory effect of CNP on muscarinic current. cGMP production was dramatically enhanced by CNP and this effect was suppressed by LY83583 in gastric smooth muscle. These results suggest that CNP modulates muscarinic activity via CNP–NPR–particulate guanylate cyclase (pGC)–cGMP pathway in guinea-pig.

We report here the antihypertensive effect of wheat germ (WG) hydrolysate and its dominant peptide, Ile-Val-Tyr (IVY), with potent angiotensin I-converting enzyme (ACE) inhibitory activity. The toxicity test of AG50W fraction purified from the WG hydrolysate and IVY in ddy mice revealed that 1 week median lethal concentrations of AG fraction and IVY were less than 100 and 10 mg/kg, respectively. As a result of an intravenous administration test of both inhibitors in spontaneously hypertensive rat (SHR), the mean arterial blood pressure (MAP) significantly decreased with the dose; the MAP reduction of 10.3 and 19.2 mmHg was observed at a dose of 50 mg/kg of AG fraction and 5 mg/kg of IVY, respectively. In addition to this behavior, the MAP gradually decreased after the 5 mg/kg of IVY injection (time to give a maximum reduction; 8 min), and the reduction was held for 20 min. By using rat and human plasma, IVY was found to be metabolized by the action of aminopeptidase in plasma to form a subsequent ACE inhibitor, Val-Tyr (VY). Thus, the intake of IVY as a physiologically functional food would serve in the lowering of blood pressure (BP) by the combined depressor effect of itself and its metabolite after the absorption.

AIM: To study the preventive effects of Qianggan-Rongxian Decoction on liver fibrosis induced by dimethylnitrosamine (DMN) in rats. METHODS: Male Wistar rats were randomly divided into hepatic fibrosis model group, control group and 3 treatment groups (12 rats in each group). Except for the normal control group, all the rats received 1% DMN (10 μL/kg body weight, i.p), 3 times a week for 4 wk. The rats in the 3 treatment groups including a high-dose DMN group (10 mL/kg), a medium-dose DMN group (7 mL/kg), and a low-dose DMN group (4 mL/kg) were daily gavaged with Qianggan-Rongxian Decoction, and the rats in the model and normal control groups were given saline vehicle. Enzyme-linked immunosorbent assay (ELISA) was used to determine the changes in serum hyaluronic acid (HA), laminin (LN), and type IV collagen levels. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured using routine laboratory methods. Pathologic changes, particularly fibrosis, were examined by hematoxylin and eosin (HE) and Sirius red staining. Hepatic stellate cells (HSC) were examined by transmission electron microscopy. RESULTS: Compared with the model control group, the serum levels of HA, LN, type IV collagen, ALT and AST were decreased markedly in the other groups after treatment with Qianggan-Rongxian Decoction, especially in the medium-dose DMN group (P < 0.05). Moreover, the area-density percentage of collagen fibrosis was lower in the Qianggan-Rongxian Decoction treatment groups than in the model group, and a more significant drop was observed in the medium-dose DMN group (P < 0.05). CONCLUSION: Qianggan-Rongxian Decoction can inhibit hepatic fibrosis due to chronic liver injury, delay the development of cirrhosis, and notably ameliorate liver function. It may be used as a safe and effective thera-peutic drug for patients with fibrosis.

AIM: To study the morphological positive expression of antrial natriuretic peptide (ANP)-synthesizing cells and ultrastructural localization and the relationship between ANP-synthesizing cells and microvessel density in the stomach of rats and to analyze the distribution of the three histologically distinct regions of ANP-synthesizing cells. METHODS: Using immunohistochemical techniques, we studied positive expression of ANP-synthesizing cells in rat stomach. A postembedding immunogold microscopy technique was used for ultrastructural localization of ANP-synthesizing cells. Microvessel density in the rat stomach was estimated using tannic acid-ferric chloride (TAFC) method staining. Distribution of ANP-synthesizing cells were studied in different regions of rat stomach histochemically. RESULTS: Positive expression of ANP-synthesizing cells were localized in the gastric mucosa of rats. Localization of ANP-synthesizing cells identified them to be enterochrochromaffin cells (EC) by using a postembedding immunogold electron microscopy technique. EC cells were in the basal third of the cardiac mucosa region. ANP-synthesizing cells existed in different regions of rat stomach and its density was largest in the gastric cardiac region, and the distribution order of ANP-synthesizing cells in density was cardiac region, pyloric region and fundic region in mucosa layer. We have also found a close relationship between ANP-synthesizing cells and microvessel density in gastric mucosa of rats using TAFC staining. CONCLUSION: ANP-synthesizing cells are expressed in the gastric mucosa. EC synthesize ANP. There is a close relationship between ANP-synthesizing cells and microvessel density in gastric mucosa of rats.The distribution density of ANP-synthesizing cells is largest in the gastric cardiac region.

AIM: To study the morphological and serum hyaluronic acid (HA), laminin (LN), and type IV collagen changes in hepatic fibrosis of rats induced by dimethylnitrosamine (DMN). METHODS: The rat model of liver fibrosis was induced by DMN. Serum HA, type IV collagen, and LN were measured by ELISA. The liver/weight index and morphological changes were examined under electron microscope on d 7, 14, 21, and 28 by immunohistochemical alpha smooth muscle actin α-SMA staining as well as Sirius-red and HE staining. RESULTS: The levels of serum HA, type IV collagen and LN significantly increased from d 7 to d 28 (P = 0.043). The liver/weight index increased on d 7 and decreased on d 28. In the model group, the rat liver stained with HE and Sirius-red showed evident hemorrhage and necrosis in the central vein of hepatic 10 lobules on d 7. Thin fibrotic septa were formed joining central areas of the liver on d 14. The number of α-SMA positive cells was markedly increased in the model group. Transitional hepatic stellate cells were observed under electron microscope. All rats in the model group showed micronodular fibrosis in the hepatic parenchyma and a network of α-SMA positive cells. Typical myofibroblasts were embedded in the core of a fibrous septum. Compared to the control group, the area-density percentage of collagen fibrosis and pathologic grading were significantly different in the model group (P