Ferulic acid (FA) is a natural polyphenol, a derivative of cinnamic acid, widely found in Angelica, Chuanxiong and other fruits, vegetables and traditional Chinese medicine. FA contains methoxy, 4-hydroxy and carboxylic acid functional groups that bind covalently to neighbouring adjacent unsaturated Cationic C and play a key role in many diseases related to oxidative stress. Numerous studies have shown that ferulic acid protects liver cells and inhibits liver injury, liver fibrosis, hepatotoxicity and hepatocyte apoptosis caused by various factors. FA has protective effects on liver injury induced by acetaminophen, methotrexate, antituberculosis drugs, diosbulbin B and tripterygium wilfordii, mainly through the signal pathways related to TLR4/NF-κB and Keap1/Nrf2. FA also has protective effects on carbon tetrachloride, concanavalin A and septic liver injury. FA pretreatment can protect hepatocytes from radiation damage, protects the liver from damage caused by fluoride, cadmium and aflatoxin b1. At the same time, FA can inhibit liver fibrosis, inhibit liver steatosis and reduce lipid toxicity, improve insulin resistance in the liver and exert the effect of anti-liver cancer. In addition, signalling pathways such as Akt/FoxO1, AMPK, PPAR γ, Smad2/3 and Caspase-3 have been shown to be vital molecular targets for FA involvement in improving various liver diseases. Recent advances in the pharmacological effects of ferulic acid and its derivatives on liver diseases were reviewed. The results will provide guidance for the clinical application of ferulic acid and its derivatives in the treatment of liver diseases.

Hand, foot, and mouth disease (HFMD) is a common infectious disease in children. Enterovirus A71 (EV-A71) is one of the main pathogens, and coxsackievirus A6 (CVA6) has gradually become the dominant pathogen of HFMD in recent years. This study was conducted mainly to assess the serological prevalence of EV-A71 and CVA6 antibodies in people of different ages, sexes, and regions through a systematic review and meta-analysis. A comprehensive study was performed based on the EV-A71 and CVA6 serological literature published before May 2022. Heterogeneity analysis (Cochrane's Q test and the I² statistic) and random effect models were adopted. Subgroup and meta-regression analyses were used to identify potential sources of heterogeneity in the data, and all analysis was performed using STATA version 16.0. This study included 71 studies involving 55,176 people from 13 countries that met the inclusion criteria. The serological prevalence of EV-A71 antibody in different studies was 4.31-88.8%, and that of CVA6 antibody was 40.8-80.9%. Meta-analysis results showed that the serum positive rate for EV-A71 antibody was 45.9% (95% CI: 37.6-54.1%). The rate in the Chinese population was 47.8% (95% CI: 42.4-53.2%), and in the other countries, it was 38% (95% CI: 23-55%). The serum positive rate for CVA6 antibody was 58.3% (95% CI: 46.5-70.2%). The rate in the Chinese population was 49.1% (95% CI: 38.3-59.9%), and in the other countries, it was 68% (95% CI: 51-83%). Subgroup analysis was also conducted. The seroprevalence of EV-A71 and CVA6 antibodies is related to age rather than gender or region. The rates of EV-A71 and CVA6 seropositivity are considerably lower in children younger than five years of age. However, the rates gradually increase with age. The findings of this study suggest that children under five years of age may be susceptible to EV-A71 and CVA6. Thus, safety education and vaccination should be strengthened accordingly. This study provides a basis for understanding the risk factors for EV-A71 and CVA6 infection in China and for deciding how to formulate standard preventive measures to prevent the spread of the virus.

Hand, foot, and mouth disease (HFMD) is a common global infectious disease in children. Coxsackievirus A6 (CVA6) has emerged as the most important pathogen of HFMD. Molecular epidemiological and evolutionary surveillance of CVA6 is vital for the prevention and control of HFMD outbreaks. This study comprehensively analyzed the molecular epidemiology and genetic characteristics of CVA6 circulating in mainland China during 1992-2023. Phylogenetic analysis based on VP1 sequences revealed that in addition to the previously reported subgenotypes B1, B2, C1, D2, D3a, and D3b, genotype A was first identified in mainland China. Phylogenetic analysis based on the P3 region identified ten evolutionary lineages (defined as recombination forms, RFs) in mainland China, including previously reported lineages (RF-I, -C, -D, -K1, -A, -J, -L, and -K2) and two new lineages, RF-K2.1 and RF-Z. Recombination analysis revealed that RF-C and RF-A acted as the major parents and generated 2 derived lineages (-D and -K1) and 5 derived lineages (-J, -L, -K2, -K2.1 and -Z), respectively, by recombination with other enteroviruses in nonstructural regions. Furthermore, amino acid variations in 3D proteins were predicted across CVA6 lineages. Polymorphism in 3D might partially account for differences in pathogenicity among CVA6 lineages within the same subgenotypes. The residues at the site 3D-259 may be associated with the high-frequency recombination of CVA6. The findings reveal the longitudinal molecular epidemiological and evolutionary characteristics of CVA6 in mainland China, providing critical insights for the continuous monitoring of CVA6-associated HFMD and the development of antiviral drugs and vaccines.