1.Exploring the pathogenesis,prevention,and treatment of "inflammation cancer transformation" in chronic gastritis based on the theory of stomach collaterals
Yuanping JIA ; Xinning YAO ; Xia DING
Journal of Beijing University of Traditional Chinese Medicine 2024;47(8):1037-1042
The " inflammation cancer transformation" in chronic gastritis is a complex process that involves multiple factors,stages,and mechanisms. As the disease progresses,morphological changes occur in the gastric mucosal gland orifices and capillary vessels,and pathologically,it is characterized by a reduction in the number of glands,structural disarray,or cellular atypia. In traditional Chinese medicine,the onset of chronic gastritis is believed to be related to external pathogenic factors invading the stomach or the internal generation of various pathogenic factors. The disease process is considered to progress from qi to blood,and from meridians to collaterals,which is in line with the theory of "prolonged disease invading collaterals". This article explores the pathogenesis,prevention,and treatment of the "inflammation cancer transformation" in chronic gastritis based on the theory of the stomach collaterals,summarizing the characteristics of the disease evolution as follows:the stomach collaterals are invaded by pathogenic factors,leading to disharmony of qi and collaterals;obstruction of the stomach collaterals,resulting in the internal production of turbid toxins;and deficiency of the stomach collaterals,leading to the loss of nourishment and masses. Clinically,the therapeutic methods include expelling pathogenic factors,regulating qi,and activating collaterals;resolving stasis and detoxifying to unblock collaterals;and replenishing deficiency and eliminating masses to nourish the collaterals,thereby ensuring the patency of the stomach collaterals and the nourishment of the stomach. Starting from the theory of the stomach collaterals and integrating modern scientific research,this article aims to provide theoretical reference and practical guidance for the differential diagnosis and dynamic comprehensive management of the "inflammation cancer transformation" in chronic gastritis.
2.Best evidence summary of prevention and management of lower limb ischemia in patients with veno-arterial extracorporeal membrane oxygenation
Lihua CHEN ; Xinning WANG ; Jing WANG ; Tingting HE ; Yao HUANG ; Qingqing SHENG ; Yufeng TAN ; Shuqin ZHANG ; Xiaoqun HUANG ; Mengmeng XU ; Ling SANG ; Jie ZHANG ; Yonghao XU
Chinese Critical Care Medicine 2024;36(11):1190-1195
Objective:To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) patients during treatment according to search, evaluate, and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.Methods:Based on the PIPOST framework (population, intervention, professional, outcome, setting, and type of evidence), an evidence-based question was formulated. A systematic search was conducted according to the "6S" evidence pyramid model in both domestic and international databases, as well as professional association websites, for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients (aged ≥18 years). The types of evidence included clinical decisions, guidelines, expert consensus, systematic reviews, evidence summaries, and original studies. The search was conducted from the construction of the databases to February 2024. Two researchers independently conducted a literature quality evaluation, extracted and summarized evidence from the studies that met the quality criteria.Results:A total of 13 articles were included, consisting of 3 clinical decisions, 3 guidelines, 3 expert consensus, 3 systematic reviews, and 1 randomized controlled trial. A total of 18 pieces of evidence in 7 dimensions were summarized, including risk factors of VA-ECMO lower limb ischemia, evaluation before catheterization, evaluation and monitoring during treatment, prevention of lower limb ischemia, treatment of lower limb ischemia, management of distal perfusion catheter (DPC), and monitoring after VA-ECMO weaning.Conclusion:This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients, aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.