Objective:To compare the safety apnea time during endotracheal intubation in the patients from different altitudes using oxygen reserve index (ORI).Methods:Sixty American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 18-70 yr, undergoing elective surgery requiring tracheal intubation under general anesthesia and requiring catheterization via arterial puncture, were included.Among the patients, 30 cases who had long lived at an altitude of 1 500-3 000 m in Qinghai Province People′s Hospital (Xining, 2 200 m above sea level) served as middle-altitude group, and 30 Tibetan patients who had long lived at an altitude >3 000-meter area in Yushu People′s Hospital (Yushu, 3 600 m above sea level) served as high-altitude group.The patients were preoxygenated for 5 min before induction of anesthesia, and then endotracheal intubation was performed with a video laryngoscope.Before induction (T 0), at 3 min of pre-oxygenation (T 1), and at 5 min of pre-oxygenation (T 2), arterial blood was collected for blood gas analysis, and PaO 2 was recorded, ORI and SpO 2 were simultaneously recorded.The time from the beginning of intubation to the time when ORI was decreased to 0 and the time from the beginning of intubation to the time when SpO 2 was decreased to 98% were recorded. Results:Compared with middle-altitude group, the time from the beginning of intubation to the time when ORI was decreased to 0 and the time from the beginning of intubation to the time when SpO 2 was decreased to 98% were significantly prolonged ( P<0.05), and no significant change was found in SpO 2, ORI and PaO 2 at each time point in high-altitude group ( P>0.05). Conclusions:The safety apnea time during endotracheal intubation is longer in the patients at high altitudes (altitude > 3000 m) than those at the moderate altitudes (altitude 1500-3000 m).

Precancerous lesions of gastric cancer （PLGC） are a group of pathological changes caused by abnormalities in the structure， morphology， and differentiation of gastric mucosal epithelial cells. Since the early symptoms are hidden and non-specific， PLGC is not easy to be diagnosed and it has often developed into intermediate or advanced gastric cancer once being diagnosed and missed the best time for treatment. Accordingly， the incidence of this disease is increasing year by year， which lifts a heavy burden on the patients. The pathogenesis of PLGC is complex， involving inflammatory microenvironment， bile reflux， glycolysis， autophagy， and apoptosis. Currently， PLGC is mainly treated with anti-inflammatory and endoscopic therapies， which are difficult to curb the development of PLGC. Therefore， seeking a safe and effective therapy is an important topic of modern research. Traditional Chinese medicine （TCM）， characterized by treatment based on syndrome differentiation and a holistic view， exerts effects via multiple pathways， mechanisms， and targets. Recent studies have confirmed that TCM can regulate the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR）， Wnt/β-catenin， Sonic Hedgehog， nuclear factor-κB （NF-κB）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， hypoxia-inducible factor-1α （HIF-1α）， neurogenic locus notch homolog protein （Notch）， nuclear factor E₂-related factor 2 （Nrf2） and other signaling pathways. By targeting these pathways， TCM can inhibit aerobic glycolysis， reduce oxidative stress， repair the inflammatory microenvironment， regulate cellular autophagy， and promote vascular normalization， thereby delaying or reversing PLGC. However， few researchers have systematically summarized the TCM regulation of PLGC-associated pathways. By reviewing the relevant articles at home and abroad， this paper summarized the roles of the above signaling pathways in the development of PLGC and the research progress in the regulation of signaling pathways by TCM in the treatment of PLGC， with a view to providing a new theoretical basis for the clinical research on PLGC and the drug development for this disease.