To explore the advantages of traditional Chinese medicine （TCM） and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications （DMC）， refine key pathophysiological insights and treatment principles， and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine， hosted by the China Association of Chinese Medicine， was held in Beijing， 2024. Experts in TCM， Western medicine， and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis， diagnostic and treatment challenges， and mechanism research related to DMC， ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development， research prioritization， and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM， strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.

Glucose-6-phosphate dehydrogenase (G6PD), the first rate-limiting enzyme of the pentose phosphate pathway (PPP), is aberrantly activated in multiple types of human cancers, governing the progression of tumor cells as well as the efficacy of anticancer therapy. Here, we discovered that cyclin-dependent kinase 5 (CDK5) rewired glucose metabolism from glycolysis to PPP in breast cancer (BC) cells by activating G6PD to keep intracellular redox homeostasis under oxidative stress. Mechanistically, CDK5-phosphorylated G6PD at Thr-91 facilitated the assembly of inactive monomers of G6PD into active dimers. More importantly, CDK5-induced pho-G6PD was explicitly observed specifically in tumor tissues in human BC specimens. Pharmacological inhibition of CDK5 remarkably abrogated G6PD phosphorylation, attenuated tumor growth and metastasis, and synergistically sensitized BC cells to poly-ADP-ribose polymerase (PARP) inhibitor Olaparib, in xenograft mouse models. Collectively, our results establish the crucial role of CDK5-mediated phosphorylation of G6PD in BC growth and metastasis and provide a therapeutic regimen for BC treatment.

Objective:To develop a Protection Motivation Questionnaire(PMQ)for frailty management in the elderly based on the Protection Motivation Theory(PMT), and test its reliability and validity.Methods:Guided by PMT, the initial questionnaire items were formulated through literature review, semi-structured interviews, and Delphi expert consultation.A total of 551 elderly patients with frailty from a tertiary hospital in Changsha were investigated.Item screening was conducted via critical ratio method, Cronbach's α coefficient, correlation analysis, and factor analysis.The reliability was assessed through internal consistency and test-retest reliability, while validity was evaluated via content validity and structural validity.Results:The final PMQ comprised 25 items across five dimensions: severity, susceptibility, response efficacy, response cost, and self-efficacy.The overall Cronbach's α coefficient was 0.818, with subscale coefficients ranging from 0.701 to 0.821.The split-half reliability was 0.811, test-retest reliability was 0.929, and content validity indexwas 0.86.Exploratory factor analysis extracted five factors, accounting for 52.0% of the cumulative variance.Confirmatory factor analysis demonstrated good model fit( χ2/df=1.626, RMSEA=0.05, CFI =0.914). Conclusions:The developed questionnaire exhibits strong reliability and validity, serving as an effective tool to assess protection motivation for frailty management in the elderly.

ObjectiveThis study aims to investigate the effect of Dictamni Cortex on intestinal barrier damage in rats and its mechanism by untargeted metabolomics and targeted metabolomics for short-chain fatty acids （SCFAs）. MethodsRats were randomly divided into a control group， a high-dose group of Dictamni Cortex （8.1 g·kg^-1）， a medium-dose group （2.7 g·kg^-1）， and a low-dose group （0.9 g·kg^-1）. Except for the control group， the other groups were administered different doses of Dictamni Cortex by gavage for eight consecutive weeks. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in the ileal tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to detect the level of cytokines， including tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-1β （IL-1β）， in the ileal tissue of rats. Quantitative real-time fluorescence polymerase chain reaction （Real-time PCR） technology was used to detect the expression level of tight junction proteins， including zonula occludens-1 （ZO-1）， Occludin， and Claudin-1 mRNAs， in the ileal tissue of rats to preliminarily explore the effects of Dictamni Cortex on intestinal damage. The dose with the most significant toxic phenotype was selected to further reveal the effects of Dictamni Cortex on the metabolic profile of ileal tissue in rats by non-targeted metabolomics combined with targeted metabolomics for SCFAs. ResultsCompared with the control group， all doses of Dictamni Cortex induced varying degrees of pathological damage in the ileum， increased TNF-α （P<0.01）， IL-6 （P<0.01）， and IL-1β （P<0.01） levels in the ileal tissue， and decreased the expression level of ZO-1 （P<0.05， P<0.01）， Occludin （P<0.01）， and Claudin-1 （P<0.05） in the ileal tissue， with the high-dose group showing the most significant toxic phenotypes. The damage mechanisms of the high-dose group of Dictamni Cortex on the ileal tissue were further explored by integrating non-targeted metabolomics and targeted metabolomics for SCFAs. The non-targeted metabolomics results showed that 21 differential metabolites were identified in the control group and the high-dose group. Compared with that in the control group， after Dictamni Cortex intervention， the level of 14 metabolites was significantly increased （P<0.05， P<0.01）， and the level of seven metabolites was significantly decreased （P<0.05， P<0.01） in the ileal contents. These metabolites collectively acted on 10 related metabolic pathways， including glycerophospholipids and primary bile acid biosynthesis. The quantitative data of targeted metabolomics for SCFAs showed that Dictamni Cortex intervention disrupted the level of propionic acid， butyric acid， acetic acid， caproic acid， isobutyric acid， isovaleric acid， valeric acid， and isocaproic acid in the ileal contents of rats. Compared with those in the control group， the level of isobutyric acid， isovaleric acid， and valeric acid were significantly increased， while the level of propionic acid， butyric acid， and acetic acid were significantly decreased in the ileal contents of rats after Dictamni Cortex intervention （P<0.05， P<0.01）. ConclusionDictamni Cortex can induce intestinal damage by regulating glycerophospholipid metabolism， primary bile acid biosynthesis， and metabolic pathways for SCFAs.

Objective:To assess the attitudes toward and factors influencing starting insulin use among community-based patients with type 2 diabetes (T2D).Methods:A cross- sectional study. This secondary analysis used baseline data from patients with T2D recruited through convenience sampling from a community-based peer support intervention study implemented in nine community health service centers in Shanghai since 2017. Attitudes toward insulin use were assessed using the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ); the higher the score, the more negative the attitude toward starting insulin use. Multiple linear regression was used to analyze the factors influencing attitudes toward starting insulin use.Results:A total of 336 patients with T2D were included in the survey. The patients had a mean age of (67.7±7.9) years, mean disease duration of (13.62±7.73) years, relatively low levels of depression [Patient Health Questionnaire 8 (PHQ-8): 2 (0, 5)] and diabetes distress [Diabetes Distress Scale 4 (DDS-4): 1.97±0.95], and suboptimal target achieving rates of risk factors including body mass index, blood pressure, blood glucose, and lipid levels. The total score on the Ch-ASIQ among all patients was 1.84±0.55. Multivariate analyses showed that refusing insulin use was positively significantly associated with higher scores on the Ch-ASIQ and the three sub-dimensions of "Factors promoting self-efficacy," "Fear of pain or needles," and "Time and family support" [ β (95% CI): 0.515 (0.355-0.674), 0.728 (0.470-0.986), 0.273 (0.030-0.515), 0.909 (0.606-1.213), all P<0.05]. In addition, disease duration [ β (95% CI):-0.011 (-0.019 to -0.004)] was independently negatively associated with the Ch-ASIQ score. In comparison, age [ β (95% CI): 0.011 (0.003-0.018)], DDS-4 [0.129 (0.069-0.190)], and PHQ-8 [0.015 (0.000-0.029)] were independently positively associated with the Ch-ASIQ score (all P<0.05). There were slight differences in the factors influencing the four sub-dimensions of the Ch-ASIQ scale. Conclusions:Community-based patients with T2D had moderate negative attitudes toward starting insulin treatment. Refusing insulin use, shorter diabetes duration, older age, higher diabetes distress, and higher levels of depression were associated with higher negative attitudes towards starting insulin use.

Objective:To develop a Protection Motivation Questionnaire(PMQ)for frailty management in the elderly based on the Protection Motivation Theory(PMT), and test its reliability and validity.Methods:Guided by PMT, the initial questionnaire items were formulated through literature review, semi-structured interviews, and Delphi expert consultation.A total of 551 elderly patients with frailty from a tertiary hospital in Changsha were investigated.Item screening was conducted via critical ratio method, Cronbach's α coefficient, correlation analysis, and factor analysis.The reliability was assessed through internal consistency and test-retest reliability, while validity was evaluated via content validity and structural validity.Results:The final PMQ comprised 25 items across five dimensions: severity, susceptibility, response efficacy, response cost, and self-efficacy.The overall Cronbach's α coefficient was 0.818, with subscale coefficients ranging from 0.701 to 0.821.The split-half reliability was 0.811, test-retest reliability was 0.929, and content validity indexwas 0.86.Exploratory factor analysis extracted five factors, accounting for 52.0% of the cumulative variance.Confirmatory factor analysis demonstrated good model fit( χ2/df=1.626, RMSEA=0.05, CFI =0.914). Conclusions:The developed questionnaire exhibits strong reliability and validity, serving as an effective tool to assess protection motivation for frailty management in the elderly.

Objective:To assess the attitudes toward and factors influencing starting insulin use among community-based patients with type 2 diabetes (T2D).Methods:A cross- sectional study. This secondary analysis used baseline data from patients with T2D recruited through convenience sampling from a community-based peer support intervention study implemented in nine community health service centers in Shanghai since 2017. Attitudes toward insulin use were assessed using the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ); the higher the score, the more negative the attitude toward starting insulin use. Multiple linear regression was used to analyze the factors influencing attitudes toward starting insulin use.Results:A total of 336 patients with T2D were included in the survey. The patients had a mean age of (67.7±7.9) years, mean disease duration of (13.62±7.73) years, relatively low levels of depression [Patient Health Questionnaire 8 (PHQ-8): 2 (0, 5)] and diabetes distress [Diabetes Distress Scale 4 (DDS-4): 1.97±0.95], and suboptimal target achieving rates of risk factors including body mass index, blood pressure, blood glucose, and lipid levels. The total score on the Ch-ASIQ among all patients was 1.84±0.55. Multivariate analyses showed that refusing insulin use was positively significantly associated with higher scores on the Ch-ASIQ and the three sub-dimensions of "Factors promoting self-efficacy," "Fear of pain or needles," and "Time and family support" [ β (95% CI): 0.515 (0.355-0.674), 0.728 (0.470-0.986), 0.273 (0.030-0.515), 0.909 (0.606-1.213), all P<0.05]. In addition, disease duration [ β (95% CI):-0.011 (-0.019 to -0.004)] was independently negatively associated with the Ch-ASIQ score. In comparison, age [ β (95% CI): 0.011 (0.003-0.018)], DDS-4 [0.129 (0.069-0.190)], and PHQ-8 [0.015 (0.000-0.029)] were independently positively associated with the Ch-ASIQ score (all P<0.05). There were slight differences in the factors influencing the four sub-dimensions of the Ch-ASIQ scale. Conclusions:Community-based patients with T2D had moderate negative attitudes toward starting insulin treatment. Refusing insulin use, shorter diabetes duration, older age, higher diabetes distress, and higher levels of depression were associated with higher negative attitudes towards starting insulin use.

Objective To explore and identify the nutritional/inflammatory indicator with the highest predictive potential for overall survival(OS)in postoperative tumor patients so as to provide guidance for postoperative rehabilitation of tumor patients.Methods Data from 3 191 surgical patients were collected,including 15 nutritional/inflammatory indicators.The maximum selection rank statistic method was used to calculate the optimal cut-off values for continuous indicators.The Kaplan-Meier method was used to assess OS,and Cox proportional hazards models were used to analyze the association between the aforementioned 15 indicators and survival.The predictive value of these 15 indicators was evaluated with receiver operating characteristic(ROC)curves and C-index.Results Multivariate analysis showed that all 15 indicators were significantly associated with poorer OS in surgical patients(P＜0.05 for all).Time-dependent area under the curve(AUC)and C-index analysis indicated that 3 indicators with the highest predictive potential in OS in postoperative tumor patients were the nutritional risk index(NRI)(C-index:0.597),C-reactive protein-to-albumin ratio(CAR)(C-index:0.587),and C-reactive protein-to-lymphocyte ratio(CLR)(C-index:0.587).The optimal cut-off value for NRI was determined to be 104.31(i.e.,NRI＜104.31 suggests malnutrition)with the maximum selection rank statistic method,the optimal cut-off value for CAR to be 0.05(i.e.,CAR≥0.05 suggests a strong inflammatory response,often accompanied by malnutrition),and the optimal cut-off value for CLR to be 1.18(i.e.,CLR≥1.18 suggests a strong inflammatory response).Subgroup analysis indicated that NRI,CAR,and CLR had good correlation with tumor staging,and there were significant differences between tumor node metastasis(TNM)Ⅲ/Ⅳ stage patients and TNM Ⅰ/Ⅱ stage patients when there was a strong inflammatory response or malnutrition.Conclusion In postoperative tumor patients,NRI,CLR,and CAR have high prognostic value.Combining these with the patient's clinical stage,it enables more precise guidance for clinical diagnosis and treatment strategies.

Objective To explore and identify the nutritional/inflammatory indicator with the highest predictive potential for overall survival(OS)in postoperative tumor patients so as to provide guidance for postoperative rehabilitation of tumor patients.Methods Data from 3 191 surgical patients were collected,including 15 nutritional/inflammatory indicators.The maximum selection rank statistic method was used to calculate the optimal cut-off values for continuous indicators.The Kaplan-Meier method was used to assess OS,and Cox proportional hazards models were used to analyze the association between the aforementioned 15 indicators and survival.The predictive value of these 15 indicators was evaluated with receiver operating characteristic(ROC)curves and C-index.Results Multivariate analysis showed that all 15 indicators were significantly associated with poorer OS in surgical patients(P＜0.05 for all).Time-dependent area under the curve(AUC)and C-index analysis indicated that 3 indicators with the highest predictive potential in OS in postoperative tumor patients were the nutritional risk index(NRI)(C-index:0.597),C-reactive protein-to-albumin ratio(CAR)(C-index:0.587),and C-reactive protein-to-lymphocyte ratio(CLR)(C-index:0.587).The optimal cut-off value for NRI was determined to be 104.31(i.e.,NRI＜104.31 suggests malnutrition)with the maximum selection rank statistic method,the optimal cut-off value for CAR to be 0.05(i.e.,CAR≥0.05 suggests a strong inflammatory response,often accompanied by malnutrition),and the optimal cut-off value for CLR to be 1.18(i.e.,CLR≥1.18 suggests a strong inflammatory response).Subgroup analysis indicated that NRI,CAR,and CLR had good correlation with tumor staging,and there were significant differences between tumor node metastasis(TNM)Ⅲ/Ⅳ stage patients and TNM Ⅰ/Ⅱ stage patients when there was a strong inflammatory response or malnutrition.Conclusion In postoperative tumor patients,NRI,CLR,and CAR have high prognostic value.Combining these with the patient's clinical stage,it enables more precise guidance for clinical diagnosis and treatment strategies.

Objective To investigate the levels of plasma bile acids(BA)in patients with primary liver cancer(PLC)or metastatic liver cancer(MLC)and their correlation with clinical indicators,as well as the value of plasma BAs combined with alpha-fetoprotein(AFP)in the diagnosis of PLC.Methods This study was conducted among 75 patients with PLC and 79 patients with MLC who attended Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2020 to September 2021 and had a confirmed diagnosis based on histopathological and imaging findings.Peripheral blood samples were collected from all patients,and serum and plasma were separated.Colorimetry and chromatography were used to measure biochemical parameters;electrochemiluminescence immunoassay was used to measure the levels of tumor markers;liquid chromatography-tandem mass spectrometry was used to measure the content of BA.The t-test was used for comparison of normally distributed continuous data,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data;the Spearman's coefficient was used for correlation analysis;the receiver operating characteristic(ROC)curve was used to evaluate clinical diagnostic efficacy.Results The PLC group had significantly lower levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol,and apolipoprotein B than the MLC group(U=1 598,1 255,909,and 889,all P＜0.05).Compared with the MLC group,the PLC group had a significantly higher level of AFP and a significantly lower level of carcinoembryonic antigen(U=1 873 and 926,both P＜0.05).Compared with the MLC group,the PLC group had significantly higher levels of TBA,CA,CDCA,UDCA,TCA,TCDCA,GCA,GCDCA,TUDCA,and GUDCA and a significantly lower level of DCA(all P＜0.05).In the total population,the levels of TBA,CDCA,GCA,GCDCA,GUDCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P＜0.05).In the patients with PLC,the levels of GCA,TCA,TCDCA,and TUDCA were significantly positively correlated with the level of AFP(all P＜0.05).Combined measurement of AFP+TCA+GCA+TCDCA had an area under the ROC curve of 0.822(95%confidence interval:0.746-0.898,P＜0.000 1),suggesting that it had the highest diagnostic efficacy.Conclusion There are significant differences in the levels of plasma BA between the patients with PLC and those with MLC,and the differentially expressed BAs are closely associated with liver function impairment and the increase in AFP.BAs combined with AFP has a better clinical value in the diagnosis of PLC.