This article systematically explores the traditional Chinese medicine （TCM） pathogenesis evolution and metastatic mechanisms of advanced gastric cancer from the perspective of "phlegm-toxin flowing infusion". Based on this theory， it is proposed that advanced gastric cancer presents a pathogenesis evolution characterized by healthy qi depletion， phlegm-toxin flowing infusion， and collateral damage with blood stasis. Healthy qi depletion is the root of the disease， in which spleen and kidney insufficiency leads to weakened healthy qi and inability to resist pathogenic factors. Phlegm-toxin flowing infusion is the core pathogenesis， where phlegm-dampness and cancer toxin intertwine and migrate to other organs along with qi movement. Collateral damage with blood stasis constitutes the final pathological stage of metastasis， where phlegm-toxin obstruction damages the collaterals， and congealed qi and blood form accumulations. On this basis， the meridian pathways and metastasis mechanisms of advanced gastric cancer spreading to multiple sites such as the liver， peritoneum， lungs， bones， brain， ovary， and lymph nodes are further analyzed， providing references for clinical management and research of this disease.

ObjectiveTo investigate the current status of assistive device use and unmet needs among persons with disabilities in Sichuan-Chongqing region, and to identify the key factors associated with satisfaction with these devices. MethodsFrom October, 2024 to February, 2025, quota sampling was adopted to recruit 1 040 persons with disabilities in Sichuan and 260 persons with disabilities in Chongqing. Telephone and online questionnaires were used to collect data on demographic characteristics, status of assistive device utilization and unmet assistive device needs, as well as satisfaction with assistive device use. Correlation analysis, multiple linear regression analysis and structural equation modeling were performed to identify key factors associated with satisfaction. ResultsA total of 1 186 valid responses were collected, of which 942 were from Sichuan Province and 244 from Chongqing Municipality. The utilization rate of assistive devices among persons with disabilities in Sichuan-Chongqing region was 61.9%, and the rate of unmet assistive device needs was 30.6%. The assistive device utilization rate of participants with agricultural household registration (57.98%) was lower than that of participants with non-agricultural household registration (66.86%). The utilization rate showed a J-shaped upward trend with the increase of educational attainment. Educational attainment (P = 0.002), perceived usefulness of assistive devices (P < 0.001), home living environment (P < 0.001), public environment (P < 0.001) and disability type (significant differences were found in visual and hearing disabilities compared with physical disability, P < 0.05) were key predictors of satisfaction with assistive device use. The impact of public environment on satisfaction was exerted through two indirect mediating paths: mediating effect via perceived usefulness of assistive devices (ind₁ = 0.357, 95%CI 0.279 to 0.437, P < 0.001), contributing approximately 70% of the total indirect effect; mediating effect via home living environment (ind₂ = 0.129, 95%CI 0.006 to 0.242, P = 0.038), contributing approximately 25% of the total indirect effect. ConclusionThere is a structural imbalance between assistive device use and demand in Sichuan-Chongqing region. People with psycho-intellectual disabilities are most likely to be excluded from the service chain because they neither perceive need nor access information. Education exerts a robust positive effect on both adoption and satisfaction, so training content must be tailored to different educational levels. Satisfaction is shaped by disability type, device usefulness and environmental factors. Future product development should therefore integrate functional and psychosocial dimensions. Priority should be given to micro-scale home-and-community accessibility retrofits before extending upward to public transportation and employment settings, to maximize the cost-effectiveness of limited funds.

Objective To investigate the prognostic role of serum beta 2-microglobulin(β2M)as a systemic inflammatory biomarker in hospitalized patients with exacerbation of COPD,compared with other inflammatory biomarkers.Methods We retrospectively analyzed hospitalized patients with exacerbated COPD as the first diagnosis at Beijing Chao-Yang hospital,P.R.China,from December 31,2012 to December 28,2017.Serum β2M levels,laboratory and clinical indexes were measured or collected on admission,and all patients were followed up for 90 days.The prognostic performance of β2M was compared with the neutrophils-lymphocytes ratio(NLR),C-reactive protein values(CRP)and white blood cell(WBC)using MedCalc.Results For 30-day mortality,β2M,NLR,and CRP showed significant predictive value(all P<0.001)and were better than WBC(P=0.044,0.003 and 0.030,respectively)in hospitalized patients with exacerbated COPD,while WBC had no predictive significance.For 90-day mortality,β2M,NLR,CRP,and WBC were all statistically significant,but only NLR outperformed WBC(P=0.004).No significant differences were observed among β2M,NLR,and CRP.Conclusion As a systemic inflammatory biomarker,serum β2M was a useful prognostic biomarker for short-term death in hospitalized patients with COPD exacerbations.It performed slightly better than NLR and CRP for 30-day mortality prediction and slightly superior to CRP and slightly inferior to NLR for 90-day mortality prediction.

Objective:To analyze the current status and trend of the mortality burden of cardiovascular disease in China from 2010 to 2021.Methods:Data related to cardiovascular disease mortality and disability-adjusted life year (DALY) were extracted from the Global Burden of Disease Study 2021 (GBD2021) database. The age-standardized mortality rate and DALY rate were calculated, using the 2021 world standard population estimated by GBD2021. Joinpoint 5.2.0 software was used to calculate the mortality rate, standardized mortality rate, DALY rate, standardized DALY rate, annual percent change (APC), average annual percent change (AAPC), and 95% CI of cardiovascular disease in China from 2010 to 2021. Results:The mortality rate of cardiovascular disease was 357.44/100 000, and the age-standardized mortality rate was 280.11/100 000 in China in 2021. The DALY rate was 7 043.33/100 000, and the age-standardized DALY rate was 5 120.06/100 000. From 2010 to 2021, the mortality rate and DALY rate of cardiovascular disease in China showed an upward trend (AAPC was 1.58% and 0.83%, respectively, both P<0.05), and the standardized mortality rate and standardized DALY rate showed a downward trend (AAPC was -2.13% and -2.02%, respectively, both P<0.05). The mortality burden of cardiovascular disease was higher in males (mortality rate 392.80/100 000, DALY rate 8 156.19/100 000) than in females (mortality rate 320.38/100 000, DALY rate 5 876.87/100 000). With the increase older in age, the mortality burden of cardiovascular disease in China decreased first and then increased. China ranked high in the mortality burden of cardiovascular disease among G20 member countries. Conclusions:The death burden of cardiovascular disease is serious in China. The mortality rate and DALY rate of cardiovascular disease in China showed an increasing trend from 2010 to 2021, and the standardized mortality rate and standardized DALY rate of cardiovascular disease ranked high in G20 member countries. The death burden of cardiovascular disease was more serious in men and the elderly. It is necessary to develop more comprehensive prevention, treatment, and rehabilitation measures for men and the elderly to reduce mortality and disability rates, decrease the disease burden, and improve the quality of life.

Objective Compare the tip perfusion index(TPI)with the disappearance of eyelash reflex in guiding the timing of intubation for painless gastroscopy,in order to find the optimal timing for painless gastroscopy.Methods 362 patients who underwent painless gastroscopy from January to June 2024 were selected.According to the random number table method,they were divided into group N(122 cases,direct endoscopic examination after the disappearance of eyelash reflex),group NS(121 cases,endoscopic examination 30 seconds after the disappearance of eyelash reflex),and group E[119 cases,endoscopic examination after continuous increase of TPI(newly measured value>previous measured value more than 3 times)].The changes in heart rate(HR),mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)before anesthesia induction(T0),before intubation(T1),through the throat(T2),and after examination(T3)were recorded and compared among the three groups.The intubation waiting time(from the completion of general anesthesia induction to the moment of intubation)and the incidence of adverse reaction were compared among the three groups.Results The waiting time for endoscopy in group N was(5.52±2.17)s,which was significantly shorter than that in group E[(18.60±3.89)s]and group NS[(35.74±2.17)s],and the differences were statistically significant(P<0.01).At T1 time point,the SpO2 of the group E was significantly higher than that of group N and group NS,the differences were statistically significant(P<0.01).There were no statistical difference of SpO2 at T0,T2 and T3 time points among the three groups(P>0.05).There were no statistical differences in HR and MAP at the T0,T1,T2 and T3 time points among the three groups(P>0.05);The MAP and HR of the three groups of patients at time point T0 were significantly higher than those at time points T1,T2 and T3,and the differences were statistically significant(P<0.05).The incidence of lower jaw support in group E was significantly lower than that in group NS and group N,the incidence of body movement and the rate of additional propofol administration were significantly lower than those in group N,the incidence of coughing was significantly lower than that in group NS,and the differences were statistically significant(P<0.05).Conclusion The TPI is a simple,non-invasive,objective,and real-time predictor of the timing of intubation for painless gastroscopy,which is significantly better than guiding the timing of intubation through the eyelash reflex.When the TPI continuously increases from a low point,it is a good time for painless gastroscopy intubation.

Objective To investigate the correlation between G protein-coupled receptor family C group 6 member A(GPRC6A)gene polymorphisms and their expression and pulmonary infections in elderly patients with chronic heart failure(CHF).Methods 138 elderly CHF patients admitted to the Xianyang First People's Hospital from January 2021 to January 2024 were selected as the research subjects,and were divided into an infected group(n=42)and an uninfected group(n=96)based on their lung infection status.Polymerase chain reaction(PCR)was used to detect polymorphisms at the rs6901250 and rs1606365 loci of the GPRC6A gene.The allele and genotype frequency distributions of the infected and uninfected groups were compared.Logistic regression modeling was used to analyze the s6901250 and rs1606365 loci under three genetic models(co-dominant,dominant and reces-sive)and lung infections in elderly patients with CHF.Real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression level of GPRC6A gene.The predictive value of the mRNA expression level of the GPRC6A gene for the development of pulmonary infections in elderly patients with CHF was analyzed by applying the receiver operator characteristic(ROC)curve.Results The distribution of genotypes at loci rs6901250 and rs1606365 of the GPRC6A gene in both the infected and uninfected groups of the lungs of elderly CHF patients conformed to the Hardy-Weinberg equilibrium law(χ2=0.199～0.376,all P>0.05),which was representative of the population.Compared with the uninfected group,the frequency of allele A at locus rs6901250(57.14%vs 41.67%)was significantly higher in the infected group,Allele G(54.76%vs.37.50%)and genotype GG(14.06%vs 29.99%)frequencies were significantly higher at locus rs1606365,and the differences were statistically significant(χ2=5.628,7.114,6.849,all P<0.05).At locus rs6901250,in the co-dominant model(GG vs AA)and the dominant model(GA+AA vs GG),the elderly CHF patients with AA genotype the risk of lung infection was higher than that of GG genotype(OR=1.753,1.546,all P<0.05);.rs1606365 locus showed that the risk of lung infection was higher than that of CC genotype in el-derly CHF patients with GG genotype under all three genetic models of co-dominant model(CC vs GG),dominant model(CG+GG vs CC)and recessive model(CG+CC vs GG)(OR=1.833,1.741,0.695,all P<0.05).The mRNA expression level of GPR-C6A gene in the lung-infected group of elderly CHF patients(1.43±0.35)was significantly higher than that in the uninfected group(1.02±0.21),and the difference was statistically significant(t=8.515,P<0.001).The results of the ROC curve analysis showed that the GPRC6A gene expression level predicted lung infection in elderly CHF patients with an AUC value of 0.895,a cut-offvalue of 1.37,and sensitivity and specificity of 85.7%and 66.7%,respectively.Conclusion The AA genotype at the rs6901250 locus and the GG genotype at the rs1606365 locus of the GPRC6A gene increased the risk of developing lung infec-tions in elderly patients with CHF.MRNA expression levels of the GPRC6A gene were elevated in the infected group,and its ex-pression level could be used as a predictive indicator for the development of lung infections in elderly patients with CHF.

Objective To evaluate the evidence about impact of physical activity(PA)on glycemic control and related health out-comes in patients with type 2 diabetes mellitus(T2DM).Methods Adhering to PRISMA guideline,systematic reviews and meta-analyses published between 2017 and 2024 were retrieved from the databases such as Medline,Embase and Cochrane Library.Two researchers independently ex-tracted data and assessed the quality using AMSTAR2.The included systematic reviews were systematically re-viewed.Results Eight systematic reviews were included,with six rated as high quality and two as low quality.Various forms of PA interventions,such as aerobic exercise,resistance training,combined training and high-intensity interval train-ing,might significantly reduce glycated hemoglobin,enhance cardiorespiratory fitness,lower cardiovascular risk factors(such as body mass,blood pressure and blood lipids),and decrease the risk of diabetes-related complica-tions and mortality in T2DM patients.Combined training and high-intensity training seemed to be better.Profes-sionally supervised PA was more effective.Conclusions Regular and multimodal PA is effective on glycemic control,and cardiovascular and metabolic risk factors in T2DM patients.It is advocated an individualized,diversified,adequately dosed(encouraging higher total dos-es),intensity-appropriate(promoting higher intensity),combined-mode and supervision-integrated PA strategies.

AIM:Study on the bioequivalence of rivaroxaban tablets from two different manufactur-ers in healthy subjects under fasting and postpran-dial conditions.METHODS:Adopting a single cen-ter,randomized,open,fasting and postprandial,four cycle,fully repeated crossover trial design.28 healthy male and female subjects were given oral administration of either the test or reference for-mulation(10 mg)on an empty stomach or in a post-prandial state,with a cleaning period of 7 days be-tween cycles.The concentration of rivaroxaban in the plasma(heparin sodium)of the subjects was measured using liquid chromatography tandem mass spectrometry(LC-MS/MS),and pharmacoki-netic(PK)parameters were calculated using Phoe-nix WinNonlin 7.0 software to evaluate the bio-equivalence of the test and reference formulations.RESULTS:Fasting group:After oral administration of the investigational drug,the Cmax of the test formula-tion and reference formulation were(200.96±68.99)ng/mL and(196.96±50.97)ng/mL,respec-tively,and the AUC0-t were(1 439.93±493.94)h·ng·mL-1 and(1 395.90±411.49)h·ng·mL-1,respectively,the AUC0-∞ were(1 506.56±511.47)h·ng·mL-1 and(1 451.94±417.89)h·ng·mL-1,respectively,the 90％confidence intervals for the geometric mean ratios of Cmax,AUC0-t,and AUC0-∞ were 91.87％-103.37％,95.00％-105.07％,95.33％-105.57％,respectively,the 90％CI of the intra-individual standard devia-tion ratio(SWT/SWR)for Cmax,AUC0-t,AUC0-∞were 0.88-1.73,0.74-1.45 and 0.72-1.41,respectively.Post-prandial group:After oral administration of the ex-perimental drug,the Cmax of the test and reference formulations were(241.23±54.44)ng/mL and(226.54±48.04)ng/mL,respectively,and the AUC0-t were(1 383.26±437.05)h·ng·mL-1 and(1 333.54±372.53)h·ng·mL-1,respectively,the AUC0-∞ were(1 404.01±439.89)h·ng·mL-1 and(1 352.31±374.45)h·ng·mL-1,respectively,the 90％confi-dence intervals for the geometric mean ratios of Cmax,AUC0-t,and AUC0-∞ were 100.92％-110.50％,98.30％-108.31％,and 98.46％-108.39％,respective-ly,the 90％CI of the intra-individual standard devia-tion ratio(SWT/SWR)for Cmax,AUC0-t and AUC0-∞ were 0.63-1.29,0.78-1.61 and 0.79-1.61,respectively.CONCLUSION:Bioequivalence of the two prepara-tions in fasting and postprandial state in healthy subjects.

Objective:To investigate the surgical effect of total parathyroidectomy combined with calf subcutaneous autotransplantation in the treatment of secondary hyperparathyroidism.Method:From Dec 2018 to Dec 2022,31 patients with secondary hyperparathyroidism who underwent total parathyroidectomy combined with calf subcutaneous autotransplantation in our hospital were selected to analyze the therapeutic effect.Results:All 31 operations were successfully completed.A total of 120 parathyroid glands were removed,including 27 cases(87.10%)with 4 parathyroid glands and 4 cases(12.90%)with 3 parathyroid glands.The average length of hospitalization was(15.82±8.74)days.Compared with preoperative parathyroid hormone,the value of parathyroid hormone decreased by more than 50%after 20 min of total parathyroidectomy.The levels of serum calcium,phosphorus,iPTH and calcium-phosphorus product at each time point after operation were significantly lower than those before operation(P＜0.01).The symptoms of joint pain was significantly improved in all patients after operation.During the postoperative follow-up of 31 patients,1 patient was confirmed to have graft recurrence at 6 months after operation,which was surgically removed.Conclusion:Total parathyroidectomy combined with calf subcutaneous autotransplantation can effectively treat secondary hyperparathyroidism and significantly improve the quality of life.

BACKGROUND:Research has shown that vanillic acid has anti-inflammatory and anti-oxidative stress effects,but it is unclear whether it has a protective effect on endplate chondrocytes.OBJECTIVE:To explore the effect and mechanism of vanillic acid on endplate chondrocytes under inflammatory microenvironment.METHODS:(1)Primary endplate chondrocytes were isolated from the intervertebral disc of SD rats and identified by toluidine blue staining and collagenⅡ immunofluorescence.(2)The CCK-8 assay was employed to detect the effects of interleukin-1β and vanillic acid on the proliferation activity of endplate chondrocytes,in order to determine the concentration of vanillic acid for subsequent cell treatment.(3)An inflammatory microenvironment was simulated by adding 10 ng/mL interleukin-1β to the culture medium,and the endplate chondrocytes were treated with low,medium,and high mass concentrations of vanillic acid.The expression levels of inflammatory markers and extracellular matrix proteins were detected by western blot assay and immunofluorescence.(4)The expression of nuclear factor κB signaling pathway-related proteins was detected by western blot assay.RESULTS AND CONCLUSION:(1)The morphology of endplate chondrocytes in adherent culture was pike or triangular in shape,positive for toluidine blue staining and immunofluorescence for collagen Ⅱ,indicating that the experimentally extracted cells were endplate chondrocytes.(2)The CCK-8 assay results showed that treatment with 2.5,5,10,and 20 μg/mL vanillic acid for 24 hours did not significantly inhibit the proliferation of endplate chondrocytes.Compared with the interleukin-1β group,the viability of endplate chondrocytes treated with 5,10,and 20 μg/mL vanillic acid for 24 hours was significantly increased(P＜0.05).Therefore,5,10,and 20 μg/mL vanillic acid was selected as the low,medium,and high dose groups for subsequent treatment of endplate chondrocytes.(3)Compared with the model group(complete medium containing 10 ng/mL interleukin-1β),the expression of NOD-like receptor thermal domain associated protein 3(NLRP3),matrix metalloproteinase 13,matrix metalloproteinase 3,and tumor necrosis factor alpha protein in the endplate chondrocytes of the low,medium,and high doses of vanillic acid groups were significantly reduced(P＜0.05).(4)Compared with the model group,the protein expression of aggrecan and collagen Ⅱ in the endplate chondrocytes of the low,medium,and high dose groups of vanillic acid significantly increased(P＜0.05).(5)Compared with the model group,the protein expression of phospho-nuclear factor κB and phospho-inhibitor of nuclear factor κB in the endplate chondrocytes of the low,medium,and high dose groups of vanillic acid was significantly reduced(P＜0.05).(6)The above results indicate that vanillic acid may alleviate the inflammatory response and extracellular matrix degradation induced by interleukin-1β in rat endplate chondrocytes by inhibiting the activation of the nuclear factor κB signaling pathway.