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.

Objective To investigate the relationship between the levels of peripheral blood iri-sin,myostatin(MSTN),and 25-hydroxyvitamin D[25(OH)D]and the risk and predictive value of sarcopenia in elderly patients with type 2 diabetes mellitus(T2DM)complicated by heart failure.Methods Elderly patients with T2DM complicated by heart failure who visited Xingtai Central Hospi-tal from March 2023 to March 2024 were selected as the study subjects.The sample size was calculated based on the effect size.Patients were divided into modeling set(n=140)and validation set(n=60)at a ratio of 7 to 3 using a simple randomization method.Additionally,according to the occur-rence of sarcopenia,patients in the modeling set were divided into sarcopenia group and non-sar-copenia group.Clinical data and the levels of peripheral blood irisin,MSTN,and 25(OH)D were compared between the modeling and validation sets.The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of peripheral blood irisin,MSTN,and 25(OH)D for sarcopenia.Multivariate logistic regression analysis was employed to identify the influencing fac-tors of sarcopenia in elderly patients with T2DM complicated by heart failure,and a relevant predic-tive model was constructed using R software.Results Among 200 elderly patients with T2DM com-plicated by heart failure,71 cases developed sarcopenia,with an incidence rate of 35.50％.The proportion of regular exercise,bone mineral content,and the levels of irisin and 25(OH)D in the sarcopenia group were lower than those in the non-sarcopenia group,while the MSTN level was high-er in the sarcopenia group,and the differences were statistically significant(P＜0.05).The areas under the curve(AUCs)for predicting sarcopenia by irisin,MSTN,and 25(OH)D were 0.878(95％CI,0.812 to 0.927),0.848(95％CI,0.778 to 0.903),and 0.826(95％CI,0.753 to 0.885),respectively.The sensitivities were 74.16％,79.78％,and 88.76％,and the specifici-ties were 74.16％,79.79％,and 88.76％,respectively.The results of multivariate logistic regres-sion analysis showed that lack of exercise habits(OR=2.489,95％CI,1.665 to 3.735),de-creased bone mineral content(OR=2.340,95％CI,1.596 to 3.595),irisin ≤105.44 ng/mL(OR=3.111,95％CI,2.004 to5.147),MSTN＞19.06 μg/L(OR=2.667,95％CI,2.015 to 4.693),and25(OH)D ≤12.23 ng/mL(OR=2.547,95％CI,1.285 to 4.492)were all inde-pendent risk factors for sarcopenia in these patients(P＜0.05).The results of ROC curve analysis showed that the AUCs of the nomogram model for predicting postoperative recurrence in the modeling and validation sets were 0.875 and 0.853,respectively.The Hosmer-Lemeshow test for the model-ing and validation sets showed the following results:x2=0.715,P=0.510;x2=0.651,P=0.568.The calibration curves were basically consistent with the standard curves.The threshold probability range of decision curve analysis(DCA)was 0.1 to 0.9.Within this range,both the modeling and validation sets showed good clinical net benefits.Conclusion Peripheral blood iri-sin,MSTN,and 25(OH)D all have certain predictive values for the occurrence of sarcopenia in elderly patients with T2DM complicated by heart failure.The nomogram model constructed based on irisin,MSTN,and 25(OH)D can provide a quantitative basis for the early screening of sarcopenia in these patients.

Objective:To understand the incidence rate of herpes zoster (HZ) and postherpetic neuralgia (PHN) in Beijing, and analyze the incidence trend of HZ and PHN from 2015 to 2022.Methods:Cases of HZ and PHN from 2015 to 2022 were retrieved from the Hospital Information Systems (HIS) of all primary and above hospitals/clinics in three districts representing the urban, inner suburban, and outer suburban areas of Beijing. After duplication screening, the first visit cases were screened, and the incidence characteristics were described. The incidence rate of HZ and PHN in each year by sex and age group and the age-standardized incidence rate were calculated. The annual percentage increase (APC) of incidence rate was calculated using the Joint regression model, and the change trend was analyzed.Results:The age-standardized incidence rate of HZ in Beijing from 2015 to 2022 ranged from 7.44‰ to 10.05‰, with an average annual incidence rate of 8.95 ‰, significantly increasing with age ( P<0.001). The Joinpoint regression model showed that the overall age-standardized incidence of HZ remained relatively stable, with no significant difference (APC=2.28%, t=1.56, P=0.170). However, the incidence rate among the 0-19-year-old group exhibited a trend of decrease (APC=-10.70%, t=-6.29, P<0.001). For PHN, the age-standardized incidence in Beijing ranged from 0.77‰ to 2.67‰, with an average annual incidence rate of 1.59‰ and a proportion of 9.48% to 26.86% among HZ cases. Both the incidence of PHN and its proportion among HZ cases increased with age ( P<0.001). The age-standardized incidence of PHN increased annually (APC=18.56%, t=9.02, P<0.001). Conclusion:The incidence rate of HZ and PHN in Beijing continues to be at a high level, and PHN shows an increasing trend over time.

Objective To investigate the expression levels of serum microRNA-15a(miR-15a),microRNA-195-5p(miR-195-5p),and microRNA-33(miR-33)in pregnant women with gestational diabetes mellitus(GDM)and to explore their associations with maternal and neonatal outcomes.Methods The research subjects were selected from 208 patients with GDM who completed delivery at our hospital between September 2021 and October 2024.Based on maternal pregnancy outcomes,the subjects were categorized into either the poor maternal outcome group or the good maternal outcome group.Similarly,they were classified into the poor perinatal outcome group and the good perinatal outcome group according to perinatal outcomes.Clinical data and serum levels of fasting plasma glucose(FPG),miR-15a,miR-195-5p,and miR-33 were collected and compared between groups with different maternal and perinatal outcomes.Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse maternal and perinatal outcomes among GDM patients.Additionally,the predictive value of these biomarkers for adverse maternal and perinatal outcomes was evaluated using receiver operating characteristic(ROC)curve analysis.Results Among 208 patients with GDM,81 experienced adverse maternal pregnancy outcomes(38.94％).Of the 192 newborns,51 cases were associated with adverse perinatal outcomes,resulting in an incidence rate of 26.56％.Multivariate logistic regression analysis revealed that a high insulin resistance index(OR=2.197),poor glycemic control(OR=2.482),a history of adverse pregnancy or childbirth(OR=2.838),elevated FPG levels(OR=1.910),increased serum expression of miR-15a(OR=1.988),miR-195-5p(OR=2.273),and miR-33(OR=2.479)were independent risk factors for adverse maternal pregnancy outcomes in GDM patients(P<0.05).The area under the receiver operating characteristic curve(AUC)for the combined detection of miR-15a,miR-195-5p,and miR-33 was higher than that of FPG alone in predicting maternal pregnancy outcomes,with the combined detection showing the highest AUC(P<0.05).Similarly,multivariate logistic regression results also indicated that elevated levels of the aforementioned biomarkers—insulin resistance index(OR=2.155),poor glycemic control(OR=2.408),history of adverse pregnancy or childbirth(OR=2.838),FPG(OR=2.018),miR-15a(OR=2.197),miR-195-5p(OR=2.246),and miR-33(OR=3.043)—were independent risk factors for adverse perinatal outcomes in GDM patients(P<0.05).The AUC for combined detection of miR-15a,miR-195-5p,and miR-33 was significantly higher than that of FPG alone in predicting perinatal outcomes,with the combination yielding the highest predictive accuracy(P<0.05).Conclusions Patients with GDM are at increased risk of adverse maternal and perinatal outcomes.Elevated insulin resistance index,poor glycemic control,a history of adverse pregnancy or childbirth,and increased serum levels of miR-15a,miR-195-5p,and miR-33 were identified as independent risk factors for adverse pregnancy outcomes in individuals with gestational diabetes.The individual measurement of miR-15a,miR-195-5p,and miR-33,as well as their combined detection,demonstrated greater predictive value for pregnancy outcomes in GDM patients compared to FPG alone,with the combined detection showing the highest predictive accuracy.

Objective·To explore the effect of intermittent theta burst stimulation(iTBS)targeting the left dorsolateral prefrontal cortex(DLPFC)on reducing craving in alcohol-dependent patients during the withdrawal period,as well as its impact on patients'emotions and cognitive functions.Methods·A total of 41 inpatients with alcohol dependence in the withdrawal period were recruited from the Addiction Department of Mental Health Center,Shanghai Jiao Tong University School of Medicine,and randomly assigned to the experimental group(20 patients)and the control group(21 patients).Both groups received routine inpatient treatment for alcohol-dependence.The experimental group received real iTBS stimulation targeting the left DLPFC on the basis of routine inpatient treatment,while the control group received sham stimulation with the same parameters.The intervention course lasted for 2 weeks,with a total of 10 sessions.The Visual Analogue Scale(VAS),Beck Depression Inventory(BDI),and Beck Anxiety Inventory(BAI)were used to measure the craving,anxiety,and depression of the patients before and after the intervention.The behavioral tasks of the detection task(DET),identification task(IDN),two back task(TWOB),the Groton maze learning task(GML),and international shopping list task(ISL)in the CogState software package were used to assess the cognitive processing speed,attention/vigilance,working memory,spatial problem-solving/error monitoring ability,and verbal learning and memory of the patients before and after the intervention.Results·Repeated measures ANOVA showed that the time effect[F=126.713,P＜0.001,partial η2(ηp2)=0.765]and interaction effect(F=7.080.P=0.011,ηp2=0.154)of the VAS scores in the two groups of patients were statistically significant.The time effect(F=9.114,P=0.004,ηp2=0.189),group effect(F=5.557,P=0.024,ηp2=0.125),and interaction effect(F=4.977,P=0.032,η2=0.113)of the TWOB score were all statistically significant.Only the time effects of BDI(F=45.273,P＜0.001,ηp2=0.578),BAI(F=31.432,P＜0.001,ηp2=0.473),GML(F=8.993,P=0.005,ηp2=0.209),and ISL(F=26.657,P＜0.001,ηp2=0.439)scores were statistically significant.There were no statistically significant effects of time,group,or interaction on the DET and IDN scores.Simple effect analysis showed that the VAS score of the real stimulation group was lower than that of the sham stimulation group after the intervention(F=8.805,P=0.005,ηp2=0.184),and the TWOB score of the real stimulation group was higher than that of the sham stimulation group(F=11.293,P=0.002,ηp2=0.225).Conclusion·Combining iTBS with routine inpatient treatment can enhance the efficacy of reducing alcohol craving in alcohol-dependent patients during the withdrawal period,and improve their working memory.

Objective:To understand the incidence rate of herpes zoster (HZ) and postherpetic neuralgia (PHN) in Beijing, and analyze the incidence trend of HZ and PHN from 2015 to 2022.Methods:Cases of HZ and PHN from 2015 to 2022 were retrieved from the Hospital Information Systems (HIS) of all primary and above hospitals/clinics in three districts representing the urban, inner suburban, and outer suburban areas of Beijing. After duplication screening, the first visit cases were screened, and the incidence characteristics were described. The incidence rate of HZ and PHN in each year by sex and age group and the age-standardized incidence rate were calculated. The annual percentage increase (APC) of incidence rate was calculated using the Joint regression model, and the change trend was analyzed.Results:The age-standardized incidence rate of HZ in Beijing from 2015 to 2022 ranged from 7.44‰ to 10.05‰, with an average annual incidence rate of 8.95 ‰, significantly increasing with age ( P<0.001). The Joinpoint regression model showed that the overall age-standardized incidence of HZ remained relatively stable, with no significant difference (APC=2.28%, t=1.56, P=0.170). However, the incidence rate among the 0-19-year-old group exhibited a trend of decrease (APC=-10.70%, t=-6.29, P<0.001). For PHN, the age-standardized incidence in Beijing ranged from 0.77‰ to 2.67‰, with an average annual incidence rate of 1.59‰ and a proportion of 9.48% to 26.86% among HZ cases. Both the incidence of PHN and its proportion among HZ cases increased with age ( P<0.001). The age-standardized incidence of PHN increased annually (APC=18.56%, t=9.02, P<0.001). Conclusion:The incidence rate of HZ and PHN in Beijing continues to be at a high level, and PHN shows an increasing trend over time.

Objective To investigate the expression levels of serum microRNA-15a(miR-15a),microRNA-195-5p(miR-195-5p),and microRNA-33(miR-33)in pregnant women with gestational diabetes mellitus(GDM)and to explore their associations with maternal and neonatal outcomes.Methods The research subjects were selected from 208 patients with GDM who completed delivery at our hospital between September 2021 and October 2024.Based on maternal pregnancy outcomes,the subjects were categorized into either the poor maternal outcome group or the good maternal outcome group.Similarly,they were classified into the poor perinatal outcome group and the good perinatal outcome group according to perinatal outcomes.Clinical data and serum levels of fasting plasma glucose(FPG),miR-15a,miR-195-5p,and miR-33 were collected and compared between groups with different maternal and perinatal outcomes.Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse maternal and perinatal outcomes among GDM patients.Additionally,the predictive value of these biomarkers for adverse maternal and perinatal outcomes was evaluated using receiver operating characteristic(ROC)curve analysis.Results Among 208 patients with GDM,81 experienced adverse maternal pregnancy outcomes(38.94％).Of the 192 newborns,51 cases were associated with adverse perinatal outcomes,resulting in an incidence rate of 26.56％.Multivariate logistic regression analysis revealed that a high insulin resistance index(OR=2.197),poor glycemic control(OR=2.482),a history of adverse pregnancy or childbirth(OR=2.838),elevated FPG levels(OR=1.910),increased serum expression of miR-15a(OR=1.988),miR-195-5p(OR=2.273),and miR-33(OR=2.479)were independent risk factors for adverse maternal pregnancy outcomes in GDM patients(P<0.05).The area under the receiver operating characteristic curve(AUC)for the combined detection of miR-15a,miR-195-5p,and miR-33 was higher than that of FPG alone in predicting maternal pregnancy outcomes,with the combined detection showing the highest AUC(P<0.05).Similarly,multivariate logistic regression results also indicated that elevated levels of the aforementioned biomarkers—insulin resistance index(OR=2.155),poor glycemic control(OR=2.408),history of adverse pregnancy or childbirth(OR=2.838),FPG(OR=2.018),miR-15a(OR=2.197),miR-195-5p(OR=2.246),and miR-33(OR=3.043)—were independent risk factors for adverse perinatal outcomes in GDM patients(P<0.05).The AUC for combined detection of miR-15a,miR-195-5p,and miR-33 was significantly higher than that of FPG alone in predicting perinatal outcomes,with the combination yielding the highest predictive accuracy(P<0.05).Conclusions Patients with GDM are at increased risk of adverse maternal and perinatal outcomes.Elevated insulin resistance index,poor glycemic control,a history of adverse pregnancy or childbirth,and increased serum levels of miR-15a,miR-195-5p,and miR-33 were identified as independent risk factors for adverse pregnancy outcomes in individuals with gestational diabetes.The individual measurement of miR-15a,miR-195-5p,and miR-33,as well as their combined detection,demonstrated greater predictive value for pregnancy outcomes in GDM patients compared to FPG alone,with the combined detection showing the highest predictive accuracy.

Objective·To explore the effect of intermittent theta burst stimulation(iTBS)targeting the left dorsolateral prefrontal cortex(DLPFC)on reducing craving in alcohol-dependent patients during the withdrawal period,as well as its impact on patients'emotions and cognitive functions.Methods·A total of 41 inpatients with alcohol dependence in the withdrawal period were recruited from the Addiction Department of Mental Health Center,Shanghai Jiao Tong University School of Medicine,and randomly assigned to the experimental group(20 patients)and the control group(21 patients).Both groups received routine inpatient treatment for alcohol-dependence.The experimental group received real iTBS stimulation targeting the left DLPFC on the basis of routine inpatient treatment,while the control group received sham stimulation with the same parameters.The intervention course lasted for 2 weeks,with a total of 10 sessions.The Visual Analogue Scale(VAS),Beck Depression Inventory(BDI),and Beck Anxiety Inventory(BAI)were used to measure the craving,anxiety,and depression of the patients before and after the intervention.The behavioral tasks of the detection task(DET),identification task(IDN),two back task(TWOB),the Groton maze learning task(GML),and international shopping list task(ISL)in the CogState software package were used to assess the cognitive processing speed,attention/vigilance,working memory,spatial problem-solving/error monitoring ability,and verbal learning and memory of the patients before and after the intervention.Results·Repeated measures ANOVA showed that the time effect[F=126.713,P＜0.001,partial η2(ηp2)=0.765]and interaction effect(F=7.080.P=0.011,ηp2=0.154)of the VAS scores in the two groups of patients were statistically significant.The time effect(F=9.114,P=0.004,ηp2=0.189),group effect(F=5.557,P=0.024,ηp2=0.125),and interaction effect(F=4.977,P=0.032,η2=0.113)of the TWOB score were all statistically significant.Only the time effects of BDI(F=45.273,P＜0.001,ηp2=0.578),BAI(F=31.432,P＜0.001,ηp2=0.473),GML(F=8.993,P=0.005,ηp2=0.209),and ISL(F=26.657,P＜0.001,ηp2=0.439)scores were statistically significant.There were no statistically significant effects of time,group,or interaction on the DET and IDN scores.Simple effect analysis showed that the VAS score of the real stimulation group was lower than that of the sham stimulation group after the intervention(F=8.805,P=0.005,ηp2=0.184),and the TWOB score of the real stimulation group was higher than that of the sham stimulation group(F=11.293,P=0.002,ηp2=0.225).Conclusion·Combining iTBS with routine inpatient treatment can enhance the efficacy of reducing alcohol craving in alcohol-dependent patients during the withdrawal period,and improve their working memory.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

[Objective]To introduce the experiences of prescription based on syndrome differentiation of Ningbo famous traditional Chinese medicine doctor CHEN Ninggang in using Baihua Sheshecao Decoction to treat acne.[Methods]Comparing analyse of the similarities and differences of the pathogenesis based on the ancient classics,combining Master CHEN's experience through both ancient and modern learning to explore the clinical pathogenic factors and pathogenesis characteristics of modern patients,the prescription structure and the connotation of the prescription of the Baihua Sheshecao Decoction are deeply analyzed and a medical case is attached to support.[Results]Generations of traditional Chinese medical doctors have held different ideas on the pathogenesis of acne,and the related theories are numerous.Master CHEN believes that Ningbo is located in the south of the Yangtze River,coupled with the influence of bad living habits and emotions of modern people,patients get lung and stomach dampness and heat as the main pathogenesis,so the treatment should clear heat and dampness to promote acne through the skin.Therefore,Master CHEN creates Baihua Sheshecao Decoction which based on many years of clinical experience.In the formula,Herba Hedyotis as king medicine is used to clear the dampness and heat and scatter knot to eliminate sores,Poria cocos as minister medicine is used to help Herba Hedyotis to alleviate water retention,Mustard as assistant medicine is used to reducing phlegm and resolving masses,Gleditsia sinensis as assistant medicine is used to break sores and Rhizoma Zingiberis is to warm the spleen and protect the stomach,Ephedra sinica as guiding medicine is to take all medicine through the skin and dissipate the Yin knot,Radix Glycyrrhizae as guiding medicine is to keep the whole formula in harmony.The case attached reviews Master CHEN's process of thought from prescription to syndrome,which solves the pathological factors such as dampness,heat,phlegm and blood stasis in the process of disease and get remarkable results.[Conclusion]Master CHEN takes lung and stomach dampness and heat as the core of the pathogenesis,self-creating Baihua Sheshecao Decoction which existing both powerful destruction to pathogenic factors and considerate protection to patient's body,coupling hardness with softness.The formula can be flexible modified according to the various changes of the state of illnesses and is effective in treatment.This thinking process of prescription to syndrome analysis is worth further exploration and research for clinical reference.