Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective:Pediatric chronic sinusitis （CRS） is a common disease within the field of otolaryngology-head and neck surgery. Due to the immaturity of sinus development and immune competence in children, its etiology and pathophysiology are complex, and its clinical features and outcomes differ significantly from those in adult patients. Currently, there are issues in the diagnosis and treatment of pediatric CRS, particularly in areas such as antibiotic use and surgical interventions, owing to a lack of sufficient attention. In recognition of this, the Chinese Rhinopathy Research Cooperation Group developed this expert consensus based on a systematic review of the latest literatures from both domestic and international sources, with reference to the latest evidence-based medical evidence worldwide, and in combination with their own clinical experience. The consensus covers various aspects including epidemiology, predisposing factors, pathophysiology, diagnosis and differential diagnosis, as well as treatment strategies such as medical therapy and surgical intervention. It aims to standardize the clinical diagnosis and treatment of pediatric CRS, improve clinical efficacy and patient satisfaction, reduce clinical expenditures, and decrease the occurrence of adverse reactions.
Humans ; Sinusitis/therapy* ; Chronic Disease ; Child ; Consensus ; Anti-Bacterial Agents/therapeutic use*

Objective To study the effects of an abnormal mechanical load in the developmental dysplasia of the hip(DDH)on the bone microstructure and blood vessels of the subchondral bone,and the correlation between bone microstructure and blood vessels.Methods A newborn rat DDH model was constructed using the swaddling method.Histological staining such as hematoxylin-eosin staining,safranin-fast green staining,and immunohistochemical staining was performed on the articular cartilage and subchondral bone of the femoral head.The microstructure of the subchondral bone was analyzed using microcomputed tomography(micro-CT).Results The DDH rats showed degeneration of the articular cartilage accompanied by deterioration of the microstructure of the subchondral bone,decreased bone formation,and increased vascular formation.The level of vascular formation in the subchondral bone was positively correlated with the degree of deterioration of the bone microstructure.Conclusions An abnormal mechanical load in the DDH causes articular cartilage degeneration,increased vascular formation in the subchondral bone,and subchondral bone microstructure deterioration.The correlation analysis revealed that the abnormal vascular formation in the subchondral bone may be an important factor causing the deterioration of bone microstructure and progression of DDH.This study has provided a new direction for the development of DDH.

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease with a high prevalence of high prevalence,mainly manifested by hyperglycemia,insulin secretion or insulin resistance,often complicated by hypertension,hyperlipidemia and other metabolic abnormalities.In recent years,the association between intestinal flora,bile acids and T2DM has been a hot topic in clinical research.Traditional Chinese medicine believes that the spleen and stomach belong to soil,liver and gallbladder belong to wood,spleen soil stagnation,soil internal heat,affecting the drainage of liver wood;The liver wood is staggered,Liver qi stagnation,the middle scorch is suppressed,and finally the spleen is stagnant,which is the image of"earth stagnation,wood depression".Earth stagnation and wood depression are the cause and effect of each other,which is the theoretical basis for the occurrence and development of T2DM,and earth stagnation cannot transport water valley to nourish liver wood,and the liver loses nourishment,resulting in liver qi loss in drainage,qi depression and fire injury yin,burning lungs,robbing gastric juice,consuming kidney water,and inducing thirst quenching.From the perspective of modern medicine and biotechnology,the intestinal flora-bile acid metabolic axis is used as the starting point to explain the scientific connotation of the theory of soil wood.Intestinal flora disorder is an important biological basis of the soil,the spleen and soil are stagnant,the water valley does not change,affecting the body's digestion,immunity,lipids and other aspects,resulting in intestinal flora disorders.Abnormal bile acid metabolism is an important microscopic embodiment of wood depression,liver loss and drainage,gas engine lifting and lowering abnormalities,resulting in bile depression,bile acid metabolism secretion abnormal.The intestinal microbiota-bile acid metabolism axis regulates glucose metabolism and glucose homeostasis by affecting the structural composition and diversity of intestinal flora and bile acid pool composition in T2DM patients,thereby affecting the development process of diabetes.Therefore,this paper discusses the biological connotation of T2DM"earth stagnation,wood depression"from the perspective of intestinal microbiota-bile acid metabolic axis,better explains the scientific nature of T2DM soil woody depression mechanism,and provides new clinical ideas and theoretical basis for the prevention and treatment of T2DM.

Objective To observe the regulatory effects of Yitangkang on neuroinflammation and polarization of microglia and astrocytes in db/db mice;To explore the its mechanism in the treatment of cognitive impairment in diabetes.Methods Totally 32 db/db mice were randomly divided into model group,liraglutide group,and Yitangkang low-and high-dosage group.Another C57BL/6 mice were taken as blank group,with 8 mice in each group.Yitangkang low-and high-dosage group were given Yitangkang Decoction 15,30 g/kg respectively,the liraglutide group was intraperitoneally injected with liraglutide 200 μg/kg,the blank group and model group were given the same volume of distilled water by gavage,for 5 weeks.FJC staining was used to observe the damage of hippocampal neurons,ELISA was used to detect the content of IL-6 and IL-1β in hippocampal tissue,immunohistochemistry was used to detect the expressions of IL-6,IL-1β,Iba1 and GFAP in hippocampal tissue,the expressions of CD86,CD206,C3,S100A10,NLRP3,Iba1 and GFAP were detected by immunofluorescence,the protein expressions of CD86,CD206,C3,S100A10 and NLRP3 in hippocampal tissue were detected by Western blot.Results Compared with the blank group,the FJC positive cells in the model group significantly increased,and the contents of IL-6 and IL-1β significantly increased,the expressions of Iba1,CD86,GFAP and C3 significantly increased,CD206 and S100A10 expressions significantly decreased,NLRP3 protein expression and co-expression with Iba1 and GFAP significantly increased,with statistical significance(P<0.05,P<0.01).Compared with the model group,the FJC positive cells in hippocampal tissue of liraglutide group and Yitangkang low-and high-dosage group significantly decreased,the contents of IL-6 and IL-1β significantly decreased,the expressions of Iba1,CD86,GFAP and C3 significantly decreased,the expressions of CD206 and S100A10 significantly increased,the expression of NLRP3 protein and co-expression with Iba1 and GFAP were significantly decreased,the differences were statistically significant(P<0.05,P<0.01)except for CD206 in Yitangkang low-dosage group.Conclusion Yitangkang can effectively regulate the expression of NLRP3 in db/db mice,promote the transformation of microglia/astrocytes from M1/A1 type to M2/A2 type,inhibit the inflammatory response,and exert neuroprotective effects.

Objective To study the effects of an abnormal mechanical load in the developmental dysplasia of the hip(DDH)on the bone microstructure and blood vessels of the subchondral bone,and the correlation between bone microstructure and blood vessels.Methods A newborn rat DDH model was constructed using the swaddling method.Histological staining such as hematoxylin-eosin staining,safranin-fast green staining,and immunohistochemical staining was performed on the articular cartilage and subchondral bone of the femoral head.The microstructure of the subchondral bone was analyzed using microcomputed tomography(micro-CT).Results The DDH rats showed degeneration of the articular cartilage accompanied by deterioration of the microstructure of the subchondral bone,decreased bone formation,and increased vascular formation.The level of vascular formation in the subchondral bone was positively correlated with the degree of deterioration of the bone microstructure.Conclusions An abnormal mechanical load in the DDH causes articular cartilage degeneration,increased vascular formation in the subchondral bone,and subchondral bone microstructure deterioration.The correlation analysis revealed that the abnormal vascular formation in the subchondral bone may be an important factor causing the deterioration of bone microstructure and progression of DDH.This study has provided a new direction for the development of DDH.

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease with a high prevalence of high prevalence,mainly manifested by hyperglycemia,insulin secretion or insulin resistance,often complicated by hypertension,hyperlipidemia and other metabolic abnormalities.In recent years,the association between intestinal flora,bile acids and T2DM has been a hot topic in clinical research.Traditional Chinese medicine believes that the spleen and stomach belong to soil,liver and gallbladder belong to wood,spleen soil stagnation,soil internal heat,affecting the drainage of liver wood;The liver wood is staggered,Liver qi stagnation,the middle scorch is suppressed,and finally the spleen is stagnant,which is the image of"earth stagnation,wood depression".Earth stagnation and wood depression are the cause and effect of each other,which is the theoretical basis for the occurrence and development of T2DM,and earth stagnation cannot transport water valley to nourish liver wood,and the liver loses nourishment,resulting in liver qi loss in drainage,qi depression and fire injury yin,burning lungs,robbing gastric juice,consuming kidney water,and inducing thirst quenching.From the perspective of modern medicine and biotechnology,the intestinal flora-bile acid metabolic axis is used as the starting point to explain the scientific connotation of the theory of soil wood.Intestinal flora disorder is an important biological basis of the soil,the spleen and soil are stagnant,the water valley does not change,affecting the body's digestion,immunity,lipids and other aspects,resulting in intestinal flora disorders.Abnormal bile acid metabolism is an important microscopic embodiment of wood depression,liver loss and drainage,gas engine lifting and lowering abnormalities,resulting in bile depression,bile acid metabolism secretion abnormal.The intestinal microbiota-bile acid metabolism axis regulates glucose metabolism and glucose homeostasis by affecting the structural composition and diversity of intestinal flora and bile acid pool composition in T2DM patients,thereby affecting the development process of diabetes.Therefore,this paper discusses the biological connotation of T2DM"earth stagnation,wood depression"from the perspective of intestinal microbiota-bile acid metabolic axis,better explains the scientific nature of T2DM soil woody depression mechanism,and provides new clinical ideas and theoretical basis for the prevention and treatment of T2DM.

ObjectiveTo determine the mechanism of Yitangkang in correcting excessive apoptosis of skeletal muscle cells to improve insulin resistance （IR） by inhibiting the advanced glycation end product （AGE）/receptor for the advanced glycation end product （RAGE） signaling pathway. Method① In vitro experiments. Yitangkang-medicated serum was prepared. C2C12 cells were divided into a blank group， a model group， high-， medium-， and low-dose Yitangkang-medicated serum groups （40， 20， and 10 g·kg^-1）， and a RAGE inhibitor group. The IR model was induced by palmitic acid in C2C12 cells except for those in the blank group. After the corresponding intervention methods were conducted，the cell viability and glucose consumption level of each group were determined. In addition，the apoptosis rate was determined using flow cytometry. The mRNA and protein expression levels of the important apoptotic proteins ［B-cell lymphoma 2 （Bcl-2）， Bcl-2-associated X protein （Bax）， p53， cysteinyl aspartate-specific protease-3 （Caspase-3）， and cysteinyl aspartate-specific protease-9 （Caspase-9）］ were determined using Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot. ② In vivo experiments. Ninety-six eligible Wistar rats were divided into a blank group， a model group， high-，medium-，and low-dose Yitangkang groups （40， 20， and 10 g·kg^-1）， and a western medicine group （pioglitazone hydrochloride，1.35 mg·kg^-1）. The IR model was induced using high-glucose and high-fat feed for diabetes combined with intraperitoneal injection of low-dose streptozotocin （STZ） in animals and verified by the hyperinsulinemic-euglycemic clamp （HEC） test. After the model was determined successfully， the rats in each group were given intragastric administration of drugs as required. Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay was performed to determine the number of positive apoptotic cells in the skeletal muscle tissues of rats in each group，while Real-time polymerase chain reaction（Real-time PCR） and Western blot were performed to determine the mRNA and protein expression levels of the important apoptotic proteins Bcl-2， Bax， p53， Caspase-3， and Caspase-9. Result① In vitro experiments. compared with the blank group， the model groups showed increased apoptosis rate of C2C12 cells and decreased cell viability and glucose consumption （P<0.01）. Compared with the model group， the Yitangkang-medicated serum groups and the RAGE inhibitor group showed decreased apoptosis rate of C2C12 cells and increased cell viability and glucose consumption （P<0.01）. Compared with the blank group， the model group showed decreased expression levels of Bcl-2 mRNA and protein in C2C12 cells and increased mRNA and protein expression levels of Bax， p53， Caspase-3， and Caspase-9 （P<0.01）. Compared with the model group， the Yitangkang-medicated serum groups and the RAGE inhibitor group showed increased expression levels of Bcl-2 mRNA and protein in C2C12 cells （P<0.01） and decreased mRNA and protein expression levels of Bax， p53， Caspase-3， and Caspase-9 （P<0.05， P<0.01）. ② In vivo experiments. The number of positive apoptotic cells in the skeletal muscle tissues of rats in the model group significantly increased as compared with that in the blank group （P<0.01）. The number of positive apoptotic cells in the skeletal muscle tissues of rats in the Yitangkang groups and the western medicine group decreased as compared with that in the model group （P<0.01）. Compared with the blank group， the model group showed decreased expression levels of Bcl-2 mRNA and protein in skeletal muscle tissues of rats and increased mRNA and protein expression levels of Bax， p53， Caspase-3， and Caspase-9 （P<0.01）. Compared with the model group， the Yitangkang groups and the western medicine group showed increased expression levels of Bcl-2 mRNA and protein in skeletal muscle tissues of rats （P<0.01） and decreased mRNA and protein expression levels of Bax， p53， Caspase-3， and Caspase-9 （P<0.05， P<0.01）. The medium-dose Yitangkang showed a similar effect as RAGE inhibitor， and the effect was equivalent to that of pioglitazone hydrochloride. ConclusionYitangkang can inhibit skeletal muscle cell apoptosis by inhibiting the AGE/RAGE signaling pathway.

Objective To make a system evaluation regarding the effect and safety of the"Nourishing Kidney and Activating Blood"method in the treatment of diabetic cognitive impairment.Methods According to the requirements of evidence-based medicine,the domestic and foreign databases were searched comprehensively,and the time limit was from the establishment of databases to June 2022,so as to find out the clinical randomized controlled trials of"Nourishing Kidney and Activating Blood"method in treating diabetic cognitive impairment.Revman5.3 was used for meta-analysis and risk bias evaluation,TSA0.9 for sequential analysis,Stata15.0 for publication bias evaluation,and GRADE3.6 for evidence quality evaluation.Results Eventually,14 RCTs were included with a sample size of 1126 cases.Meta-analysis showed that compared with conventional western medicine treatment,the"Nourishing Kidney and Activating Blood"method could significantly improve the effective rate of treating cognitive dysfunction in diabetes[OR=5.06,95%CI(3.38,7.57),P<0.00001],and significantly improve the total MoCA score of patients[MD=2.11,95%CI(1.76,2.47),P<0.00001],MMSE score[MD=1.86,95%CI(1.13,2.59),P<0.00001],MQ score[MD=13.40,95%CI(11.23,15.57),P<0.00001]and HDS score[MD=-3.36,95%CI(2.61,4.11),P<0.00001].Meanwhile,the"Nourishing Kidney and Activating Blood"method could reduce the level of glycosylated hemoglobin in DCI patients[MD=-0.84,95%CI(-1.37,-0.32),P=0.002].However,since the drugs used in the control group have no hypoglycemic effect,this conclusion needs to be further verified.In addition,the ability of the"Nourishing Kidney and Activating Blood"method to improve CDR score[MD=-0.01,95%CI(-0.08,0.07),P=0.84],ADL score[MD=2.10,95%CI(-1.62,5.82),P=0.27],TCM syndrome score[MD=-4.46,95%CI(-10.94,2.02),P=0.18]and reduce adverse reactions[OR=0.36,95%CI(0.08,1.60),P=0.18]was equivalent to that of conventional western medicine.Begg's test and Egger's test suggested that there might be some publication bias in the research.Metaninf command chart and sequential analysis of experiments indicated that the stability of research results was relatively good.The quality evaluation of evidence showed that the evidence of effective rate,glycosylated hemoglobin,MoCA scale score,MMSE score and MQ score was medium quality,the evidence of fasting blood glucose,CDR score and HDS score was low quality,and the evidence of ADL score,TCM syndrome score and adverse reactions was extremely low quality.Conclusion The existing literature evidence showed that the"Nourishing Kidney and Activating Blood"method had a good clinical effect in treating diabetic cognitive impairment,and it could reduce the blood glucose level and improve the cognitive function of patients,with certain safety.However,the above conclusions still needed more large samples and multi-center RCT to be further verified due to the limitation of the quality and quantity of the included literature.

Ferroptosis is a novel iron-dependent mode of programmed cell death characterized by iron deposition and accumulation of lipid peroxidation. More and more studies have found that ferroptosis is closely related to the pathogenesis of type 2 diabetes mellitus （T2DM）. The yin-fire theory is an important part of LI Gao's spleen-stomach theory， and it is believed that qi-fire imblance and yin-fire internal generation is the main pathogenesis of T2DM. Abnormal iron metabolism may be an important prerequisite for T2DM yin-fire internal generation， while oxidative stress is the specific manifestation of T2DM qi-fire imbalance. Reactive oxygen species （ROS） is the end product of qi-fire imbalance， and lipid peroxide is the pathological products of T2DM yin-fire internal generation. This study intends to explore the pathological mechanism of qi-fire imbalance and yin-fire internal generation from the perspectives of iron metabolism， oxidative stress and lipid peroxidation， enriching the modern connotation of yin-fire theory， and benefiting traditional Chinese medicine to target against ferroptosis， and prevent and treat T2DM precisely.