Diabetic kidney disease （DKD） is one of the most common microvascular complications of diabetes. Traditional Chinese medicine （TCM） plays a unique role in improving clinical symptoms， reducing proteinuria， and delaying the initiation of dialysis. Over time， scholars have held diverse views on the etiology， pathogenesis， and treatment strategies of DKD. This paper systematically reviews the etiology and pathogenesis， syndrome differentiation and treatment， and medication rules of DKD， aiming to provide a reference for clinical practice. Regarding etiology， DKD is closely related to insufficient innate endowment， improper diet， emotional disorders， overexertion， and prolonged diabetes. Its pathogenesis evolves dynamically. Specifically， early stage is characterized by Yin deficiency with dryness-heat and subtle discharge. Middle stage involves both Qi and Yin deficiency with dampness and blood stasis. Late stage presents Yin and Yang deficiency with intrinsic turbidity toxins. Blood stasis and sugar toxicity are the core pathological factors， persisting throughout the disease course and accelerating renal collateral damage and fibrosis. In terms of diagnosis and treatment， contemporary scholars advocate stage-specific treatment， emphasize the integration of prevention and therapy， recommend whole-course management， and support comprehensive TCM and Western medicine approaches. Analysis of medication rules shows that treatment consistently addresses the core principle of deficiency at the root and excess at the surface， strengthens the body while dispelling pathogenic factors， emphasizes promoting blood circulation and removing blood stasis， consolidates the kidney and astringes essence， clears Fu-organs and eliminates turbidity and toxins， invigorates the spleen， replenishes Qi， protects the stomach， and advocates treatment based on pathogenic wind. Further refinement of the academic thoughts of classical TCM masters and research into innovative pathogenesis theories and clinically effective prescriptions are needed to enhance TCM's ability to prevent and treat major clinical diseases， including DKD.

ObjectiveTo investigate the therapeutic effect of sitravatinib on carbon tetrachloride （CCl₄）-induced liver fibrosis in mice. MethodsA total of 30 male C57BL/6J mice， aged 8 weeks， were randomly divided into control group， CCl₄ model group， and low- （5 mg/kg）， middle- （10 mg/kg）， and high-dose （20 mg/kg） sitravatinib groups. All mice except those in the control group were given intraperitoneal injection of CCl₄ for 4 consecutive weeks to induce liver fibrosis， and since the first day of modeling， the mice in the low-， middle-， and high-dose sitravatinib groups were given sitravatinib at the corresponding dose by gavage every day. The serum levels of total cholesterol （TC）， triglyceride （TG）， and alanine aminotransferase （ALT） were measured for the mice in each group； hepatic hydroxyproline content was measured； HE staining， Masson staining， and Sirius Red staining were used to observe liver histopathological changes； quantitative real-time PCR and Western blot were used to measure the mRNA and protein expression levels of α-smooth muscle actin （α-SMA） and collagen type I alpha 1 （Col1a1） in liver tissue. The therapeutic effect of sitravatinib was assessed based on the above results. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the control group， the model group had significant increases in the levels of TC， TG， and ALT （all P<0.05）， and there were no significant differences in the levels of TC， TG， and ALT between the model group and the low-， middle-， and high-dose sitravatinib groups （all P>0.05）. Hepatic hydroxyproline content decreased after sitravatinib intervention， with a significant difference between the middle-/high-dose sitravatinib groups and the CCl₄ model group （both P<0.05）. Histopathological staining showed that the sitravatinib treatment groups had a reduction in collagen deposition， along with thinning and fragmentation of fibrous septa， and in the high-dose sitravatinib group， 4 mice had a fibrosis stage of S0—S1 and 2 mice had a fibrosis stage of S2—S3， suggesting a certain degree of alleviation of liver fibrosis degree compared with the CCl₄ model group （mainly S3—S4）. The measurement of related molecules showed that sitravatinib downregulated the mRNA and protein expression levels of α-SMA and Col1a1 （all P<0.05）. ConclusionSitravatinib can effectively alleviate CCl₄-induced liver fibrosis in mice， possibly by inhibiting hepatic stellate cell activation and collagen synthesis.

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer. METHODS: A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups. RESULTS: In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group (P<0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups (P<0.05, P<0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group (P<0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups (P>0.05). CONCLUSION TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.
Humans ; Female ; Acupuncture Points ; Pain, Postoperative/blood* ; Middle Aged ; Breast Neoplasms/surgery* ; Adult ; Transcutaneous Electric Nerve Stimulation ; Mastectomy, Modified Radical/adverse effects* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Interleukin-10/blood* ; Aged

Stent migration is one of the common complications following transcatheter valve implantation. This study aims to design a "drum-shaped" balloon-expandable aortic valve stent to address this issue and conduct a mechanical analysis. The implantation process of the stent was evaluated using a method that combines numerical simulation and in vitro experiments. Furthermore, the fatigue process of the stent under pulsatile cyclic loading was simulated, and its fatigue performance was assessed using a Goodman diagram. The process of the stent migrating toward the left ventricular side was simulated, and the force-displacement curve of the stent was extracted to evaluate its anti- migration performance. The results showed that all five stent models could be crimped into a 14F sheath and enabled uniform expansion of the native valve leaflets. The stress in each stent was below the ultimate stress, so no fatigue fracture occurred. As the cell height ratio decreased, the contact area fraction between the stent and the aortic root gradually decreased. However, the mean contact force and the maximum anti-migration force first decreased and then increased. Specifically, model S5 had the smallest contact area fraction but the largest mean contact force and maximum anti-migration force, reaching approximately 0.16 MPa and 10.73 N, respectively. The designed stent achieves a "drum-shaped" change after expansion and has good anti-migration performance.
Stents ; Prosthesis Design ; Heart Valve Prosthesis ; Humans ; Aortic Valve/surgery* ; Stress, Mechanical ; Transcatheter Aortic Valve Replacement/instrumentation*

Yttrium-90(90Y)selective internal radiation therapy(SIRT)is an emerging modality for the treatment of hepatocellular carcinoma(HCC),leveraging the nuclide 90Y to deliver targeted radiation therapy.90Y has a long half-life and can be used to selectively ablate tumor cells by high-energy beta rays.It has high biological effectiveness and robust local control capabilities.In recent years,with the continuous advancement of basic and clinical research,the application of 90Y-SIRT in the conversion treatment of unresectable HCC(uHCC)has made significant progress.However,challenges remain in the clinical application of 90Y-SIRT,including how to improve the efficacy of conversion therapy and how to optimize therapy regimens.This review aims to summarize the research progress of90Y-SIRT in the conversion therapy of uHCC.

Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.

Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.

Intervertebral disc degeneration(IDD) is the pathological basis of spinal diseases. With the development and change of working and living style, IDD gradually presents the trend of younger in recent years. The effective prevention and treatment of IDD has become a hotspot in clinical research. Recent studies have shown that oxidative stress plays an important role in IDD. The disruption of reactive oxygen species balance in cells or the body leads to changes in extracellular matrix and intervertebral disc cell phenotype, which induces oxidative stress of intervertebral disc and leads to IDD. Oxidative stress can affect the development of IDD through apoptosis, autophagy, senescence and extracellular matrix of intervertebral disc. Currently, opioids and drugs for promoting blood circulation and pain relief are commonly used in clinical treatment of IDD, which can alleviate some symptoms to a certain extent, but is easy to induce gastrointestinal and other adverse reactions. Meanwhile, due to the long treatment cycle and poor patient compliance to a certain extent, which brings great difficulties to the treatment. At the same time, traditional Chinese medicine plays an important role in the treatment of IDD due to its advantages of low cost and fewer adverse reactions. With the in-depth research of modern technologies such as molecular biology and network pharmacology, it has been found that traditional Chinese medicine can intervene in the expression of oxidative stress-related functions, namely, slowing down apoptosis, autophagy and degradation of extracellular matrix, etc, to play a role in the treatment of IDD. In this paper, the role of oxidative stress in IDD and the research results on the intervention of traditional Chinese medicine in oxidative stress will be expounded, in order to provide reference for the prevention and treatment of IDD by traditional Chinese medicine.

Polycystic ovary syndrome（PCOS） is a common reproductive endocrine and metabolic disorder， affecting about 6%-10% of women of childbearing age worldwide， and has always been a major challenge in clinical treatment. Guizhi Fulingwan， derived from the Synopsis of the Golden Chamber（《金匮要略》）， has the effect of promoting blood circulation， removing blood stasis， and alleviating blockages. In recent years， many studies have found that it has a good therapeutic effect on PCOS. By sorting out the research literature on the mechanism of Guizhi Fulingwan treating PCOS， it is found that this formula can decrease the autophagy and apoptosis of ovarian granulosa cells， correct endocrine hormone disorder， improve the inflammatory environment， alleviate oxidative stress. Moreover， it regulates phosphatidylinositide 3-kinase（PI3K）/protein kinase B（Akt）/mammalian target of rapamycin（mTOR）， lncRNA H19/miR-29b-3p， nuclear factor E₂-related factor 2（Nrf2）/heme oxygenase-1（HO-1）， PI3K/Akt/nuclear factor-κB（NF-κB）， and other signaling pathways. And also effects the regulator expression of matrix metallopeptidase-9（MMP-9）， matrix metalloproteinase inhibitor-1（TIMP-1）， cytochrome P45019A1 enzyme（CYP19A1）， glucose transporter protein 4（GLUT4）， regulated on activation normal T cell expressed and secreted（RANTES）， monocyte chemoattractant protein-1（MCP-1）. Thus， Guizhi Fulingwan is confirmed to treat PCOS based on these molecular mechanisms. Besides， the main active ingredients of the formula such as cinnamic aldehyde， （+）-catechin， stigmasterol， also have the effect of anti-oxidant， anti-inflammatory， regulating mitochondrial function， regulating endocrine， and regulating metabolism. According to the summary of clinical literature on Guizhi Fulingwan， it is found that the use of the formula alone or in combination with other drugs can significantly alleviate the clinical symptoms and complications of PCOS. Thus， it is safe with no adverse reactions in long-term use， which is worthily further promoted in clinical application. This paper comprehensively analyzed the current research status of Guizhi Fulingwan for the treatment of PCOS through the mechanism and clinical studies， summarized the limitations in current research， and put forward suggestions， aiming to provide the strong literature support for the future in-depth research on and clinical application of the formula.

Objective The objective of this study was to analyze the long-term change trend of gastric cancer incidence in China from 1990 to 2021,and to provide scientific suggestion for the prevention and control of gastric cancer in China.Methods The incidence burden data of gastric cancer from 1990 to 2021 were obtained from the Global Burden of Disease(GBD)2021 database.The age-period-cohort model was to evaluate its independent effects,and the Nordpred model was used to predict its incidence trend from 2022 to 2031.Results The number and incidence of gastric cancer from 1990 to 2021 in China showed an upward trend,while the age-standardized incidence showed a decreasing trend.The results of age-period-cohort model showed that in the same birth cohort,the incidence of gastric cancer in China increased with age,the incidence of the total population increases from 0.91/100,000 to 233.37/100,000 in total population,the incidence of men increases from 0.91/100,000 to 508.90/100,000,and the incidence of women increases from 1.04/100,000 to 115.86/100,000.During the period from 1992-1996 to 2017-2021,the relative risk(RR)of gastric cancer incidence showed a decreasing trend with the passage of time.The RR of the total population period decreased from 1.10 to 0.72,with males decreasing from 1.06 to 0.75 and females decreasing from 1.19 to 0.65.The later the birth cohort through-out the birth cohort years,the lower the risk of onset;The RR of gastric cancer incidence in the total population decreased from 1.60 to 0.34,from 1.36 to 0.40 for males and from 2.23 to 0.22 for females.The incidence prediction results showed that by 2031,the in-cidence of gastric cancer would increase to 470,429 cases,including 323,399 cases for men and 147,029 cases for women.The stand-ardized incidence of the total population would decrease to 23.80/100,000 cases,35.13/100,000 cases for men and 24.17/100,000 cases for women.Conclusion The prevention and treatment measures of gastric cancer from 1990 to 2021 have achieved certain re-sults in reducing the risk of gastric cancer,but the incidence of gastric cancer is still serious,and it is necessary to focus on strengthe-ning the intervention for men over 50 years old.