It is considered that "latent wind in stomach collaterals" is the core pathogenesis underlying the inflammation-caner transformation of helicobacter pylori-associated gastritis （HpAG）. The concept of "latent wind in stomach collaterals" integrates stomach wind theory， latent pathogen theory， and collateral disease theory， referring to wind pathogen deeply hidden in the stomach collaterals， characterized by both external and internal wind pathogen as well as latent pathogen that remain concealed and may be triggered under certain conditions. Accordingly， the Correa cascade is reclassified into four stages including the prodromal stage， progressive stage， transitional stage and carcinogenic stage. In the prodromal stage， the fundamental pathogenesis is described as "wind toxin invading externally with collateral deficiency and stirring of wind". In the progressive stage， wind is accompanied by qi constraint， fire pathogen， and dryness pathogen， manifesting as "wind pathogen complicated by constraint" "wind-fire agitation" and "wind-dryness interaction". In the transitional stage， "wind transforming into phlegm-drool and stomach collaterals being obstructed by stasis" is identified as a critical window for disease reversal. In the carcinogenesis stage， "wind-qi hyperactivity leading to pathological transformation， and collateral damage resulting in abdominal masses" drives tumor progression and metastasis. This paper proposes the treatment principle of "wind-dispelling throughout the entire process and stage-based treatment"， according to the pathological evolution of "collateral deficiency-collateral stagnation-collateral accumulation". In the prodromal stage， it is suggested to dispel wind and resolve toxin， fortify spleen and tonify collaterals； in the progressive and transitional stage， the method of dispelling wind pathogen， clearing phlegm and eliminating stasis should be used； in the carcinogenesis stage， it is suggested to expel wind and remove pathogens from collaterals， disperse concretions and eliminate tumors.

Gastric precancerous lesions， often presenting as decreased appetite， weight loss， fatigue， epigastric fullness， and upper abdominal pain， pose challenges to treatment and considerably affect patients' quality of life. Pathologically， these lesions are characterized by alterations in the gastric mucosa accompanied by intestinal metaplasia or dysplasia， which markedly elevate the risk of developing gastric cancer. Traditional Chinese medicine （TCM） practitioners have explored various therapeutic approaches focusing on invigorating the spleen， resolving dampness， clearing heat， addressing phlegm accumulation， activating blood， and detoxifying. For contemporary populations suffering from gastric precancerous lesions， our team has innovatively proposed a core pathogenesis theory encompassing deficiency， stagnation， phlegm， stasis， and toxin. Furthermore， our team has developed a comprehensive prevention and treatment framework： Invigorating the spleen and harmonizing the stomach （foundational principles）， balancing and restoring Qi movement （primary objectives）， resolving phlegm and unblocking collaterals （routine practices）， detoxifying and dissipating nodules （critical interventions）， and comprehensive health management （supportive care）. This framework provides a robust theoretical foundation along with practical guidance for preventing and treating diseases related to the spleen-stomach axis. From a pathological perspective， key interventions for managing gastric precancerous lesions include restoring integrity of the gastric mucosae while regulating its microenvironmental conditions and enhancing mucosal circulation， which are integral throughout the entire treatment process. On this basis， a full-course chain of prevention and treatment has been established within clinical practice， encompassing functional gastrointestinal disorders-superficial gastritis-atrophic gastritis-gastric precancerous lesions-prevention and treatment post-endoscopic submucosal dissection. The guiding principles of this treatment approach involve invigorating the spleen， regulating Qi movement， resolving phlegm， unblocking collaterals， and detoxifying. TCM compound formulas such as Jianpi Tongluo Jiedu prescription and Hezhong Xiaopi granules， as well as Chinese patent medicines like Weifuchun and Moluodan， can be used for treating gastric precancerous lesions at different stages. Through medicinal regulation， the state of the gastric mucosa can be improved， and thus the development of gastric precancerous lesions can be curbed from the perspective of full-course prevention and treatment.

Senile chronic atrophic gastritis （SCAG） is a condition characterized by high prevalence， prolonged duration， and difficulty in treatment， along with a significant risk of carcinogenesis. This severely impacts the quality of life among the elderly population in China. The prevention and management of SCAG represent one of the most urgent and prominent needs within the current health care and elderly care sectors. However， existing treatment options are limited， with insufficient mucosal repair following Helicobacter pylori eradication， as well as a lack of effective methods to reverse atrophy or intestinal metaplasia. The primary objectives in treating chronic gastritis in older adults are symptom relief and alleviation of mucosal histological abnormalities. Traditional Chinese medicine （TCM） offers unique advantages for managing patients with SCAG. Therefore， utilizing TCM methodologies underpinned by TCM theory to prevent and treat the progression of SCAG holds considerable clinical significance. Our research team has been dedicated to theoretical， clinical， and fundamental investigations into gastric precancerous lesions and SCAG for an extended period. This article systematically reviews the intricate causal relationship between the spleen-stomach system and aging while elucidating TCM pathogenesis of SCAG as internal deficiency coupled with excess in manifestations. It explores evolutionary patterns of dampness， stagnation， stasis， toxicity， and deficiency and proposes a progressive pathogenic evolution chain： Aging-deficiency of spleen and kidney-imbalance of Qi and blood-phlegm turbidity accompanied by Qi stagnation-accumulation of phlegm， stasis， and toxicity-weakness of stomach collaterals. The core treatment principle emphasizes simultaneous treatment targeting both spleen and kidney as its foundation while employing strategies such as promoting Qi movement to resolve dampness， alongside efforts aimed at removing stasis and detoxifying as primary approaches. Finally， this article summarizes current research achievements in TCM interventions for SCAG， aiming to provide new insights for clinical practice and scientific research in TCM interventions for SCAG.

ObjectiveTo investigate the effect of Danggui Shaoyaosan on ferroptosis in the rat model of non-alcoholic fatty liver disease （NAFLD） and explore the underlying mechanism based on the nuclear factor E₂-related factor 2 （Nrf2）/solute carrier family 7 member 11 （SLC7A11）/glutathione peroxidase 4 （GPX4） signaling pathway. MethodsThe sixty SD rats were randomly grouped as follows： control， model， Yishanfu （0.144 g·kg^-1）， and low-， medium-， and high-dose （2.44， 4.88， and 9.76 g·kg^-1， respectively） Danggui Shaoyaosan. A high-fat diet was used to establish the rat model of NAFLD. After 12 weeks of modeling， rats were treated with corresponding agents for 4 weeks. Then， the body weight and liver weight were measured， and the liver index was calculated. At the same time， serum and liver samples were collected. The levels or activities of total cholesterol （TC）， triglycerides （TG）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， and Fe²⁺ in the serum and TC， TG， free fatty acids （FFA）， malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione peroxidase （GPX）， and Fe²⁺ in the liver were measured. Hematoxylin-eosin staining and oil red O staining were employed to observe the pathological changes in the liver. Immunofluorescence was used to assess the reactive oxygen species （ROS） content in the liver. Mitochondrial morphology was observed by transmission electron microscopy. The protein levels of Nrf2， SLC7A11， GPX4， transferrin receptor 1 （TFR1）， and divalent metal transporter 1 （DMT1） in the liver were determined by Western blot. ResultsCompared with the control group， the model group showed increases in the body weight， liver weight， liver index， levels or activities of TC， TG， ALT， AST， and Fe²⁺ in the serum， levels of TC， TG， FFA， MDA， Fe²⁺， and ROS in the liver， and protein levels of TFR1 and DMT1 in the liver （P<0.01）， and decreases in the activities of SOD， GPX and the protein levels of Nrf2， SLC7A11， and GPX4 in the liver （P<0.05， P<0.01）. Meanwhile， the liver tissue in the model group presented steatosis， iron deposition， mitochondrial shrinkage， and blurred or swollen mitochondrial cristae. Compared with the model group， all doses of Danggui Shaoyaosan reduced the body weight， liver weight， liver index， levels or activities of TC， TG， ALT， AST， and Fe²⁺ in the serum， levels of TC， TG， FFA， MDA， Fe²⁺， and ROS in the liver， and protein levels of TFR1 and DMT1 in the liver （P<0.01）， while increasing the activities of SOD and GPX and the protein levels of Nrf2， SLC7A11， and GPX4 in the liver （P<0.01）. Furthermore， Danggui Shaoyaosan alleviated steatosis， iron deposition， and mitochondrial damage in the liver. ConclusionDanggui Shaoyaosan may inhibit lipid peroxidation and ferroptosis by activating the Nrf2/SLC7A11/GPX4 signaling pathway to treat NAFLD.

Objective·To analyze the influencing factors of left ventricular mass index(LVMI)in patients with essential hypertension,and explore the relationship between aldosterone levels and left ventricular hypertrophy(LVH).Methods·A total of 155 patients with essential hypertension,hospitalized in the Hypertension Department of the Northern Campus of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,from January 2013 to December 2019,and excluded from primary aldosteronism by saline load test(post-saline suppression plasma aldosterone<60 pg/mL),were enrolled.General clinical data(age,gender,smoking status,duration of hypertension,etc.),physical examination data(blood pressure and body mass index),blood biochemistry(renal function,electrolytes,fasting blood glucose,and lipids),urinary sodium,and relevant hormones(basal and activated aldosterone,basal and activated renin,urinary aldosterone,post-saline suppression aldosterone,etc.)were collected.LVMI was evaluated by echocardiography.Pearson correlation analysis was used to assess the linear association between LVMI and each variable.Binary Logistic regression models were applied to screen independent risk factors for LVH.Multiple linear regression models were used to assess the impact of variables on LVMI.Results·The mean age of the 155 patients was(46.85±11.08)years,with 51.6%being male.Pearson correlation analysis showed that LVMI was significantly positively correlated with post-saline suppression aldosterone(r=0.334,P<0.001),age(r=0.184,P=0.032),duration of hypertension(r=0.241,P=0.005),systolic blood pressure(r=0.280,P=0.001),and pulse pressure(r=0.339,P<0.001).No significant correlations were found with diastolic blood pressure,body mass index,fasting blood glucose,total cholesterol,low-density lipoprotein cholesterol,triglyceride,high-density lipoprotein cholesterol,urinary sodium,basal aldosterone,activated aldosterone,or urinary aldosterone.After adjusting for confounders,including gender,smoking history,age,duration of hypertension,body mass index,pulse pressure,systolic blood pressure,fasting blood glucose,and total cholesterol,binary Logistic regression showed that each 1 pg/mL increase in post-saline suppression aldosterone was associated with a 5.1%increased risk of LVH(OR=1.051,95%CI 1.016?1.088,P=0.004).Multiple linear regression identified suppressed aldosterone(β=0.359,P<0.001),duration of hypertension(β=0.168,P=0.046),and pulse pressure(β=0.226,P=0.008)as independent influencing factors for LVMI.Conclusion·Suppressed aldosterone is an independent influencing factor for LVH in patients with essential hypertension.

Objective·To analyze the influencing factors of left ventricular mass index(LVMI)in patients with essential hypertension,and explore the relationship between aldosterone levels and left ventricular hypertrophy(LVH).Methods·A total of 155 patients with essential hypertension,hospitalized in the Hypertension Department of the Northern Campus of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,from January 2013 to December 2019,and excluded from primary aldosteronism by saline load test(post-saline suppression plasma aldosterone<60 pg/mL),were enrolled.General clinical data(age,gender,smoking status,duration of hypertension,etc.),physical examination data(blood pressure and body mass index),blood biochemistry(renal function,electrolytes,fasting blood glucose,and lipids),urinary sodium,and relevant hormones(basal and activated aldosterone,basal and activated renin,urinary aldosterone,post-saline suppression aldosterone,etc.)were collected.LVMI was evaluated by echocardiography.Pearson correlation analysis was used to assess the linear association between LVMI and each variable.Binary Logistic regression models were applied to screen independent risk factors for LVH.Multiple linear regression models were used to assess the impact of variables on LVMI.Results·The mean age of the 155 patients was(46.85±11.08)years,with 51.6%being male.Pearson correlation analysis showed that LVMI was significantly positively correlated with post-saline suppression aldosterone(r=0.334,P<0.001),age(r=0.184,P=0.032),duration of hypertension(r=0.241,P=0.005),systolic blood pressure(r=0.280,P=0.001),and pulse pressure(r=0.339,P<0.001).No significant correlations were found with diastolic blood pressure,body mass index,fasting blood glucose,total cholesterol,low-density lipoprotein cholesterol,triglyceride,high-density lipoprotein cholesterol,urinary sodium,basal aldosterone,activated aldosterone,or urinary aldosterone.After adjusting for confounders,including gender,smoking history,age,duration of hypertension,body mass index,pulse pressure,systolic blood pressure,fasting blood glucose,and total cholesterol,binary Logistic regression showed that each 1 pg/mL increase in post-saline suppression aldosterone was associated with a 5.1%increased risk of LVH(OR=1.051,95%CI 1.016?1.088,P=0.004).Multiple linear regression identified suppressed aldosterone(β=0.359,P<0.001),duration of hypertension(β=0.168,P=0.046),and pulse pressure(β=0.226,P=0.008)as independent influencing factors for LVMI.Conclusion·Suppressed aldosterone is an independent influencing factor for LVH in patients with essential hypertension.

Objective To evaluate the effect of intensive hypertension management model for patients with uncontrolled blood pressure in community.Methods Three hundred and seven hypertensive patients,whose blood pressure was not controlled with administration of two or more kinds of antihypertensive drugs,entered in the intensive management program from May 2015 to December 2017.Using calcium channel blockers,angiotensin converting enzyme inhibitors or angiotensin receptor blockers and diuretic as the primary scheme,the medication was adjusted by general practitioners under the guidance of specialists in tertiary hospitals.The "seamless" two-way referral between community and tertiary hospitals was implemented,and the blood pressure control,medication and adverse effects were analyzed.Results Among 307 patients,157 were males (51.1％) and the mean age was (65.0±8.6) years.There were 246 (80.0％)patients with moderate and severe hypertension 44 (14.3％) patients complicated with diabetes,and 63(20.5％) patients having comorbidities,and the patients with high risk or extremely high-risk accounted for 85.0％ (261/307).Through (3.97± 1.21) months (1-6 months) intensive management,systolic blood pressure decreased from (167.56±16.73)mmHg(1 mmHg=0.133 kPa) in the baseline to (132.79±11.24)mmHg (t=33.34,P＜0.01),and diastolic blood pressure from (95.34± 12.59) mmHg to(79.11 ±7.85) mmHg (t=23.67,P＜0.01),blood pressure control rate was 75.6％(232/307).No serious adverse reactions occurred.During the period 42 patients were referral to hospital through green channel with a referral rate of 13.7％,and six patients were diagnosed as secondary hypertension.Angiotensin receptor antagonists and calcium antagonists were the main antihypertensive drugs.After intensive management patients taking three or more antihypertensive drugs increased by 158 and those taking diuretics increased by 116.Conclusions The intensive management model is effective in patients with uncontrolled blood pressure in community.Early use of C+A,A+D,and A+C+D treatment schemes for uncontrolled patients in the community can improve the rate of reaching the target and is safe.

Background Hypertension and dyslipidemia are the 2 important risk factors of cardiovascular affecting the prognosis of cardiovascular disease. However paucity data of characteristics of lipid metabolism and prognosis of cardiovascular diseases in high-risk groups with hypertension are available. Objective To analyze the lipid metabolism level and the relevant risk factors of inpatients with essential hypertension (EH) from 2000 to 2007. Methods Retrospective study was performed based on the clinical characteristic and the relationship between different kinds of hyperlipidemia and target organ damages in inpatient with EH. Results For the level of triglyceride (TG) and the prevalence of hypertriglyceridemia,males(n=3056) were significantly higher than females(n=1932)(P

OBJECTIVETo investigate the genetic linkage between several cytokine and cytokine-related receptor gene loci and essential hypertension (EH) in Chinese.

METHODSLinkage between seven genetic markers and EH in 95 Chinese nuclear families with EH (including 477 subjects) was analyzed using a technique of fluorescence-based gene scan with DNA short tandem repeat loci. These markers were selected from the chromosomal regions nearby eight cytokines and their receptor genes. The two-point non-parametric linkage analysis (NPL), maximum Lod score and transmission/disequilibrium test (TDT) with GENEHUNTER software package were used in this study.

RESULTSResult of TDT showed significant transmission disequilibrium between D14S61 and EH (Chi square 14.29,P=0.00016) although NPL and Lod score revealed no significant linkage (Z=0.78, P>0.05 and Lod score =0.72 respectively) at this locus. No linkage between other loci typed and EH was found by the three genetic analysis methods (P>0.05 or Lod score<-1).

CONCLUSIONAlleles at D14S61 were of significant transmission disequilibrium in affected siblings. Transforming growth factor beta 3 is 0.1 cM away from D14S61, which suggests that the relationship between genes at or near this regions and EH needs to be further explored.

Adult ; Alleles ; Blood Glucose ; metabolism ; Blood Pressure ; physiology ; Body Mass Index ; China ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Cytokines ; genetics ; DNA ; genetics ; Family Health ; Female ; Genetic Linkage ; Humans ; Hypertension ; blood ; genetics ; physiopathology ; Linkage Disequilibrium ; Lod Score ; Male ; Microsatellite Repeats ; Middle Aged ; Receptors, Cytokine ; genetics ; Triglycerides ; blood

OBJECTIVETo verify the linkage of the candidate regions identified in a previous study (markers D2S168, D2S151, D2S142 on chromosome 2) with hypertension in Chinese families.

METHODSA genetic linkage study focused on chromosome 2 was performed on 240 Chinese families containing 856 patients with essential hypertension. A total of 1080 individuals were genotyped using 9 highly polymorphic microsatellite markers around the candidate regions on chromosome 2 with an average spacing of 5 cM. Non-parametric linkage (NPL), parametric linkage analysis and transmission-disequilibrium test (TDT) with the GENEHUNTER software were used to assess evidence for linkage.

RESULTSLinkage of a region on chromosome 2 around D2S151 and D2S142 with hypertension was confirmed by different statistical methods (NPL, LOD score and TDT). However, the linkage of D2S168 could not be replicated in this extension study.

CONCLUSIONSThe data suggest that a region on chromosome 2 at or near the loci of D2S142 and D2S151 may harbor genes responsible for the development of essential hypertension in Chinese.

Alleles ; China ; Chromosomes, Human, Pair 2 ; genetics ; Family Health ; Female ; Gene Frequency ; Genetic Linkage ; Humans ; Hypertension ; genetics ; Linkage Disequilibrium ; Male ; Microsatellite Repeats