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.

Objective: To explore the causal relationship between gut microbiota and upper urinary tract stones using Mendelian randomization (MR) analysis，and to investigate the potential mediating role of plasma metabolites. Methods: Data on gut microbiota，plasma metabolites，and upper urinary tract stones were obtained from publicly available Genome-wide Association Studies (GWAS).Bidirectional MR analysis was performed to examine the causal relationship between gut microbiota and upper urinary tract stones.Subsequently，a two-step MR approach was employed to determine whether gut microbiota contribute to upper urinary tract stones through plasma metabolites，and the mediating effects and mediator ratio were calculated.The inverse variance weighted (IVW) method was used as the primary analytical tool，supplemented by Bayesian weighted Mendelian randomization (BWMR)，MR-Egger，and weighted median (WM) analyses.Horizontal pleiotropy and heterogeneity tests were conducted to ensure the robustness of the findings. Results: Bidirectional MR analysis identified causal associations between 7 gut microbial taxa and 6 microbial metabolic pathways with upper urinary tract stones，while the development of upper urinary tract stones affected 13 gut microbial taxa and 5 metabolic pathways.Additionally，43 plasma metabolites (including 27 identified metabolites，8 unidentified metabolites，and 8 metabolite ratios) were causally associated with upper urinary tract stones.The two-step MR analysis identified 11 potential causal pathways.After metabolic pathways and unidentified metabolites were excluded，a causal link mediated by Bacteroides faecis between galactarate and upper urinary tract stones was confirmed，with a mediation proportion of 16.99% (95%CI：5.76%-33.95%，P=0.0371). Conclusion: This study establishes a causal relationship between parabacteroides and upper urinary tract stones，and elucidates the mediating role of galactarate，offering new insights into the pathogenesis and prevention strategies for upper urinary tract stones.

Objective: To investigate the protective effect of dulaglutide on lipopolysaccharide (LPS)-induced inju- ry in MLE-12 cells. Methods: An in vitro model of acute lung injury was established by inducing MLE-12 cells with LPS ( 1 μg/mL) , followed by treatment with dulaglutide for 24 hours. The cells were divided into four groups : CON group , LPS group , LPS + 100 nmol/L dulaglutide group , and LPS + 200 nmol/L dulaglutide group. Protein and RNA were extracted from each group. The mRNA levels of inflammatory factors , including interleukin (IL)-6 , tumor necrosis factor-α (TNF-α ) , IL-1β , monocyte chemotactic protein 1 (CCL2) , C-X-C motif chemokine lig- and (CXCL) 1 and CXCL2 , were detected by qRT-PCR. Cell apoptosis was assessed by TUNEL assay , and the expression levels of phosphorylated protein kinase B (P-Akt) and phosphorylated extracellular signal-regulated ki- nase (P-Erk) were measured by Western blot. Results: Compared with the CON group , the LPS group showed in- creased mRNA levels of inflammatory mediators (TNF-α , IL-6 , IL-1β , CCL2 , CXCL1 , and CXCL2) , increased TUNEL-positive cells , and elevated expression of P-Akt and P-Erk proteins. Compared with the LPS group , the LPS + 100 nmol/L dulaglutide treatment group exhibited reduced mRNA levels of TNF-α , IL-6 , IL-1β , CCL2 , CXCL1 , and CXCL2 , decreased TUNEL-positive cells , and downregulated expression of P-Akt and P-Erk pro- teins. However, the LPS + 200 nmol/L dulaglutide treatment group showed less pronounced improvement in inflam- matory factors compared to the LPS + 100 nmol/L dulaglutide group. Conclusion Dulaglutide has a protective effect on LPS-induced injury in MLE-12 cells , potentially through inhibiting Akt and Erk phosphorylation , thereby reducing the expression of inflammatory mediators and alleviating inflammatory damage , ultimately protecting the lungs.

Objective To clarify the evidence of the frequency and risk factors for falls in knee osteoarthritis(KOA)of adults by meta-analysis.Methods Computerized searches of the CNKI,VIP,Wanfang data,CBM,PubMed,Cochrane Library,Embase,Web of Science were conducted for literature on risk factors for falls in adults with KOA from the inception of the databases to August 2024.After literature screening,data extraction,and quality evaluation,RevMan 5.4 software was used for Meta-analysis.Results A total of 26 articles were involved.Meta-analysis result showed that the rate of falls was 29.0％.Factors associated with increased risk of falls included being female(OR=1.35),decreased lower limb muscle strength(OR=1.72),decreased knee flexion muscle strength(OR=7.05),decreased static posture stability(OR=1.28),opioid use(OR=1.79),antidepressant use(OR=1.69),frequent stair climbing(OR=7.58),combined neurological disease(OR=1.77),history of falls(OR=3.29)and fear of falling(OR=2.54).Conclusion The rate of falls of patients with KOA is high.The adults with KOA who are women,have lower muscle strength of lower limbs and knee flexion muscle strength,poorer static posture stability,use opioids,antidepressant,frequent stair climbing,combined neurological disorders,previous falls in the past year and fear of falls are at higher risk of falls.Healthcare professionals should dynamically assess and detect the risk of falls in the patients with KOA and adopt targeted,individualized interventions to prevent falls.

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from the elderly population with infections in Baotou,Inner Mongolia.METHODS The clinical data were collected from 9268 elder-ly patients with infections(with no less than 60 years of age)who were treated in Baotou Medical College of Cen-ter Clinical Medical School and the Second Affiliated Hospital of Baotou Medical College from 2017 to 2021 and were retrospectively analyzed.The 9268 samples were cultured for isolation of pathogens,the isolated pathogens were identified,and the drug susceptibility testing was performed.RESULTS Totally 9268 strains of pathogens were isolated,53.11％of which were gram-negative bacteria,28.94％were gram-positive bacteria,and 17.95％were fungi.Escherichia coli and Klebsiella pneumoniae were the major species of gram-negative bacteria;Entero-cocci and coagulase-negative Staphylococcus were dominant among the gram-positive bacteria;Candida albicans was the predominant species of fungi.There were certain differences in the pathogens isolated from the elderly pa-tients with infection between different sexes,among the different seasons and age groups.With respect to drug re-sistance,the gram-positive bacteria maintained highly sensitive to vancomycin and teicoplanin,while the drug re-sistance rates to ampicillin and penicillin were relatively high.The drug resistance rates of the gram-negative bacte-ria to carbapenems were relatively low,but the drug resistance rates to ampicillin and cefazolin were high.CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the elderly population with infections in Baotou City,Inner Mongolia;the distribution of pathogens is affected by the sex,age and sea-son.There is serious problem with the drug resistance of pathogens,the strains are highly resistant to the com-monly used antibiotics such as ampicillin and penicillin.It is necessary for the hospital to reasonably use antibiotics according to the epidemiological characteristics and drug resistance trends of the pathogens and optimize the strate-gies for clinical diagnosis and treatment of infectious diseases.

AIM: To investigate the predictive value of serum histone deacetylase 1(HDAC1)and endothelial nitric oxide synthase(eNOS)for infectious endophthalmitis after cataract surgery.METHODS: A total of 362 cataract patients(362 eyes)admitted to our hospital from January 2020 to January 2023 were selected as the research objects. According to the occurrence of postoperative infectious endophthalmitis, they were divided into infection group(15 cases, 15 eyes)and non-infection group(347 cases, 347 eyes). Enzyme linked immunosorbent assay(ELISA)was applied to detect the levels of serum HDAC1 and eNOS in all subjects, and the levels of serum HDAC1 and eNOS in both groups were compared; the influencing factors of infectious endophthalmitis were analyzed by multivariate Logistic regression; the receiver operative curve(ROC)was applied to analyze the predictive value of serum HDAC1 and eNOS levels for postoperative infectious endophthalmitis in cataract patients.RESULTS: The levels of serum HDAC1 and eNOS in the infected group were obviously higher than those in the uninfected group(all P<0.01). Surgical time, vitreous overflow, HDAC1, and eNOS were all risk factors for postoperative infectious endophthalmitis(all P<0.05). ROC results showed that the AUC of HDAC1 and eNOS in predicting postoperative infectious endophthalmitis in cataract patients was 0.878 and 0.877, respectively, with sensitivity of 88.7% and 87.7%, specificity of 70.4% and 7.8%, respectively, while the AUC of the two combination in predicting postoperative infectious endophthalmitis in cataract patients was 0.978, with a sensitivity of 86.7% and a specificity of 85.3%.CONCLUSION:The serum levels of HDAC1 and eNOS in patients with infectious endophthalmitis after cataract surgery are obviously increased, and the combined detection of serum HDAC1 and eNOS can improve the predictive efficacy of infectious endophthalmitis in cataract patients after surgery. Both can provide reference for clinical diagnosis and treatment.

AIM: To investigate the predictive value of serum histone deacetylase 1(HDAC1)and endothelial nitric oxide synthase(eNOS)for infectious endophthalmitis after cataract surgery.METHODS: A total of 362 cataract patients(362 eyes)admitted to our hospital from January 2020 to January 2023 were selected as the research objects. According to the occurrence of postoperative infectious endophthalmitis, they were divided into infection group(15 cases, 15 eyes)and non-infection group(347 cases, 347 eyes). Enzyme linked immunosorbent assay(ELISA)was applied to detect the levels of serum HDAC1 and eNOS in all subjects, and the levels of serum HDAC1 and eNOS in both groups were compared; the influencing factors of infectious endophthalmitis were analyzed by multivariate Logistic regression; the receiver operative curve(ROC)was applied to analyze the predictive value of serum HDAC1 and eNOS levels for postoperative infectious endophthalmitis in cataract patients.RESULTS: The levels of serum HDAC1 and eNOS in the infected group were obviously higher than those in the uninfected group(all P<0.01). Surgical time, vitreous overflow, HDAC1, and eNOS were all risk factors for postoperative infectious endophthalmitis(all P<0.05). ROC results showed that the AUC of HDAC1 and eNOS in predicting postoperative infectious endophthalmitis in cataract patients was 0.878 and 0.877, respectively, with sensitivity of 88.7% and 87.7%, specificity of 70.4% and 7.8%, respectively, while the AUC of the two combination in predicting postoperative infectious endophthalmitis in cataract patients was 0.978, with a sensitivity of 86.7% and a specificity of 85.3%.CONCLUSION:The serum levels of HDAC1 and eNOS in patients with infectious endophthalmitis after cataract surgery are obviously increased, and the combined detection of serum HDAC1 and eNOS can improve the predictive efficacy of infectious endophthalmitis in cataract patients after surgery. Both can provide reference for clinical diagnosis and treatment.

AIM: To investigate the expression changes and significance of serum microRNA-34a-5p(miR-34a-5p)and silent information regulator T1(SIRT1)in patients with endophthalmitis after cataract surgery.METHODS: Patients with endophthalmitis after cataract surgery from May 2020 to May 2024 were selected as infection group(20 cases), and patients without endophthalmitis were selected as control group(74 cases). Serum SIRT1 levels were detected by ELISA; the serum level of serum miR-34a-5p was detected by qRT-PCR; the correlation between miR-34a-5p and SIRT1 was analyzed by Pearson method; Logistic regression was used to analyze the influencing factors of endophthalmitis after cataract operation. Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum miR-34a-5p and SIRT1 levels in postoperative endophthalmitis.RESULTS: Compared with the control group, the serum level of miR-34a-5p in the infected group was significantly increased(P<0.001), and the serum level of SIRT1 was significantly decreased(P<0.001). Correlation analysis showed that miR-34a-5p was negatively correlated with SIRT1(r=-0.421, P<0.001). Logistic multivariate regression analysis showed that miR-34a-5p was an independent risk factor affecting endophthalmitis infection after cataract surgery(OR=3.532, P<0.05), and SIRT1 was a protective factor affecting endophthalmitis infection after cataract surgery(OR=0.875, P<0.05). The ROC curve showed that the area under curve(AUC)of serum miR-34a-5p combined with SIRT1 in the diagnosis of postoperative endophthalmitis was 0.933(95%CI: 0.861-0.975).CONCLUSION:Serum levels of miR-34a-5p are highly expressed and SIRT1 is lowly expressed in postoperative endophthalmitis, they are closely related to the occurrence and development of endophthalmitis after cataract surgery.

AIM: To explore the value of changes in the serum expression levels of triggering receptor expressed on myeloid cells-1(TREM-1)and matrix metalloproteinase-9(MMP-9)in early clinical diagnosis of postoperative endophthalmitis in patients with cataract surgery.METHODS: A total of 21 patients who underwent cataract surgery with infectious endophthalmitis in our hospital from May 2021 to May 2023 were selected as the study subjects(endophthalmitis group), and another 100 patients who underwent cataract surgery without endophthalmitis were selected as the non-endophthalmitis group. The serum levels of TREM-1, MMP-9, and the expression levels of inflammatory factors such as interleukin-1β(IL-1β), IL-17, and tumor necrosis factors-α(TNF-α)were detected and compared between the endophthalmitis group and the non-endophthalmitis group. The correlation between TREM-1 and MMP-9 was analyzed by Pearson method. Logistic regression was applied to analyze the factors that affected the occurrence of endophthalmitis in cataract patients after surgery. Receiver operating characteristic(ROC)curve was applied to analyze the early clinical diagnostic efficacy of TREM-1 and MMP-9 levels for postoperative endophthalmitis in cataract patients.RESULTS: Compared with the non-endophthalmitis group after cataract surgery, the expression levels of serum TREM-1, MMP-9, and inflammatory factors IL-1β, IL-17, and TNF-α in the endophthalmitis group were obviously increased(all P<0.05), and the TREM-1 was positively correlated with MMP-9(r=0.389, P<0.001). Logistic regression results showed that elevated levels of serum TREM-1 and MMP-9 expression, and vitreous overflow were independent risk factors for postoperative endophthalmitis in cataract patients(all P<0.05). ROC curve showed that the area under the curve(AUC)of TREM-1, MMP-9, and their combination in diagnosing postoperative endophthalmitis in cataract patients was 0.845, 0.844, and 0.935, respectively, and the clinical efficacy of the combination of the two in early diagnosis of postoperative endophthalmitis in cataract patients was better than that of serum TREM-1 and MMP-9 alone(all P<0.05).CONCLUSION: The expression levels of serum TREM-1 and MMP-9 in patients with endophthalmitis after cataract surgery are abnormally elevated, and the combination of the two has high clinical application value in early diagnosis of endophthalmitis after cataract surgery.

AIM: To summarize 10 surgical pearls for managing proliferative diabetic retinopathy(PDR)adapted from the ancient Chinese allusions and analyze the application of these pearls in a real-world fashion.METHODS: Retrospective, noncomparative, interventional study. Ten surgical pearls were summarized and adapted from the ancient Chinese philosophy. Totally 346 cases(443 eyes)that underwent pars plana vitrectomy(PPV)at our hospial from January 2016 to February 2024 were selected. Flexible combinations of these pearls were applied according to the specific condition of each patient during surgeries. The efficacy and safety were analyzed, as well as the application frequencies according to the existence of tractional retinal detachment or not.RESULTS: A total of 473 times of surgeries were performed on all the patients. According to ancient Chinese allusions, ten surgical pearls were summarized from these surgeries. All PPVs went smoothly with the application of different combinations. Finally, almost all proliferative membranes were successfully peeled except for 10 patients(11 eyes), who went through strategy No.10(minimal membranectomy)that, only necessary relaxation incisions were made with most of the proliferative membranes left on purpose. The final visual acuities were mostly improved or stable(1.92±0.83 LogMAR preoperatively vs 1.16±0.85 LogMAR postoperatively, P<0.01). Postoperative complications mainly included early inflammatory responses in the anterior chamber and nuclear sclerosis. Recurrent vitreous hemorrhage, retinal detachment, and hyphema or neovascular glaucoma occurred in 1.9%(9/473), 3.2%(15/473), 0.4%(2/473)and 0.4%(2/473)times of PPVs, respectively. After 12/473(2.5%)times of PPVs, retinal detachment at the macular area still existed, and multiple times of subsequent PPVs were conducted. Final retinal attachment at the macular area was realized in 98.9% eyes. Those 5 unattached eyes were with heavily reproliferated membranes and subsequent tractional retinal detachment recurrence under the oil, and three of them were scleral buckled additionally.CONCLUSION:These 10 surgical strategies and technique pearls were mostly effective and safe in the management of severe PDR patients. They were relatively easy to be memorized and applicated once the meaning of each Chinese idiom was understood. One can use different combinations flexibly according to a patient's specific condition.