Gastrointestinal tumors （GTs）， including colorectal cancer， gastric cancer， liver cancer， pancreatic cancer， and esophageal cancer， are increasing in incidence worldwide and have become one of the major diseases threatening human health. Tumor stem cells （TSCs）， an undifferentiated subpopulation within tumor tissues， possess biological characteristics such as self-renewal， multidirectional differentiation， high tumorigenicity， and resistance to radiochemotherapy. They play an important role in the occurrence， progression， recurrence， and metastasis of GTs and have increasingly become a research hotspot in GT treatment. Although modern medicine has made remarkable progress， there remain many problems in therapeutic approaches targeting TSCs. In this context， traditional Chinese medicine （TCM）， with its favorable safety profile and multi-target mechanisms， has shown potential advantages and value in regulating TSCs. It can reduce TSC drug resistance， enhance the sensitivity of tumor cells to chemotherapeutic agents， inhibit tumor growth and metastasis， and has shown unique advantages in improving the quality of life and prolonging the survival of GT patients. Studies have found that active components of Chinese medicine， such as terpenoids， polyphenols， flavonoids， glycosides， and quinones， and Chinese medicine compound formulas， including Zuojin pills， Sijunzi decoction， Biejiajian pills， and Xuanfu Daizhe decoction， can inhibit TSCs-related signaling pathways such as the Notch signaling pathway， the Wnt/β-catenin signaling pathway， the phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway， and the Hippo signaling pathway. They also reduce the expression of TSC surface markers， including sex-determining region Y-box 2 （SOX2）， sex-determining region Y-box 9 （SOX9）， octamer-binding transcription factor 4 （OCT4）， prominin-1 （CD133）， cluster of differentiation 44 （CD44）， cluster of differentiation 24 （CD24）， and thyroid transmembrane protein 1 （CD90）， thereby hindering TSC differentiation， accelerating their metabolic processes， improving the tumor microenvironment， and consequently inhibiting GT growth. This study collects and analyzes recent research on the regulation of TSCs by TCM in the treatment of GT， aiming to provide a new theoretical basis for tumor therapy with TCM， expand its application in the comprehensive treatment of GT， and offer new therapeutic ideas and methods for clinical practice.

Objective To evaluate the extra-anatomic bypass surgery for aorto-iliac occlusive disease in the elderly. Methods From January 2005 to December 2008,33 elderly patients/39 limbs (age ranged from 70 to 87 years, mean 76.0 ± 3.0 years) with aortoiliac occlusive disease were retrospectively analyzed. According to Fontaine classification, there were 5 phase Ⅱ b cases (7 limbs), 22 phase Ⅲ cases (26 limbs), and 6 phase Ⅳ cases (6 limbs), all cases were with TASC C, D lesions. Results These 33 cases/39 limbs were tr eated with a variety of bypass, including axillobifemoral bypass (6 cases/12 limbs) ,axillofemoral bypass ( 20 cases/20 limbs ), femorofemoral bypass ( 7 cases/7 limbs ). Intermittent claudication improved in 5 cases, rest pain disappeared in 22 cases, and ulcers healed in 6 cases after operations. The mean ABI increased from 0.29 ± 0.11 to 0.66 ± 0.13 ( t = 2.69, P ＜ 0.05 ). All limbs were salvaged and there was no perioperative mortality within 30 days after operations. Postoperative complication rate was 9.1%. Patients were followed up for a median of 12 ±5 months (range, 6 to 28 months), primary patency rate was 89.7% (35/39), secondary patency rate was 94.9% (37/39), limb salvage rate was 92.3% (36/39). After dischargement the mortality was 6.1% (2/33) with one dying of myocardial infarction and another one of malignant tumor (gastric cancer). Conclusions Extra-anatomic bypass for aorto-iliac occlusive disease in the elderly is feasible, safe and effective, and the cardiopulmonary dysfunctions are the major risk factors for perioperative complications.