Chronic heart failure （CHF） is a complex clinical syndrome caused by ventricular dysfunction， with mitochondrial energy metabolism disorder being a critical factor in disease progression. Heart-Yang deficiency syndrome， as the core pathogenesis of CHF， persists throughout the disease course. Insufficiency of heart-Yang leads to weakened warming and propelling functions， resulting in the accumulation of phlegm-fluid， blood stasis， and dampness. This eventually causes Qi stagnation with phlegm obstruction and blood stasis with water retention， forming a vicious cycle that exacerbates disease progression. According to the theory of reinforcing Yang， the clinical experience of the traditional Chinese medicine （TCM） master Tang Zuxuan in treating CHF with heart-Yang deficiency syndrome， and achievements from molecular biological studies， this study innovatively proposes an integrated research framework of "TCM syndrome differentiation and staging-mitochondrial metabolism mechanisms-intervention with Yang-reinforcing prescriptions" which is characterized by the integration of traditional Chinese and Western medicine. Heart-Yang deficiency syndrome is classified into mild （Stage Ⅰ-Ⅱ）， severe （Stage Ⅲ）， and critical （Stage Ⅳ） stages. The study elucidates the precise correlations between the pathogenesis of each stage and mitochondrial metabolism disorders from theoretical， pathophysiological， and therapeutic perspectives. The mild stage is characterized by impaired biogenesis and substrate-utilization imbalance， corresponding to heart-Yang deficiency and phlegm-fluid aggregation. Linggui Zhugantang and similar prescriptions can significantly improve the expression of peroxisome proliferator-activated receptor gamma co-activator-1α（PGC-1α）/silent information regulator 2 homolog 1 （SIRT1） and ATPase activity. The severe stage centers on oxidative stress and structural damage， reflecting Yang deficiency with water overflow and phlegm-blood stasis intermingling. At this stage， Zhenwu Tang and Qiangxin Tang can effectively mitigate oxidative stress damage， increase adenosine triphosphate （ATP） content， and repair mitochondrial structure. The critical stage arises from calcium overload and mitochondrial disintegration， leading to the collapse of Yin-Yang equilibrium. At this stage， Yang-restoring and crisis-resolving prescriptions such as Fuling Sini Tang and Qili Qiangxin capsules can inhibit abnormal opening of the mitochondrial permeability transition pore （MPTP）， reduce cardiomyocyte apoptosis rate， and protect mitochondrial function. By summarizing the characteristics of mitochondrial energy metabolism disorders at different stages of CHF， this study explores the application of the theory of reinforcing Yang in treating heart-Yang deficiency syndrome and provides new insights for the clinical diagnosis and treatment of CHF.

Chronic heart failure （CHF） refers to a clinical syndrome in which the function or structure of the heart is changed due to damage to the original myocardium， resulting in reduced pumping and/or filling functions of the heart. In recent years， the mechanisms， pathways， and targets of traditional Chinese medicine （TCM） in the treatment of CHF have been continuously confirmed， and the application of TCM theories in guiding the syndrome differentiation and precise treatment of CHF is currently a research hotspot. On the basis of the syndrome differentiation and treatment in TCM， Professor LI Candong innovatively proposed the thinking of five differentiation： Disease differentiation， syndrome differentiation， pathogenesis differentiation， symptom differentiation， and individual differentiation. This article explores the clinical diagnosis and treatment of CHF from this thinking， emphasizing comprehensive syndrome differentiation， objective analysis， dynamic assessment， and individualized treatment. In terms of diagnosis， the first is to identify the disease name， cause， location， severity， and type of CHF， determine the type and its evolution， and clarify the process of transmission and transformation between deficiency and excess. Secondly， it is necessary to distinguish the authenticity， severity， primary and secondary， urgency and complexity of CHF syndromes， providing scientific guidance for syndrome differentiation and treatment. Thirdly， according to the symptoms and the principles of deficiency and excess， the physician should identify the core pathogenesis of CHF from the perspectives of Qi， blood， Yin， Yang， deficiency， stasis， phlegm， water， and toxins. Fourthly， from the macro， meso and micro levels， the physician should carefully distinguish the presence or absence， severity， authenticity， and completeness of the symptoms to guide the diagnosis and treatment process of CHF. Finally， personalized medication for CHF should be promoted based on the patient's gender， age， constitution， and living habits. In terms of treatment， based on the thinking of five differentiation， we propose that the treatment of CHF should integrate the disease and syndrome， clarify the pathogenesis， and apply precise treatment. The treatment should be people-oriented， staged， and typed， and the medication should be adjusted according to symptoms. This diagnostic and therapeutic approach is based on the holistic concept and syndrome differentiation and treatment， and combines the three causes for appropriate treatment， providing new ideas and insights for the diagnosis and treatment of CHF.

Objective To analyze the prevalence status of cardiometabolic risk factor (CMRF) and its aggregation among workers engaged in new forms of employment. Methods A total of 5 429 new employment workers (including couriers, online food delivery workers, and ride hailing drivers) who underwent health medical examinations at a tertiary hospital in Beijing City were selected as the research subjects using the judgment sampling method. Data on waist circumference, blood pressure, blood glucose, and blood lipid levels were collected to analyze their CMRF [central obesity, elevated blood pressure, elevated blood glucose, elevated triglycerides, and reduced high-density lipoprotein cholesterol (HDL-C)] and their aggregation (with ≥ 2 of the above 5 risk factors) status. Results The detection rates of central obesity, elevated blood pressure, elevated blood glucose, elevated triglycerides, and reduced HDL-C were 61.2%, 38.2%, 29.5%, 40.9% and 22.6%, respectively. The detection rates of CMRF aggregation was 57.8%. The result of multivariable logistic regression analysis showed that male, age ≥45 years, smoking, overweight, and obesity were risk factors for CMRF aggregation (all P<0.05). Conclusion The detection rate of CMRF and its aggregation among workers with new forms of employment in Beijing City is relatively high. Targeted prevention and control efforts should be strengthened for high-risk populations, especially males, workers aged ≥45 years, smokers, and those who are overweight or obese.

Objective To analyze the research status and hotspots of Poria by means of bibliometrics and visualization methods;To provide reference for scientific research and clinical practice.Methods The research literature about Poria included in CNKI,Wanfang Data,VIP,CBM,Web of Science core collection and PubMed database was retrieved from 2004 to 2023.NoteExpress3.6.0.9155 software was used to de-duplicate,and Excel2016,CiteSpace 6.2.R4 and VOSviewer 1.6.18.0 software were used to analyze the annual number of publications,institutions,journals,authors and keywords,and visual display was demonstrated.Results Totally 3 861 Chinese papers and 477 English papers were included after screening,and the annual number of papers gradually increased.The institutions that published the most Chinese and English papers were Jiangsu Kangyuan Pharmaceutical Co.,LTD.and Chinese Academy of Sciences;the authors that publish the most Chinese and English papers were Wang Zhenzhong and Chen Lin;the journals that published the most Chinese and English papers were Zhong Cao Yao and Journal of Ethnopharmacology.Keyword analysis showed higher frequency of uterine fibroids,clinical efficacy,polysaccharide and antioxidant activity.20 clusters and 36 emergent keywords were generated.Conclusion The research focus in this field is on the pharmacological components and mechanism,clinical application and data mining of Poria.

BACKGROUND:Currently,methods for obtaining primary intervertebral disc cells are mostly cumbersome and there is a lack of relevant reports on the simultaneous extraction of three types of cells. Therefore,it is crucial to find a method to simultaneously extract three types of cells. OBJECTIVE:To explore a method for simultaneously extracting and culturing three types of intervertebral disc cells from rats,to identify them,and to investigate the effects of monolayer versus micromass cultures on the extracellular matrix. METHODS:The cartilaginous endplate (CEP),nucleus pulposus (NP),and annulus fibrosus (AF) tissues were separated from 3-week-old male Sprague-Dawley rat intervertebral disc tissue. For the nucleus pulposus and annulus fibrosus tissues,0.1％ pronase E was used for 30 minutes of digestion at 37 ℃ followed by 0.2％ collagenase type Ⅱ digestion for 4 hours to release the cells;for the cartilaginous endplate tissue,direct digestion with 0.2％ collagenase type Ⅱ for 4 hours was performed to release the cells. The cells,after removal of the digestion enzymes,were seeded into culture dishes containing culture medium,and their morphology was observed. Real-time fluorescence quantitative PCR and western blot assay were performed to detect the expression levels of various cell markers. Rat primary annulus fibrosus cells and cartilaginous endplate cells were cultured in monolayer or micromass cultures,and Alcian blue and Safranin O staining were used to assess the extracellular matrix expression capability.RESULTS AND CONCLUSION:After 4 days of culture,all three types of intervertebral disc cells began to adhere to the bottom of the dish and gradually showed proliferative vitality. By the 8th day of culture,significant proliferation of the three types of cells was observed,with a spindle-shaped morphology. Notably,the nucleus pulposus cells exhibited multivesicular notochord-like cells. Through real-time fluorescence quantitative PCR and/or western blot assay,it was found that primary nucleus pulposus cells highly expressed Cytokeratin 19 (K19) and Carbonic anhydrase 3 (Car3),primary annulus fibrosus cells highly expressed Secreted protein acidic and cysteine rich (Sparc) and Biglycan (Bgn),and primary cartilaginous endplate cells highly expressed Parathyroid hormone receptor 1 (Pth1r) and Leucyl-tRNA synthetase 2 (Lars2). After micromass culture of primary annulus fibrosus and cartilaginous endplate cells,Alcian blue and Safranin O staining demonstrated that this culture method could enhance the expression capability of the extracellular matrix compared with monolayer culture. These results indicate that primary intervertebral disc cells extracted and cultured by this method have a good morphology and a high level of extracellular matrix expression. This method holds promise as a research tool to aid researchers in understanding the biology of intervertebral discs.

Objective To investigate the relationship between the expression of nuclear factor ⅠB(NFⅠB)in myeloid cells and intestinal inflammation by constructing NFⅠB conditional gene knockout(cKO)mice.Methods Human Protein Atlas database,Genotype-Tissue Expression database,and FANTOM5 database were used to investigate the expression of NFⅠB in inflammatory cells.NFⅠB-floxed mice were constructed using CRISPR/Cas9 technology and hybridized with LyZ2-Cre transgenic mice.Myeloid specific NFⅠB cKO mice(NFⅠBfl/flLyz2-Cre)were obtained by self-crossing the progeny.After the genotype identification of mice by agarose gel electrophoresis,4 NFⅠB cKO mice of C57BL/6N strain were selected as experimental group,and 4 non-cKO mice were selected as control group.Both groups were induced with 2.5％dextran sulfate sodium salt(DSS)under the same condition to establish a chronic colitis model,and the severity of colitis was evaluated by clinical manifestations and histopathology.Results Analysis showed that NFⅠB was expressed in both myeloid granulocytes and monocytes,and the highest expression was found in neutrophils.NFⅠB cKO mice were successfully constructed using CRISPR/Cas9 technology and Cre-loxP system.DSS-induced enteritis NFⅠB cKO mice developed diarrhea,gross blood stools,reduced activity,and weight loss in a short time.The gross examination of the intestines showed that the colon of the NFⅠB cKO mice was significantly shorter than that of the non-cKO mice([8.23±0.35]cm vs[10.30±0.36]cm,P＜0.01).Intestinal H-E staining showed changes in mucosal glandular structure and connective tissue hyperplasia with extensive inflammatory cell infiltration in NFⅠB cKO mice.The histological score of NFⅠB cKO mice was significantly higher than that of non-cKO mice(4.25±0.50 vs 0.50±0.58,P＜0.01).Intestinal immunohistochemical staining showed that more CD11b positive cells were recruited in NFⅠB cKO mice than non-cKO mice.Conclusion Myeloid specific NFⅠB cKO mice have been successfully constructed,and NFⅠB in myeloid cells can reduce infiltration of immune cells(granulocytes or/and monocytes)to inhibit intestinal inflammation.

Objective:To explore the mechanism of exercise on improving cardiac fibrosis in heart failure,and the role of miR-378 in regulating Cardiac fibrosis by endurance exercise.Method:Twenty-four SD rats were selected and used transverse aortic constriction(TAC)to replicate the rat model of heart failure with cardiac fibrosis.They were randomly divided into the sham group,the TAC group and the exercise group.The exercise group performed swimming endurance exercise for 6 weeks.After train-ing,the rats in each group were analyzed by echocardiography and pathological morphology,and the serum NT-proBNP concentration was detected by ELISA.Western Blot and qPCR were used to detect the expression of α-SMA,Col Ⅰ,Col Ⅲ,TGF-β1,miR-378,TGF-β1 mRNA,Col1a1,and Col3a1 in heart tissue.Result:Compared with the sham group,left ventricular ejection fraction(LVEF),left ventricular short-axis shortening(LVFS),and output per beat(SV)were significantly decreased(P＜0.05)in TAC group,and there were no significant differences in left ventricular end-diastolic volume(EDV)and left ventricular end-systolic volume(ESV)(P＞0.05),and the serum NT-proBNP concentration was increased significantly(P＜0.01).Patho-logical staining in TAC group showed that cardiomyocytes were obviously edematous and disorganzied,and col-lagen volume fraction(CVF)was significantly increased(P＜0.05);the expression of fibrosis-related factors α-SMA,Col Ⅰ,Col Ⅲ,TGF-β1,TGF-β1 mRNA,Col1a1 and Col3a1 was significantly up-regulated(P＜0.05),and the expression of miR-378 was significantly down-regulated(P＜0.05).Compared with the TAC group,in the Ex group,LVEF,LVFS,SV increased significantly(P＜0.05),LVIDs,ESV decreased significantly(P＜0.01),NT-proBNP concentration decreased(P＜0.05);CVF decreased significantly(P＜0.05).The expressions of Col Ⅰ,Col Ⅲ,Col1a1 and Col3a1 in heart tissues were significantly reduced(P＜0.05),α-SMA was not significantly different,and the expression of miR-378 increased(P＜0.05).The expression of TGF-β1 and mRNA was reduced(P＜0.05).Conclusion:TAC can better replicate the cardiac fibrosis model of pressure-overload heart failure.Endurance exercise can up-regulate miR-378 expression,which can effectively improve the level of cardiac fibrosis,slow down the degree of heart failure,and restore cardiac function.This mechanism of action may be related to the inhibition of cardiac fibroblast activation by exercise-regulated miR-378.

Objective:To evaluate the practical effectiveness of a one-to-one mentorship-based short-term training model for senior medical professionals in clinical, teaching, research, and management dimensions based on the reaction and learning levels of the Kirkpatrick model, and to explore its application value.Methods:A total of 109 physicians and their 109 mentors who participated in the senior medical professional training program at The First Affiliated Hospital of Sun Yat-sen University from June 2023 to May 2024 were included. The one-to-one mentorship teaching method was implemented. Data were collected through self-assessment questionnaires and mentor evaluation forms to analyze satisfaction, proficiency, competency improvement, and training effectiveness and their correlations.Results:Valid feedback forms were collected from 100 physicians and 100 mentors. At the reaction level, the satisfaction of trainees was high for mentors (99.00%, 99/100) and training content [clinical: 98.96%(95/96), teaching: 93.75%(15/16), research 85.71%(12/14), management: 100.00%(24/24)]. At the learning level, trainee self-assessed and mentor-evaluated proficiency exceeded 75.00% across all dimensions except research. Significant improvements in clinical, teaching, research, and management competencies were reported by both trainees and mentors ( P<0.001). Notably, evaluations of clinical competency improvement showed strong consistency ( r s=0.37, P<0.001). Conclusions:The one-to-one mentorship-based short-term training model demonstrated positive effects in enhancing mentorship outcomes and excellent educational effectiveness in senior medical professionals. This model is recommended for implementation in similar hospitals for training senior medical professionals.

As an independent first-level discipline,an appropriate classification of nursing science is significant.In China,each nursing degree-granting institution has developed its own secondary-level discipline directions based on its research characteristics and strengths,with varying names and research scopes.Furthermore,there is no unified global classification system.This paper,based on the characteristics of nursing as a discipline and combined with China's discipline classification principles,used literature analysis,comprehensive classification,philosophical reflection,logical reasoning,and expert consultation methods to explore the connotation of nursing,its unique research objects and scope,and to construct a secondary-level discipline classification system for nursing science that is suitable for China's national conditions.The paper also discussed the challenges faced by the nursing discipline and its future development directions,providing theoretical and practical guidance for the development of the nursing discipline.

Macrophages are central mediators of cardiac inflammation and are involved throughout the development of myocardial ischemia.Glucose metabolism reprogramming is an event that affects the core of macrophage polarization,and it can alter the phenotype of macrophages by regulating their glycolytic modes,which in turn affects myocardial injury-repair process.This study sorted out pathogenesis of"deficient qi stagnation"and the related study of macrophage polarization induced by glucose metabolism reprogramming,combined with the overall diagnosis and microscopic point of view,and proposed that myocardial ischemia lies in the cardiac collaterals and the accumulation of pathological products due to abnormal reprogramming of macrophage glucose metabolism in the pathogenesis of myocardial ischemia,which is similar to TCM theory of"deficient qi stagnation".The increase of inflammatory factors in myocardial ischemia and the outcome of ventricular remodeling caused by macrophage polarization imbalance can be regarded as the"toxic damage"process of heart.In the clinical practice,the method of"supporting the healthy qi and replenishing the deficiency,and eliminating the stagnation and detoxification"is used to improve the reprogramming of glucose metabolism,remodel the polarization of macrophages,reduce the inflammatory reaction,and delay the progression of the disease.Therefore,the use of TCM therapy to regulate glucose metabolism reprogramming to induce macrophage polarization is expected to bring new therapeutic ideas for myocardial ischemia.