Edema， as a common pathological phenomenon， is essentially the abnormal accumulation of body fluids in the interstitial spaces of human tissues and is often a direct manifestation of various underlying diseases， such as heart failure， impaired renal filtration function， or liver metabolic disorders. In the Western medical system， strategies for treating edema primarily focus on the use of diuretics to promote the excretion of excess fluid in the body， while simultaneously addressing the underlying causes through targeted treatment. However， long-term reliance on the use of diuretics may lead to a decrease in drug sensitivity and induce side effects， including electrolyte disorders such as hypokalemia and hypercalcemia， posing a potential threat to patients' overall health. Compared with Western medicine， traditional Chinese medicine （TCM） has demonstrated well-recognized and sustained efficacy in treating edema with its unique theoretical system. Zhulingtang， as a classic and commonly used TCM formula， is widely applied as it can effectively relieve edema and related symptoms. In recent years， ongoing in-depth studies on the treatment of edema with Zhulingtang have revealed multiple mechanisms of action of Zhulingtang， including the regulation of water metabolism and the reduction of inflammatory responses， thereby providing a solid theoretical basis for clinical practice. This review summarized the research progress on the treatment of edema with Zhulingtang in recent years and analyzed the active ingredients and action pathways of Zhulingtang. Additionally， the primary mechanisms of action and efficacy were systematically analyzed， so as to provide references for the clinical application of Zhulingtang in treating various types of edema， such as cardiogenic edema， renal edema， and hepatogenic edema. This review aims to offer theoretical support and practical guidance for clinicians in deciding treatment approaches， as well as references for subsequent in-depth studies， thereby promoting further development of TCM in the treatment of edema.

Edema， as a common pathological phenomenon， is essentially the abnormal accumulation of body fluids in the interstitial spaces of human tissues and is often a direct manifestation of various underlying diseases， such as heart failure， impaired renal filtration function， or liver metabolic disorders. In the Western medical system， strategies for treating edema primarily focus on the use of diuretics to promote the excretion of excess fluid in the body， while simultaneously addressing the underlying causes through targeted treatment. However， long-term reliance on the use of diuretics may lead to a decrease in drug sensitivity and induce side effects， including electrolyte disorders such as hypokalemia and hypercalcemia， posing a potential threat to patients' overall health. Compared with Western medicine， traditional Chinese medicine （TCM） has demonstrated well-recognized and sustained efficacy in treating edema with its unique theoretical system. Zhulingtang， as a classic and commonly used TCM formula， is widely applied as it can effectively relieve edema and related symptoms. In recent years， ongoing in-depth studies on the treatment of edema with Zhulingtang have revealed multiple mechanisms of action of Zhulingtang， including the regulation of water metabolism and the reduction of inflammatory responses， thereby providing a solid theoretical basis for clinical practice. This review summarized the research progress on the treatment of edema with Zhulingtang in recent years and analyzed the active ingredients and action pathways of Zhulingtang. Additionally， the primary mechanisms of action and efficacy were systematically analyzed， so as to provide references for the clinical application of Zhulingtang in treating various types of edema， such as cardiogenic edema， renal edema， and hepatogenic edema. This review aims to offer theoretical support and practical guidance for clinicians in deciding treatment approaches， as well as references for subsequent in-depth studies， thereby promoting further development of TCM in the treatment of edema.

Background::Although significant advances have been made in the treatment of multiple myeloma (MM), leading to unprecedented response and survival rates among patients, the majority eventually relapse, and a cure remains elusive. This situation is closely related to an incomplete understanding of the immune microenvironment, especially monocytes/macrophages in patients with treatment-na?ve MM. The aim of this study was to provide insight into the immune microenvironment, especially monocytes/macrophages, in patients with treatment-na?ve MM.Methods::This study used the single-cell RNA sequencing (scRNA-seq) data of both patients with MM and heathy donors to identify immune cells, including natural killer (NK) cells, T cells, dendritic cells (DCs), and monocytes/macrophages. Transcriptomic data and flow cytometry analysis of monocytes/macrophages were used to further examine the effect of monocytes/macrophages in treatment-na?ve MM patients.Results::A significant difference was observed between the bone marrow (BM) immune cells of the healthy controls and treatment-na?ve MM patients through scRNA-seq. It is noteworthy that, through an scRNA-seq data analysis, this study found that interferon (IFN)-induced NK/T cells, terminally differentiated effector memory (TEMRA) cells, T-helper cells characterized by expression of IFN-stimulated genes (ISG +Th cells), IFN-responding exhausted T cells, mannose receptor C-type 1 (MRC1) + DCs, IFN-responding DCs, MHCII + DCs, and immunosuppressive monocytes/macrophages were enriched in patients with treatment-na?ve MM. Significantly, transcriptomic data of monocytes/macrophages demonstrated that "don’t eat me" -related genes and IFN-induced genes increase in treatment-na?ve MM patients. Furthermore, scRNA-seq, transcriptomic data, and flow cytometry also showed an increased proportion of CD16 + monocytes/macrophages and expression level of CD16. Cell-cell communication analysis indicated that monocytes/macrophages, whose related important signaling pathways include migration inhibitory factor (MIF) and interleukin 16 (IL-16) signaling pathway, are key players in treatment-na?ve MM patients. Conclusions::Our findings provide a comprehensive and in-depth molecular characterization of BM immune cell census in MM patients, especially for monocytes/macrophages. Targeting macrophages may be a novel treatment strategy for patients with MM.

Objective:To explore the effect path of death attitude and purpose in life on attitude toward hospice care of undergraduate intern nursing students.Methods:This study was a cross-sectional study. Using the convenient sampling method, a total of 229 undergraduate intern nursing students from two schools in Hefei, Anhui Province were selected as the research objects from October to December 2022. General data questionnaire, Chinese Version of Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B-C), Chinese Version of Death Attitude Profile-Revised (DAP-R) Scale and Chinese Version of Purpose in Life Test (PIL-C) were used to investigate. Pearson correlation analysis was used to explore the correlation between death attitudes, purpose in life and attitude toward hospice care among undergraduate intern nursing students. Structural equation model was used to examine the path relationship between attitude towards death and purpose in life on attitude toward hospice care.Results:A total of 229 questionnaires were sent out in this study, and 214 were effectively recovered, with an effective recovery rate of 93.45% (214/229). Among 214 undergraduate intern nursing students, the scores of FATCOD-B-C, Chinese Version DAP-R Scale, and PIL-C were (101.06±8.16), (91.21±12.13) and (94.45±11.90), respectively. The results of Pearson correlation analysis showed that the purpose in life was positively correlated with attitude toward hospice care ( r=0.290, P<0.01), while the attitude to death was negatively correlated with attitude toward hospice care ( r=-0244, P<0.01). The results of structural equation model path analysis showed that the purpose in life (life goal, life attitude) can affect attitude toward hospice care through death attitude (escape acceptance, natural acceptance, fear of death) . Conclusions:Effective interventions on purpose in life and attitude towards death of undergraduate intern nursing students can improve their attitudes toward hospice care .

Objective:To investigate the role of dietary fiber in the intestinal rehabilitation for patients with ultra-short bowel syndrome.Methods:This study included 34 inpatients diagnosed with ultra-short bowel syndrome in the General Surgery Department of the Eastern Theater General Hospital of the People's Liberation Army from January 2012 to October 2023. Patients were grouped based on whether they received intestinal rehabilitation and whether dietary fiber was added to the treatment plan, and were divided into three groups: nutritional therapy group (11 cases), growth hormone + glutamine intestinal rehabilitation treatment group (10 cases) and growth hormone injection + glutamine + dietary fiber intestinal rehabilitation treatment group (13 cases). The therapeutic regimen and its changes, pre- and post-treatment parameters of hematology, nutrition, intestinal absorption, fecal consistency, and quality of life were recorded and compared, and the impact of different treatment regimens on clinical outcomes was analyzed.Results:Compared with nutrition treatment group and growth hormone + glutamine intestinal rehabilitation treatment group, growth hormone injection + glutamine + dietary fiber intestinal rehabilitation treatment group, the increase of enteral nutritional fluid, the decrease of parenteral nutritional energy, the increase of intestinal moisture absorption, the decrease of defecation times and the appreciation of hemoglobin were significantly increased, and the difference was statistically significant ( P<0.05). At the same time, the levels of insulin-like growth factor 1 and insulin-like growth factor binding protein were significantly increased after treatment ( P<0.01). Conclusions:Nutritional support combined with intestinal rehabilitation can significantly improve the nutritional status and intestinal absorption rate of ultra-short bowel syndrome patients. The use of dietary fiber in the intestinal rehabilitation regimen for ultra-short bowel syndrome patients yields more significant benefits, as evidenced by improved clinical outcomes.

Objective:To systematically evaluate and Meta-synthesize qualitative studies on the home management needs of patients with spinal cord injury (SCI) to understand their actual self-management needs and improve the quality of home management for patients with SCI in China.Methods:A comprehensive search was conducted in databases including CNKI, Wanfang, CBM, PubMed, Embase, Web of Science, CINAHL, and Cochrane Library for qualitative research on the home management needs of patients with SCI, with a search timeframe up to November 30, 2023. The methodological quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument (2016). Results were integrated and analyzed using Meta-synthesize methods.Results:A total of 15 studies were included, from which 58 distinct research findings were extracted. These were categorized into 10 new categories, which were further integrated into four main results: the need for positive emotional support, daily living-related needs, healthcare service needs, and social support needs.Conclusions:Healthcare providers should deeply understand the home management needs of patients with SCI. Utilizing artificial intelligence technology, an integrated support model encompassing hospital, home, and society can be constructed. Establishing a comprehensive home rehabilitation platform for patients with SCI can focus on psychological issues and enhance social support levels, thereby improving patients' quality of life.

Objective:To integrate qualitative research on the real experience of patients with spinal cord injury (SCI) returning to society after discharge, so as to provide a basis for developing transitional care intervention program, and promote patients' reintegration into society.Methods:Qualitative research on the real experience of patients with SCI returning to society after discharge was electronically retrieved on China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Service System, Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and so on .The search period was from database establishment to August 30, 2023. The quality evaluation criteria for qualitative research of the JBI Evidence-Based Health Care Center (2016) was used to assess the quality of literature, and Meta-synthesis was used to integrate the results.Results:A total of 16 articles were included, and 51 research results were extracted. Similar research results were summarized and combined to form 12 new categories, which were then synthesized into four integrated results, including experiencing physical and mental discomfort following discharge, facing challenges in reintegrating into society, seeking social support, and adapting to social life through self-adjustment role changes.Conclusions:Patients with SCI have multiple psychological experiences in the process of reintegration into society. Medical and nursing staff should attach importance to their inner needs, help them overcome stress and challenges, provide them with personalized continuous care, and promote their role adaptation and reintegration into society.

Objective:To evaluate the effect of pre-infusion of hypertonic saline on the postoperative cognitive function in elderly patients.Methods:This was a prospective study. Seventy-six patients of both sexes, aged≥60 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, who underwent elective shoulder arthroscopic surgery under brachial plexus block combined with general anesthesia from June 2022 to January 2023 in our hospital, were selected and divided into 2 groups ( n=38 each) by the random number table method: hypertonic saline group and normal saline group. At 30 min before anesthesia induction, 3% hypertonic saline of 4 ml/kg was intravenously infused in hypertonic saline group, and normal saline 4 ml/kg was intravenously infused in normal saline group. The occurrence of intraoperative cerebral desaturation events was recorded. Venous blood samples were collected at 24 h postoperatively, and the plasma concentrations of interleukin-1beta (IL-1β), IL-6, tumor necrosis factor-alpha and S-100β were measured by enzyme-linked immunosorbent assay, and the expression of neutrophil CD11b was detected by flow cytometry. Rey auditory verbal learning test, trail making test, digit symbol substitution test, and stroop color-word test were performed at 1 day before surgery and 5 days after surgery, and the postoperative cognitive dysfunction was assessed using the Z-score method. Results:Compared with normal saline group, the concentrations of plasma IL-6, tumor necrosis factor-alpha and S-100β and expression of neutrophil CD11b were significantly decreased in hypertonic saline group, and the incidence of cognitive dysfunction and cerebral desaturation events was decreased in hypertonic saline group ( P<0.05). Conclusions:Pre-infusion of hypertonic saline can reduce inflammatory responses and improve postoperative cognitive function in elderly patients.

Objective To construct a nomogram model for predicting the risk of in-hospital death in CHF patients by using noninvasive hemodynamic monitoring combined with age,DBP,CRP and renal insufficiency(serum creatinine≥ 442 μmol/L).Methods A total of 223 elderly patients with acute onset of CHF admitted in First,Second Medical Centre of Chinese PLA General Hos-pital from September 2022 to March 2023 were recruited in this study.According to their clinical outcomes,they were divided into survival group(196 cases)and death group(27 cases).Based on the in-hospital death and other related indicators,a nomogram model was constructed to predict the risk factors of in-hospital death in CHF.Results Noninvasive hemodynamic mornitoring indi-cated that the death group had significantly higher LVEF and LCWI values but lower LVEDV value than the survival group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that age(OR=1.131,95％CI:1.052-1.213,P=0.001),DBP(OR=0.932,95％CI:0.882-0.982,P=0.011),CRP(OR=1.171,95％CI:1.021-1.352,P=0.024),LVEDV(OR=0.984,95％CI:0.962-0.992,P=0.011)and renal insufficiency(OR=5.863,95％CI:1.351-1.731,P=0.004)were independent risk factors for the short-term prognosis of the elderly CHF patients.The AUC value of the nomogram model was 0.902(95％CI:0.819-0.948,P＜0.05),and calibration curve analysis showed the C-index was 0.902,indicating accurate predictive perform-ance.Conclusion Age,DBP,LVEDV,CRP and renal insufficiency are independent risk factors for the short-term prognosis of the elderly CHF patients.

Objective:To investigate whether intestinal rehabilitation therapy (IRT)could optimize the effectiveness of IRT in patients with short bowel syndrome (SBS) caused by acute mesenteric ischemia (AMI) with chronic multivessel lesions.Methods:Clinical data of 18 hospitalized patients diagnosed with AMI leading to SBS and undergoing IRT at the Eastern Theater General Hospital of the People's Liberation Army from Jan 2012 to Oct 2023 was retrospectively analyzed.Result:Following IRT, the revascularization group showed significantly greater increases in ASMI and grip strength compared to the control group [(0.28±0.26) kg/m 2vs. (0.02±0.21) kg/m 2, P=0.033, and (0.97±0.33) kg vs. (0.48±0.34) kg, P=0.007, respectively]. Similarly, the increase in EN intake was significantly higher in the revascularization group compared to the control group [(572.5±93.6) ml/d vs. (375.2±176.3) ml/d, P=0.012], accompanied by a greater improvement in intestinal nitrogen absorption rate [(25.06±14.06)% vs. (13.84±4.62)%, P=0.034] and a more substantial decrease in GSRS scores [(-15.88±3.94) vs. (-6.33±5.13), P=0.030]. Moreover, there were significant differences in the composition of EN formulations between the two groups after IRT ( P=0.046). Additionally, SF-36 scores at discharge were significantly higher in the revascularization group than that in the control group for five indicators including BP, GH, VT, SF, and MH ( P<0.05). Conclusions:For patients with SBS resulting from AMI by chronic multivessel lesions, revascularization therapy may not leading to higher growth in weight and hematological nutritional indicators during IRT, but it is beneficial for improving muscle function, improving EN absorption, increasing the likelihood of PN independence, relieving gastrointestinal symptoms, and enhancing overall quality of life.