This article discusses the key pathogenesis of atherosclerosis （AS） based on the physiological characteristics and pathological changes of lipids and introduces the therapeutic effect of Zhuyuwan on AS， aiming to provide a theoretical basis for the treatment of cardiovascular diseases from the spleen. As essential substances， lipids have the same essence but different forms. They circulate throughout the body with body fluids under the action of Yang Qi to nourish the nutrient Qi and support the defensive Qi. Lipid metabolism disorder often leads to the obstruction of Qi movement， the accumulation of dampness and turbidity， and the generation of phlegm and blood stasis. It has been proven that the formation of vulnerable plaques in AS is attributed to the interaction of three pathogenic factors： deficiency of healthy Qi， phlegm-turbidity， and collateral stasis. Their pathological essence is closely related to abnormal lipid metabolism. As lipids constitute the thick and dense components of body fluids， their impaired dispersion may lead to phlegm-turbidity and blood stasis， the pathological process of which is predominantly ascribed to the dysfunction of the spleen in distributing essence. Therefore， AS is rooted in spleen-stomach disorder， manifests as plaques formed by pathological product accumulation in vessels， with lipid transport disorder as its core pathogenesis. Specifically speaking， the dysfunction of spleen in transportation with accumulation of dampness-turbidity marks the initial stage， and blood turbidity and coagulation and phlegm-nodules accumulating in vessels represent the intermediate phase. Cold accumulation and stagnated heat transforming into toxins represent the terminal stage. Zhuyuwan， first recorded in Taiping Holy Prescriptions for Universal Relief， contains equal proportions of Coptidis Rhizoma and Evodiae Fructus. Coptidis Rhizoma， bitter and cold， exerts descending and purging actions to assist stomach Qi in lowering turbidity. Evodiae Fructus， pungent-bitter and hot， disperses obstruction and promotes free flow to support spleen Qi in ascending the clear. The compatibility of Coptidis Rhizoma and Evodiae Fructus ascends the clear and descends the turbid to harmonize Yin and Yang， assisting the spleen in distributing essence and resolving lipid accumulation to reduce lipid levels. In terms of the therapeutic mechanism， Zhuyuwan modulates lipid metabolism by correcting immune-inflammation network imbalance， improving gut microbiota composition and metabolism， and enhancing reverse cholesterol transport. By analyzing the pathological characteristics of lipid transport disorder in AS， this study delves into the intrinsic connections between cardiovascular disease and lipid transport disorder， giving novel insights into the prevention and treatment of AS.

This article discusses the key pathogenesis of atherosclerosis （AS） based on the physiological characteristics and pathological changes of lipids and introduces the therapeutic effect of Zhuyuwan on AS， aiming to provide a theoretical basis for the treatment of cardiovascular diseases from the spleen. As essential substances， lipids have the same essence but different forms. They circulate throughout the body with body fluids under the action of Yang Qi to nourish the nutrient Qi and support the defensive Qi. Lipid metabolism disorder often leads to the obstruction of Qi movement， the accumulation of dampness and turbidity， and the generation of phlegm and blood stasis. It has been proven that the formation of vulnerable plaques in AS is attributed to the interaction of three pathogenic factors： deficiency of healthy Qi， phlegm-turbidity， and collateral stasis. Their pathological essence is closely related to abnormal lipid metabolism. As lipids constitute the thick and dense components of body fluids， their impaired dispersion may lead to phlegm-turbidity and blood stasis， the pathological process of which is predominantly ascribed to the dysfunction of the spleen in distributing essence. Therefore， AS is rooted in spleen-stomach disorder， manifests as plaques formed by pathological product accumulation in vessels， with lipid transport disorder as its core pathogenesis. Specifically speaking， the dysfunction of spleen in transportation with accumulation of dampness-turbidity marks the initial stage， and blood turbidity and coagulation and phlegm-nodules accumulating in vessels represent the intermediate phase. Cold accumulation and stagnated heat transforming into toxins represent the terminal stage. Zhuyuwan， first recorded in Taiping Holy Prescriptions for Universal Relief， contains equal proportions of Coptidis Rhizoma and Evodiae Fructus. Coptidis Rhizoma， bitter and cold， exerts descending and purging actions to assist stomach Qi in lowering turbidity. Evodiae Fructus， pungent-bitter and hot， disperses obstruction and promotes free flow to support spleen Qi in ascending the clear. The compatibility of Coptidis Rhizoma and Evodiae Fructus ascends the clear and descends the turbid to harmonize Yin and Yang， assisting the spleen in distributing essence and resolving lipid accumulation to reduce lipid levels. In terms of the therapeutic mechanism， Zhuyuwan modulates lipid metabolism by correcting immune-inflammation network imbalance， improving gut microbiota composition and metabolism， and enhancing reverse cholesterol transport. By analyzing the pathological characteristics of lipid transport disorder in AS， this study delves into the intrinsic connections between cardiovascular disease and lipid transport disorder， giving novel insights into the prevention and treatment of AS.

Background Work-related musculoskeletal disorders (WMSDs) are considered to be one of the biggest health problems in the workplace, seriously affecting the productivity and quality of life of the working population. Long working hours may associate with WMSDs, and leisure-time physical activity (LTPA) is beneficial for WMSDs. However, the independent and combined effects of these two factors on WMSDs remain poorly understood. Objective To explore the independent and joint relationships between long working hours, leisure time physical activity (LTPA), and WMSDs, and to provide a basis for prevention and intervention of WMSDs. Methods A cross-sectional survey was conducted among 1227 frontline workers from multiple secondary industry companies in Nanchong City in 2023 using cluster random sampling. Demographic characteristics information, weekly working hours, LTPA, personal health behaviors, and occupational factors were collected through questionnaires. The Chinese version of Musculoskeletal Disorders Questionnaire was used to assess WMSDs. χ² test and logistic regression were used to analyze the relationships between long working hours and/or LTPA and WMSDs. Results A total of 1227 workers were surveyed with a mean age of (41.3±9.3) years and 855 (69.7%) were male and 372 (30.3%) were female. Among then, 855 (69.7%) workers reported working >40 h per week, and 254 (20.7%) reported working ≥ 55 h per week; 561 (45.7%) reported no LTPA and 192 (15.6%) reported high LTPA. The overall positive rate of WMSDs was 57.4%. The positive rate of WMSDs was 71.3% in those working ≥55 h per week, which was significantly higher than those in the other groups (51.3%-58.2%, P<0.05). Comparison among the positive rate of WMSDs in the weekly working 41-48 h group (54.4%), the 49-54 h group (58.2%), and the ≤40 h group (51.3%) showed no statistically significant difference (P>0.05). The positive rate of WMSDs was higher in workers with no LTPA (59.0%)/low LTPA (58.9%) than in those with high LTPA (49.0%) (P<0.05). The logistic regression models showed that after adjusting gender, age, work experience, income per month, night shift, industry, prolonged fixed posture, prolonged repetition, smoking and alcohol drinking, compared with weekly working ≤40 h, the risk of WMSDs was higher in those with extra-long working hours (≥55 h·week⁻¹ ) (OR=2.155, 95%CI: 1.504, 3.088), whereas those with high LTPA had a lower risk of WMSDs (OR=0.614, 95% CI: 0.432, 0.874 ). The combination of no LTPA and extra-long working hours (≥55 h·week⁻¹) and low LTPA and extra-long working hours (≥55 h·week⁻¹) showed associations with WMSDs, with 2.360 and 2.049 times higher risk of WMSDs than that of the combination of no LTPA and standard working hours (≤40 h ·week⁻¹) respectively (P<0.05), whereas the combination of high LTPA and long working hours was not observed statistical significance (P>0.05). Conclusion Extra-long working hours and/or LTPA show different associations with the risk of WMSDs. Extra-long working hours are significantly positively associated with the risk of WMSDs, whereas high LTPA is significantly negatively associated with the risk of WMSDs. The combination of extra-long working hours with no or low LTPA is associated with elevated risk of reporting WMSDs, whereas no statistical significance is observed for the high LTPA-long work hours combination.

Objective:To evaluate the efficacy and long-term outcomes of fludarabine, cyclophosphamide, and rituximab (FCR) in treatment-na?ve patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) .Methods:Clinical data from 68 CLL/SLL patients treated with FCR at Jiangsu Province Hospital (August 2008–May 2021) were retrospectively analyzed to assess efficacy, safety, and survival outcomes.Results:Among 68 patients [46 males, 22 females; median age 55 (47, 60) years], 13.1% (8/61) had a complex karyotype, 32.3% (20/62) had immunoglobulin heavy variable region mutated (IGHV-M) type, 6.6% (4/61) had del (17p), and 14.8% (8/54) had del (11q). Patients received a median of 6 (4, 6) FCR cycles. The overall response rate was 88.2% (60/68), including 47.0% (32/68) complete remissions. Over a median follow-up of 82 (59, 98) months, 66.2% (45/68) experienced disease progression. Median progression-free survival was 56 (21, 123) months, while median overall survival was not reached. The 5- and 10-year PFS rates were 42.6% (95% CI: 31.9–56.8% ) and 28.7% (95% CI: 19.0–43.4% ), respectively. Poor PFS was associated with del (17p) ( HR=5.04, 95% CI: 1.72–14.74, P=0.003), del (11q) ( HR=5.27, 95% CI: 2.11–13.15, P<0.001), IGHV unmutated (IGHV-UM) ( HR=4.11, 95% CI: 1.72–9.79, P=0.001), complex karyotype (CK) ( HR=3.53, 95% CI: 1.58–7.85, P=0.002), β 2-microglobulin >3.5 mg/L ( HR=2.87, 95% CI: 1.37–6.01, P=0.005). In multivariate analysis, IGHV-UM remained an independent predictor of PFS ( HR=8.63, 95% CI: 1.09–68.40, P=0.042). Sixteen patients with IGHV-M and lacking del (17p) or CK had a median PFS of 123 (58,123) months and a 5-year PFS rate of 70.7% (95% CI: 49.7–99.1% ), reaching a plateau after 5 years with no recurrences by 10 years. Common grade 3–4 adverse events included hematologic toxicity (44.1%, 30/68), infection (36.7%, 25/68), and liver dysfunction (4.4%, 3/68). Among 25 patients receiving single-agent BTK inhibitors after FCR progression, median follow-up was 45 (26, 64) months; 36% (9/25) experienced disease progression, with a median PFS time of 55 (27, 55) months. Conclusion:First-line FCR provides durable long-term benefits for patients with IGHV-M CLL without del (17p) or CK.

Objective:To investigate the efficacy of urethral catheter balloon dilation in the treatment of bulbar urethral stricture during transurethral bipolar plasma enucleation of the prostate (TUPEP).Methods:A retrospective analysis was conducted on the clinical data of 65 patients with benign prostatic hyperplasia (BPH) complicated by urethral stricture, who were admitted to the Second Affiliated Hospital of Kunming Medical University from January 2021 to January 2023. The patients were divided into two groups based on the intraoperative treatment of urethral stricture: the conventional group (32 cases) and the catheter group (33 cases). There were no significant differences between the conventional group and the catheter group in terms of age [(61.8±5.8) years vs. (63.0±5.0) years], body mass index [(25.0±2.5) kg/m 2 vs. (25.8±2.4) kg/m 2], international prostate symptom score [(22.6±3.3) vs. (23.0±3.7)], maximum urinary flow rate [(10.8±2.1) ml/s vs. (9.7±2.6) ml/s], residual urine volume [(108.8±20.6) ml vs. (100.6±18.9) ml], and prostate volume [(42.72±4.66) cm 3 vs. (42.99±5.83) cm 3] ( P>0.05). Both groups underwent TUPEP. In the conventional group, urethral dilators were used intraoperatively to gradually expand from F18/20 to F29. In the catheter group, an F22 urethral catheter balloon was used for hydrostatic dilation, with 0.5 ml of water injected each time, and repeated until successful(F27 sheath could pass through the stricture, and the scope could move freely with normal amplitude and clear vision) or until the total injected volume reached 4.0 ml. The following parameters were observed, icluding urethral orifice and endoscopic bleeding after dilation, operation time, postoperative catheter indwelling time, hospital stay, urinary tract infection (positive urine culture) during the postoperative period until discharge, and recurrence of urethral stricture within 6 months postoperatively (patients reported weak urinary stream, and F21 cystoscopy failed to pass through the stricture). Results:All surgeries were successfully completed, and intraoperative dilation was successful in all cases. The operation times for the conventional group and the catheter group were (144.9±30.1) minutes and (134.6±29.2) minutes, respectively, with no significant difference ( P>0.05). In the catheter group, the maximum injected volumes at successful dilation were 2.5 ml, 3.0 ml, 3.5 ml, and 4.0 ml in 5 cases(15.2%), 13 cases(39.4%), 10 cases(30.3%), and 5 cases(15.2%), respectively. In the conventional group, 5 cases(15.6%) had urethral mucosal tears, and 1 case (3.1%) developed a false passage. In the catheter group, only droplet bleeding was observed, with no mucosal tears or false passages. There were no significant differences between the conventional group and the catheter group in postoperative catheter indwelling time [(7.3±1.5) days vs. (6.8±1.5) days] or hospital stay [(5.9±1.5) days vs. (5.3±1.2) days] ( P>0.05). The catheter group had lower rates of postoperative urinary tract infection [(6 cases) 18.2% vs. (11 cases) 34.4%, P=0.037] and recurrence of urethral stricture within 6 months postoperatively [(1 case) 3.0% vs. (6 cases) 18.8%, P=0.041] compared to the conventional group. Conclusions:For mild bulbar urethral stricture discovered during TUPEP, urethral catheter balloon dilation is safe and feasible, with less bleeding at the dilation site and lower risks of postoperative urinary tract infection or urethral stricture recurrence.

Sensorineural hearing loss (SNHL), the most commonly-occurring form of hearing loss, is caused mainly by injury to or the loss of hair cells and spiral ganglion neurons in the cochlea. Numerous environmental and physiological factors have been shown to cause acquired SNHL, such as ototoxic drugs, noise exposure, aging, infections, and diseases. Several programmed cell death (PCD) pathways have been reported to be involved in SNHL, especially some novel PCD pathways that have only recently been reported, such as ferroptosis, necroptosis, and pyroptosis. Here we summarize these PCD pathways and their roles and mechanisms in SNHL, aiming to provide new insights and potential therapeutic strategies for SNHL by targeting these PCD pathways.
Humans ; Hearing Loss, Sensorineural/metabolism* ; Necroptosis/drug effects* ; Pyroptosis/drug effects* ; Ferroptosis/drug effects* ; Animals

Objective:To understand nurses' experiences providing discharge preparation services for elderly patients with multiple chronic diseases and offer references for developing intervention strategies for discharge preparation services for these patients.Methods:A purposive sampling method was used to select 24 nurses from the cardiovascular departments, geriatrics wards, and other internal medicine departments of three Grade A tertiary hospitals, four Grade B hospitals, and one community health service center in Guilin City between March and April 2024. An interview outline was developed based on the social-ecological system theory, and semi-structured interviews were conducted to collect data. A directed content analysis method was used to analyze the data.Results:A total of three themes were identified: micro-level (nurses have a positive attitude but face shortcomings in age-appropriate discharge preparation services), meso-level (team collaboration mechanisms are weak), and macro-level (there is a desire to link social resources) .Conclusions:Nurses' discharge preparation services for elderly patients with multiple chronic diseases are inadequate. It is recommended to enhance nurses' discharge preparation skills through core competency-based training, improve the development of innovative healthcare platforms, and promote establishing of a multi-dimensional social care support system to improve the quality of discharge preparation services for elderly patients with multiple chronic diseases.

Objective:To understand nurses' experiences providing discharge preparation services for elderly patients with multiple chronic diseases and offer references for developing intervention strategies for discharge preparation services for these patients.Methods:A purposive sampling method was used to select 24 nurses from the cardiovascular departments, geriatrics wards, and other internal medicine departments of three Grade A tertiary hospitals, four Grade B hospitals, and one community health service center in Guilin City between March and April 2024. An interview outline was developed based on the social-ecological system theory, and semi-structured interviews were conducted to collect data. A directed content analysis method was used to analyze the data.Results:A total of three themes were identified: micro-level (nurses have a positive attitude but face shortcomings in age-appropriate discharge preparation services), meso-level (team collaboration mechanisms are weak), and macro-level (there is a desire to link social resources) .Conclusions:Nurses' discharge preparation services for elderly patients with multiple chronic diseases are inadequate. It is recommended to enhance nurses' discharge preparation skills through core competency-based training, improve the development of innovative healthcare platforms, and promote establishing of a multi-dimensional social care support system to improve the quality of discharge preparation services for elderly patients with multiple chronic diseases.

Objective:To evaluate the efficacy and long-term outcomes of fludarabine, cyclophosphamide, and rituximab (FCR) in treatment-na?ve patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) .Methods:Clinical data from 68 CLL/SLL patients treated with FCR at Jiangsu Province Hospital (August 2008–May 2021) were retrospectively analyzed to assess efficacy, safety, and survival outcomes.Results:Among 68 patients [46 males, 22 females; median age 55 (47, 60) years], 13.1% (8/61) had a complex karyotype, 32.3% (20/62) had immunoglobulin heavy variable region mutated (IGHV-M) type, 6.6% (4/61) had del (17p), and 14.8% (8/54) had del (11q). Patients received a median of 6 (4, 6) FCR cycles. The overall response rate was 88.2% (60/68), including 47.0% (32/68) complete remissions. Over a median follow-up of 82 (59, 98) months, 66.2% (45/68) experienced disease progression. Median progression-free survival was 56 (21, 123) months, while median overall survival was not reached. The 5- and 10-year PFS rates were 42.6% (95% CI: 31.9–56.8% ) and 28.7% (95% CI: 19.0–43.4% ), respectively. Poor PFS was associated with del (17p) ( HR=5.04, 95% CI: 1.72–14.74, P=0.003), del (11q) ( HR=5.27, 95% CI: 2.11–13.15, P<0.001), IGHV unmutated (IGHV-UM) ( HR=4.11, 95% CI: 1.72–9.79, P=0.001), complex karyotype (CK) ( HR=3.53, 95% CI: 1.58–7.85, P=0.002), β 2-microglobulin >3.5 mg/L ( HR=2.87, 95% CI: 1.37–6.01, P=0.005). In multivariate analysis, IGHV-UM remained an independent predictor of PFS ( HR=8.63, 95% CI: 1.09–68.40, P=0.042). Sixteen patients with IGHV-M and lacking del (17p) or CK had a median PFS of 123 (58,123) months and a 5-year PFS rate of 70.7% (95% CI: 49.7–99.1% ), reaching a plateau after 5 years with no recurrences by 10 years. Common grade 3–4 adverse events included hematologic toxicity (44.1%, 30/68), infection (36.7%, 25/68), and liver dysfunction (4.4%, 3/68). Among 25 patients receiving single-agent BTK inhibitors after FCR progression, median follow-up was 45 (26, 64) months; 36% (9/25) experienced disease progression, with a median PFS time of 55 (27, 55) months. Conclusion:First-line FCR provides durable long-term benefits for patients with IGHV-M CLL without del (17p) or CK.

Objective:To investigate the efficacy of urethral catheter balloon dilation in the treatment of bulbar urethral stricture during transurethral bipolar plasma enucleation of the prostate (TUPEP).Methods:A retrospective analysis was conducted on the clinical data of 65 patients with benign prostatic hyperplasia (BPH) complicated by urethral stricture, who were admitted to the Second Affiliated Hospital of Kunming Medical University from January 2021 to January 2023. The patients were divided into two groups based on the intraoperative treatment of urethral stricture: the conventional group (32 cases) and the catheter group (33 cases). There were no significant differences between the conventional group and the catheter group in terms of age [(61.8±5.8) years vs. (63.0±5.0) years], body mass index [(25.0±2.5) kg/m 2 vs. (25.8±2.4) kg/m 2], international prostate symptom score [(22.6±3.3) vs. (23.0±3.7)], maximum urinary flow rate [(10.8±2.1) ml/s vs. (9.7±2.6) ml/s], residual urine volume [(108.8±20.6) ml vs. (100.6±18.9) ml], and prostate volume [(42.72±4.66) cm 3 vs. (42.99±5.83) cm 3] ( P>0.05). Both groups underwent TUPEP. In the conventional group, urethral dilators were used intraoperatively to gradually expand from F18/20 to F29. In the catheter group, an F22 urethral catheter balloon was used for hydrostatic dilation, with 0.5 ml of water injected each time, and repeated until successful(F27 sheath could pass through the stricture, and the scope could move freely with normal amplitude and clear vision) or until the total injected volume reached 4.0 ml. The following parameters were observed, icluding urethral orifice and endoscopic bleeding after dilation, operation time, postoperative catheter indwelling time, hospital stay, urinary tract infection (positive urine culture) during the postoperative period until discharge, and recurrence of urethral stricture within 6 months postoperatively (patients reported weak urinary stream, and F21 cystoscopy failed to pass through the stricture). Results:All surgeries were successfully completed, and intraoperative dilation was successful in all cases. The operation times for the conventional group and the catheter group were (144.9±30.1) minutes and (134.6±29.2) minutes, respectively, with no significant difference ( P>0.05). In the catheter group, the maximum injected volumes at successful dilation were 2.5 ml, 3.0 ml, 3.5 ml, and 4.0 ml in 5 cases(15.2%), 13 cases(39.4%), 10 cases(30.3%), and 5 cases(15.2%), respectively. In the conventional group, 5 cases(15.6%) had urethral mucosal tears, and 1 case (3.1%) developed a false passage. In the catheter group, only droplet bleeding was observed, with no mucosal tears or false passages. There were no significant differences between the conventional group and the catheter group in postoperative catheter indwelling time [(7.3±1.5) days vs. (6.8±1.5) days] or hospital stay [(5.9±1.5) days vs. (5.3±1.2) days] ( P>0.05). The catheter group had lower rates of postoperative urinary tract infection [(6 cases) 18.2% vs. (11 cases) 34.4%, P=0.037] and recurrence of urethral stricture within 6 months postoperatively [(1 case) 3.0% vs. (6 cases) 18.8%, P=0.041] compared to the conventional group. Conclusions:For mild bulbar urethral stricture discovered during TUPEP, urethral catheter balloon dilation is safe and feasible, with less bleeding at the dilation site and lower risks of postoperative urinary tract infection or urethral stricture recurrence.