The Huangdi Neijing proposes the " using bitter herbs to nourish or purge" theory to guide clinical prescription and formulation of herbal remedies based on the physiological characteristics and functions of the five zang viscera, along with the properties and flavors of medicinal herbs. This study explored diabetic kidney disease pathogenesis and treatment based on the " using bitter herbs to nourish or purge" theory. Kidney dryness is a key pathological factor in diabetic kidney disease, and the disharmony of kidney dryness is an essential aspect of its pathogenesis. Strengthening is the primary therapeutic principle, and kidney dryness is a persistent factor throughout the occurrence and progression of diabetic kidney disease. In the early stage, the pathogenesis involves heat-consuming qi and injuring yin, leading to kidney dryness. In the middle stage, the pathogenesis manifests as qi deficiency and blood stasis in the collaterals, resulting in turbidity owing to kidney dryness. In the late stage, the pathogenesis involves yin and yang deficiency, with kidney dryness and disharmony. This study proposes the staging-based treatment based on the " need for firmness" characteristic of the kidney. The aim is to provide new insights for clinical diagnosis and treatment in traditional Chinese medicine by rationally using pungent, bitter, and salty medicinal herbs to nourish and moisturize the kidney. This approach seeks to promote precise syndrome differentiation and personalized treatment for different stages of diabetic kidney disease, thereby enhancing clinical efficacy.

Compulsory medical treatment is considered a necessary means to maintain public health. It faces many ethical dilemmas during its implementation， primarily concerning issues of autonomy. The discussion of autonomy issues is grounded in the concept， which faces difficulties in explanation and challenges in power structures. In addition to conceptual issues， autonomy also encounters various controversies in practice， including rational suicide， interpersonal relationships， bioethical principles， and other aspects. Faced with challenges， Bjorn Hofmann’s polyvalent concept clarifies the concept of autonomy， and the relational ethical approach provides innovative solutions to the practical issues of autonomy.

The Chinese Pharmacopoeia is the legal technical standard which should be followed during the research, production, use, and administration of drugs. At present, the new edition of the Chinese Pharmacopoeia is planned to be promulgated and implemented. This article summarizes and analyzes the main characteristics and the content of updates and amendments of the Chinese Pharmacopoeia 2025 Edition(Volume Ⅰ), to provide a reference for the correct understanding and accurate implementation the new edition of the pharmacopoeia.

Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

Objective To analyze the correlation between serum cystatin C (Cys-C) and bone turnover markers in elderly patients with type 2 diabetes mellitus (T2DM) and osteoporosis. Methods A retrospective analysis was conducted on the data of 320 elderly patients with T2DM admitted to Huai'an First People's Hospital from August 2021 to June 2024. Patients were divided into the osteoporosis group and the non-osteoporosis group according to whether they had osteoporosis. General information, bone turnover markers, and serum Cys-C levels were collected from all patients. The data were compared between the two groups to analyze the influencing factors of osteoporosis in elderly patients with T2DM and the correlation between serum Cys-C and bone turnover markers. Results The levels of total cholesterol and LDL-C in the osteoporosis group were higher than those in the non-osteoporosis group, and the bone mineral density was lower than that in the non-osteoporosis group (P<0.05). The levels of TPINP, β-CTX, and Cys-C in the osteoporosis group were higher than those in the non-osteoporosis group, and 25-OH-D3 level was lower than that in the non-osteoporosis group (P<0.05). Serum Cys-C was positively correlated with TPINP and β-CTX, and negatively correlated with 25-OH-D₃ (P<0.05). Multivariate logistic regression analysis found that total cholesterol, LDL-C, TPINP, β-CTX, 25-OH-D₃, and Cys-C were factors influencing osteoporosis in elderly patients with T2DM (P<0.05). Conclusion Serum Cys-C levels in elderly patients with T2DM and osteoporosis are elevated. There is a significant correlation between Cys-C level and bone turnover markers.

Background: The prevalence of neck pain among adults worldwide is 4.9-22.3%. It occurs in 34.7% of office workers in industrialized countries. Aim: To study the effect of massage therapy of Mongolian medicine on neck pain Materials and Methods: In this study, a parallel clinical trial design was used, and 50 patients with neck pain were divided into two groups: the treatment group received massage therapy of Mongolian medicine and the control group received exercise therapy, and the treatment results were compared. VAS assessment, NDI, Digital Algometer, and European Quality of Life Questionnaire were used in the study. Results: 52 % of the study participants were male, while 48 % were female, and their mean age was 43.3±21.3. The VAS score for pain assessment was 5.44±0.96 in the treatment group and 5.44±0.96 in the comparison group before treatment, but after the treatment it decreased to 0.80±0.71 in the treatment group and 1.44±0.77 in the comparison group, respectively, which showed a statistically significant difference. Massage therapy of Mongolian medicine has a greater pain-relieving effect than exercise therapy in the treatment of neck pain (p<0.01). The pressure pain threshold was 934±154.60 in the treatment group and 934±154.60 in the comparison group before treatment, but after treatment, it increased to 1536±22.91 in the treatment group and 1392±83.77 in the comparison group, which was statistically significant (p<0.01). The neck disability index of patients with neck pain was 11.44±2.87 in the treatment group and 11.56±2.55 in the comparison group before treatment, but after treatment it decreased to 0.84±0.69 in the treatment group and 1.40±0.87 in the comparison group. Although exercise therapy has the effect of reducing the neck disability index, when comparing the treatment results of the two groups, massage therapy of Mongolian medicine had greater effect (p<0.05). European Quality of Life Questionnaire was 8.64±2.25 in the treatment group and 8.16±1.60 in the comparison group before treatment, but after treatment it was 5.28±0.54 in the treatment group and 7.44±1.23 in the comparison group. Massage therapy of Mongolian medicine has a greater effect on improving the quality of life of people with neck pain compared to exercise therapy (p<0.01). The neck forward bending was 36.60±2.45 in the treatment group and 37.24±2.35 in the comparison group before treatment, but after treatment, it increased to 42.32±2.14 in the treatment group and 39.32±2.14 in the comparison group, which was statistically significant (p0.01).The neck abduction was 36.20±1.89 in the treatment group and 36.56±2.24 in the comparison group before treatment, but after treatment, it increased to 42.80±2.06 in the treatment group and 39.76±1.88 in the comparison group, which was statistically significant (p=0.01).The neck left rotation was 60.84±3.77 in the treatment group and 61.56±4.31 in the comparison group before treatment, but after treatment, it increased to 75.08±3.55 in the treatment group and 67.20±4.29 in the comparison group, which was statistically significant (p0.01). The neck right rotation was 61.80±4.39 in the treatment group and 62.00±4.42 in the comparison group before treatment, but after treatment, it increased to 76.52±2.95 in the treatment group and 68.04±4.46 in the comparison group, which was statistically significant (p0.01).When comparing the treatment results of the two groups, Mongolian medical bariatric surgery was more effective (p<0.01). Conclusions 1. Massage therapy of Mongolian medicine reduces disability index in people with neck pain (p<0.05). 2. Massage therapy of Mongolian medicine has a significant effect on reducing pain and pressure pain threshold in people with neck pain (p<0.01). 3. Massage therapy of Mongolian medicine has the effect of improving the quality of life of people with neck pain (p<0.01).

Background::Cardiovascular disease (CVD) has emerged as the leading cause of death from prostate cancer (PCa) in recent decades, bringing a great disease burden worldwide. Men with preexisting CVD have an increased risk for major adverse cardiovascular events when treated with androgen deprivation therapy (ADT). The present study aimed to explore the prevalence and risk evaluation of CVD among people with newly diagnosed PCa in China.Methods::Clinical data of newly diagnosed PCa patients were retrospectively collected from 34 centers in China from 2010 to 2022 through convenience sampling. CVD was defined as myocardial infarction, arrhythmia, heart failure, stroke, ischemic heart disease, and others. CVD risk was estimated by calculating Framingham risk scores (FRS). Patients were accordingly divided into low-, medium-, and high-risk groups. χ2 or Fisher’s exact test was used for comparison of categorical variables. Results::A total of 4253 patients were enrolled in the present study. A total of 27.0% (1147/4253) of patients had comorbid PCa and CVD, and 7.2% (307/4253) had two or more CVDs. The enrolled population was distributed in six regions of China, and approximately 71.0% (3019/4253) of patients lived in urban areas. With imaging and pathological evaluation, most PCa patients were diagnosed at an advanced stage, with 20.5% (871/4253) locally progressing and 20.5% (871/4253) showing metastasis. Most of them initiated prostatectomy (46.6%, 1983/4253) or regimens involving ADT therapy (45.7%, 1944/4253) for prostate cancer. In the present PCa cohort, 43.1% (1832/4253) of patients had hypertension, and half of them had poorly controlled blood pressure. With FRS stratification, as expected, a higher risk of CVD was related to aging and metabolic disturbance. However, we also found that patients with treatment involving ADT presented an originally higher risk of CVD than those without ADT. This was in accordance with clinical practice, i.e., aged patients or patients at advanced oncological stages were inclined to accept systematic integrative therapy instead of surgery. Among patients who underwent medical castration, only 4.0% (45/1118) received gonadotropin releasing hormone antagonists, in stark contrast to the grim situation of CVD prevalence and risk.Conclusions::PCa patients in China are diagnosed at an advanced stage. A heavy CVD burden was present at the initiation of treatment. Patients who accepted ADT-related therapy showed an original higher risk of CVD, but the awareness of cardiovascular protection was far from sufficient.

Objective:To compare the effectiveness and safety of in vitro fenestration and in situ fenestration for reconstruction of the left subclavian artery in patients with aortic arch diseases.Methods:A retrospective analysis was conducted on 80 patients with thoracic aortic dissection, aortic aneurysm, and aortic intramural hematoma involving the left subclavian artery at our center from Jan 2020 to Oct 2023.Results:Thirty-eight patients underwent in vitro fenestration to reconstruct the left subclavian artery, while 42 patients underwent in situ laser fenestration to reconstruct the left subclavian artery. The technical success rates were 97.4% and 97.6% respectively, without statistically significance ( P>0.05). Postoperative CTA examination showed that the primary rupture of the dissection was completely closed, 3 cases had type Ⅱ endoleak in vitro fenestration, and 2 cases had type Ⅱ endoleak in laser in situ fenestration. The blood flow inside the fenestration stent was fluent. During the perioperative period, one patient in the in vitro fenestration group experienced mild cerebral infarction (2.6%), one patient had mild paraplegia, and no related complications occurred in the other patients. Conclusion:For patients with aortic arch diseases, both in situ laser fenestration and in vitro fenestration are safe and effective.

Objective To analyze the current research status and hotspots in the field of operating room efficiency both domestically and internationally,and provide theoretical and practical guidance for the improvement and evaluation of operating room efficiency.Methods Using bibliometric methods to search for domestic and foreign literature on operating room efficiency in CNKI and Web of Science core collection databases,Citespace software was used for visual analysis of publication volume,core authors,publication institutions,keyword co-occurrence,clustering,and emergence.Results A total of 387 foreign litera-ture on operating room efficiency were retrieved,with the United States ranking first in terms of publication volume.Research in-stitutions mostly collaborate closely,with research hotspots mainly focusing on time management,anesthesia management,cost management,and quality management.Research frontiers include artificial intelligence,quality improvement,etc;A total of 235 domestic literature have been searched,but a close cooperation network has not yet formed.The research hotspots mainly include lean management,process management,nursing management,etc.The research frontiers include information systems,quality and safety,etc.Conclusion China should integrate research capabilities,strengthen institutional cooperation,pay attention to research hotspots and frontiers,and increase the importance of research on operating room efficiency.

Objective:To investigate the perioperative impact of closure of mesenteric fissure in laparoscopic right hemicolectomy.Methods:The prospective randomized controlled trial was conducted. The clinical data of 320 patients who underwent laparoscopic right hemicolectomy in 11 medical centers, including The First Affiliated Hospital of China Medical University et al, from November 2022 to August 2023 were selected. Based on block randomization, patients were alloca-ted into the mesenteric fissure non-closure group and the mesenteric fissure closure group. Observa-tion indicators: (1) grouping of the enrolled patients; (2) intraoperative conditions; (3) postopera-tive conditions. Measurement data with skewed distribution were represented as M( Q1, Q3) and com-parison between groups was conducted using the Mann-Whitney U test. Count data were represen-ted as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher's exact probability. Comparison of ordinal data was conducted using the rank sum test. Comparison of visual analog scores was analyzed using generalized estimating equations. Results:(1) Grouping of the enrolled patients. A total of 320 patients with colon cancer were screened for eligibility, including 156 males and 164 females, aged 68(59,73)years. All the 320 patients were allocated into the mesenteric fissure non-closure group with 164 cases and the mesenteric fissure closure group with 156 cases. There was no significant difference in the age, body mass index, American Society of Anesthesiologist score, maximum tumor diameter, anastomosis location, anastomosis method, surgical approach, range of lymph node dissection, tumor staging between the two groups ( P>0.05) and there was a significant difference in the sex between them ( P<0.05). (2) Intraoperative conditions. There was no significant difference between the mesenteric fissure closure group and the mesenteric fissure non-closure group in the volume of intraoperative blood loss, operation time, conversion to laparotomy, intraoperative complication ( P>0.05). Three patients in the mesenteric fissure non-closure group were converted to laparotomy. One patient in the mesenteric fissure closure group was converted to laparotomy, and 2 cases with intraoperative complication were mesenteric hematoma. (3) Postoperative conditions. There was no significant difference between the mesenteric fissure non-closure group and the mesenteric fissure closure group in the overall postoperative complications ( χ2=0.28, P>0.05). There was no significant difference in the occurrence of postoperative intestinal obstruction, abdominal distension, ascites, pleural effusion, gastric paralysis, anastomotic bleeding, anastomotic leakage, or surgical wound infection between the two groups ( P>0.05). There was no significant difference between the two groups in the reoperation, postoperative gastric tube replacement. There was no significant differ-ence in time to postoperative first flatus, time to postoperative initial liquid food intake, time to post-operative resumption of bowel movements, duration of postoperative hospital stay, total hospital expenses between the two groups ( Z=-0.01, 0.43, 1.04, -0.54, -0.36, P>0.05). One patient in the mesenteric fissure non-closure group received reoperation. No perioperative internal hernia or death occurred in either group. The visual analog score decreased with time in both groups. There was no significant difference in the visual analog score between the mesenteric fissure closure group and the mesenteric fissure non-closure group [ β=-0.20(-0.53,0.13), P>0.05]. Conclusion:Compared with closure of mesenteric fissure, non-closure of mesenteric fissure during laparoscopic right hemi-colectomy dose not increase perioperative complications or postoperative management risk.