In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.

Objective To investigate the relationship between prognostic value and methylated expression level of circulating tumour DNA(ctDNA)sodium channel modifier 1(SCNM1)in plasma of patients with hepatocellular carcinoma(HCC).Methods A total of 67 patients with confirmed HCC admitted to the First Affiliated Hospital of AFMU from June 2018 to December 2020 were selected as the research objects.At the same time,50 healthy volunteers were selected as the control group.Their clinical and pathological data were collected and compared.The methylation level of SCNM1 was detected by droplet digital PCR(ddPCR).The differences of alpha fetoprotein(AFP),cereal third transaminase(ALT),aspartate transaminase(AST),ctDNA,SCNM1 between HCC group and control group were analyzed.Multivariate COX regression risk model was performed to analyze the risk factors of HCC patients.Receiver operating characteristic(ROC)curve was used to analyze the sensitivity and specificity of SCNM1 methylation levels methylation levels.Results AFP[351.00(14.90,1 210.00)ng/ml],ctDNA[57.65(15.79,171.90)ng/ml]and the methylated SCNM1 levels[13.23%(4.36%,26.61%)]in plasma in HCC group were higher than those in control group[2.90(2.20,5.10)ng/ml,15.75(12.85,21.07)ng/ml,4.69%(3.30%,6.68%)],and the differences were statistically significant(Z=-7.18,-5.00,-4.77,all P<0.05).High level of SCNM1 methylation was found in HCC patients with tumor lesion diameter>2cm and distant metastasis(x2=5.01,38.85,all P<0.05).The median survival was shorter in the high-methlated SCNM1 group than that in the low-methylated SCNM1 group(13.31 month vs 24.44 month)with significant difference(Log rankx2=4.141,P=0.04).High SCNM1 methylation level was independent risk factor for HCC patients survival(95%CI:2.449～62.716,P=0.002).The ROC curve showed prognostic value of increased methylated SCNM1 was 0.716(95%CI:0.583～0.848),and the sensitivity and specificity were 63.0%and 81.1%,respectively.When combined with plasma SCNM1 methylation level,ctDNA and AFP,the AUC(95%CI)of HCC progression was 0.747(0.618～0.875),and the sensitivity and specificity were 55.6%and 91.9%,respectively,which has potential application value for dynamic monitoring of liver cancer patients.Conclusion The high level of methylated SCNM1 in plasma indicates the HCC poor prognosis,and serves as an independent determinant of patient survival.Methylated SCNM1,ctDNA combined with AFP detection can serve as prognostic markers.

ObjectiveTo observe the effects of Youguiwan on bone metabolism and bone morphogenetic protein-2 （BMP-2）/Smad signaling pathway in ovaries-removed rats with osteoporosis and study the mechanism of Youguiwan in the prevention and treatment of osteoporosis. MethodA postmenopausal rat model of osteoporosis was prepared by bilateral ovariectomy. The 40 female SD rats were randomly divided into five groups， including sham operation group， model group， alendronate sodium group （0.1 mg·kg^-1）， and high-dose and low-dose （5.36 and 2.68 g·kg^-1） groups of Youguiwan. The drug was given seven days after modeling， once a day for 12 weeks. After the treatment， the changes in femur tissue structure were observed by micro-CT， including bone mineral density （BMD）， bone volume/total volume （BV/TV）， trabecular number （Tb.N）， trabecular thickness （Tb.Th）， bone surface/bone volume （BS/BV）， and trabecular separation （Tb.Sp）. Ossification was observed by saffrane-solid green staining， and serum levels of bone metabolism markers， including bone alkaline phosphatase （BALP）， osteocalcin （BGP）， type Ⅰ procollagen amino terminal propeptide （PINP）， and tartrate-resistant acid phosphatase 5b （TRACP-5b）， were determined by enzyme-linked immunosorbent assay （ELISA）. The protein and mRNA expression levels of Runx2， BMP-2， and Smad1 in rat femur were detected by Western blot and Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the sham operation group， bone trabecula in the model group was sparse. BMD， BV/TV， Tb.N， and Tb.Th were decreased （P<0.05， P<0.01）. BS/BV （P<0.05） and Tb.Sp were increased. The content of BGP， BALP， PINP， and TRACP-5b in serum was significantly increased （P<0.01）. The mRNA and protein expressions of Runx2， BMP-2， and Smad1 in rat femur were significantly decreased （P<0.05， P<0.01）. Compared with the model group， the number of bone trabeculae in the high-dose and low-dose groups of Youguiwan was increased， and the bone microstructure was improved. BMD， BV/TV， Tb.N， and Tb.Th were increased significantly （P<0.05， P<0.01）， and BS/BV and Tb.Sp were increased. The content of bone metabolic markers decreased （P<0.05， P<0.01）. ConclusionYouguiwan has certain preventive and therapeutic effects on postmenopausal osteoporosis， and its mechanism may be related to promoting bone formation by regulating the BMP-2/Smad signaling pathway.

By summarizing the biological formation and component function of Mycobacterium tuberculosis extracellular vesicles, this manuscript discusses the potential usage of Mycobacterium tuberculosis extracellular vesicles in diagnosis, prevention, and treatment of tuberculosis. It is concluded that both Mycobacterium tuberculosis membrane vesicles and exosomes secreted by the host contain the components of Mycobacterium tuberculosis to participate in immune regulation, and play different roles in the diagnosis, prevention, and treatment of tuberculosis. Mycobacterium tuberculosis extracellular vesicles contain abundant biomarkers and have natural immunogenicity, which are expected to become new targets for diagnosis, prevention, and treatment of tuberculosis.

ObjectiveTo analyze the satisfaction of service recipients with the preliminary assessment service of the unified elderly care needs evaluation in Shanghai， so as to provide reference for further optimization of the service system. MethodsA multi-stage random sampling method was employed to recruit participants. A total of 110 individuals who had received unified elderly care needs evaluation service in six districts of Shanghai were investigated using a structured questionnaire. SPSS 25.0 was used to analyze the data. Univariate analyses were conducted using the Chi-square test and Fisher’s precision probability test， while multivariate analysis was performed using ordinal regression. ResultsThere were differences in satisfaction with various aspects of the preliminary assessment process among participants from different areas， with those from outer suburbs generally exhibiting lower satisfaction （P<0.01）. Multivariate analysis results indicated that satisfaction with the timing of the preliminary assessment was related to the service recipients’ residential area and their primary source of income； satisfaction with the service attitude and capability of the assessment personnel was only related to the residential area. Satisfaction with the preliminary evaluation results was related to the participants’ marital status， educational level， income level， and the specific rating results. ConclusionThe satisfaction level with the preliminary assessment of the unified elderly care needs assessment in Shanghai is relatively high. In the process of evaluation， a deeper analysis and exploration of individual needs based on various personal information are essential to ensure the appropriateness of the provided elderly care services， and thereby effectively enhancing recipient satisfaction.

ObjectiveTo clarify the perception of the work and satisfaction levels among personnel conducting unified elderly care needs assessment in Shanghai， to analyze the factors influencing their job satisfaction， and to provide references for optimizing the job satisfaction of unified elderly care needs assessment personnel in Shanghai. MethodsA survey was conducted among 93 assessment personnel randomly selected from 29 elderly care needs assessment agencies in Shanghai. The personnel’s perception of their work and their levels of job satisfaction were examined. Chi-square test and Fisher’s precision probability test were used to compare regional differences， while the two-factor theory was employed to analyze the factors influencing job satisfaction. ResultsRegarding perception of the work， 92.5% of the surveyed personnel believed their work was important. Moreover， 87.1% were interested in their assessment tasks， and 84.9% believed they made a positive contribution to the assessment work and the assessment position was in line with their personal preferences. Regarding job satisfaction， 83.9% of the participants were satisfied with their assessment work， 78.5% considered the workload appropriate， and 74.2% found the working hours suitable. Additionally， 65.6% expressed satisfaction with the level of cooperation from the assessment subjects， while 94.6% and 91.4% of the personnel were satisfied with the support provided by the assessment agencies and had a sense of belonging， respectively. Furthermore， 65.6% of the personnel expressed satisfaction with their job compensation and benefits. Hygiene factors affecting job satisfaction included salary and compensation， workload， time spent on the job and institutional support related to external assistance， job suitability， teamwork， and client cooperation （P<0.05）， while motivational factors included recognition of the significance of the job， sense of achievement， interest in the job， sense of belonging， and opportunities for personal growth （P<0.05）. ConclusionThe overall work cognition and satisfaction of unified elderly care needs assessment personnel in Shanghai towards their work are relatively positive. Main issues include the heavy workload and actual job subsidies not meeting expectations. It is recommended to improve the standardization of the assessment process， establish a professional team of assessment personnel， and enhance the compensation and incentive mechanisms to continuously increase staff satisfaction.

Health technology assessment(HTA)is an important tool to inform health decision-making.Although highly related to ethical issues in the context of HTA,equity has attracted much attention from the academia,a consensus has not yet been reached on how to define and evaluate equity in China and abroad.It introduces the concept of equity,pointes out the necessity to realize health equity and the reflection of equity in healthcare sector,and further elaborates four ways to consider equity,and described the official practice of equity in HTA at home and abroad.It proposes several suggestions for China's HTA:considering equity in HTA and the discussion of equity should depend on specific decision-making scenarios;clarifying what health measurement perspective should be adopted before measuring health equity;paying attention to the value judgment of equity adopted by various stakeholders;conducting basic researches on the general population's preference for health measurement perspectives and value judgments of equity in China in a gesture to improve the evaluation system of equity in HTA.

Private health insurance(PHI)is an important component of China's multi-tiered medical security system,meeting people's multi-level and diversified health needs through supplementing and connecting with the basic medical insurance(BMI).It aims to draw on the practical experience of typical countries to provide implications for developing PHI that complements BMI in China.Considering the different models of medical security systems in various countries and the diverse functional positioning of PHI,France,Germany,Australia,the United Kingdom,and the United States are selected as reference objects.After examining the macro institutional systems of PHI,coverage population,benefits packages,characteristics of coordination with health care and medicines,as well as supporting regulatory measures,the experiences are summarized.Based on China's context,it proposes to improve institutional system building,enrich product supply,expand the insured population,explore the coverage list formulation,and refine supporting regulatory policies.

The development of private health insurance is crucial for the construction of a multi-tiered healthcare security.Since entering the innovative development stage,the types and protection contents of private health insurance products have been continuously enriched,but there are still some problems.Taking Shanghai as the research object,it describes the development status of private health insurance in Shanghai by analyzing relevant policies,premium income,and product types.It locates many problems such as product supply and industrial synergy,such as uneven product distribution,insufficient product differentiation,insufficient information disclosure,and the need to improve the risk management and control capabilities of insurance institutions.It also puts forward suggestions such as enriching product types,optimizing insurance content,strengthening multi-party collaboration,and establishing a long-term mechanism to promote the high-quality development of commercial health insurance.

Constructing a multi-tiered healthcare security system can meet the diverse and individualized healthcare service demand of the general public.Public hospitals,as the main providers of healthcare services in China,effectively integrate with commercial health insurance,which can accelerate the implementation of high-quality healthcare services,promote innovative development,and optimize product coverage and operational efficiency for commercial health insurance,achieving a win-win situation.Taking Shanghai as the research object,it analyzes the supply and demand status of multi-tiered healthcare security in Shanghai based on population characteristics,economic level,healthcare resources,and policy environment.It identifies the difficulties in the current collaboration between public hospitals and commercial insurance.Finally,it proposes exploring the expansion of independent development space for specialized services,improving the level of coordination between commercial insurance institutions and public hospitals in health management services,promoting the management and sharing of data,strengthening the protection of innovative medicines and devices by commercial insurance,in order to promote the coordinated development of commercial insurance and public hospitals.