Developing an intelligent agent for integrated traditional Chinese and western medicine diagnosis and treatment based on clinical practice guidelines is a key approach to advancing the standardization and intelligent deve-lopment of traditional Chinese medicine （TCM） and to supporting clinical decision-making. This paper argues for the necessity of building a knowledge base using guidelines as the sole data source， systematically identifies five core methodological challenges across the entire process， and proposes corresponding solutions. An ontology framework capable of distinguishing between TCM and western medicine concepts should be designed to address the difficulty of knowledge integration. A closed-loop "algorithm-based extraction-expert review" model is adopted to reduce data extraction errors. Expert consensus is incorporated to address decision gaps in specific clinical scenarios outlined in the guidelines， while a multi-stage， standardized output process for the AI system is established to eliminate model hallucinations. Furthermore， an evaluation framework reflecting clinical applicability is developed to enhance the AI system's accuracy and stability. Throughout the research process， it is essential to ensure the in-depth and continuous participation of multidisciplinary experts， strictly control the selection and quality evaluation of guidelines， and rely on the expert consensus method to address decision gaps in the knowledge base. Additionally， continuous validation and iterative optimization of intelligent agents are required to ensure the accuracy and stability of generated outputs. Limitations remain in the mechanisms for real-time knowledge synchronization in intelligent diagnostic and treatment systems， and further validation through large-scale real-world studies is warranted.

Objective:To understand the factors influencing new infections of 9-valent vaccine-type human papillomavirus (9-valent type HPV) among men who have sex with men (MSM) in Urumqi City and to construct a prediction model of individual dynamics of new infections of 9-valent type HPV among MSM.Methods:In this study, a snowball method was adopted to recruit MSM in Urumqi City to establish a dynamic cohort, and participants were followed up every 6 months from 2016 to 2023, and perianal exfoliated cells were collected for HPV genotyping; joint models were established using the number of same-sex sexual partners in the last six months and the number of anal intercourse in the last one week as longitudinal variables, respectively, and joint models were utilized to analyze the influence factors of 9-valent HPV new infections in MSM individuals were analyzed by the joint model; the predictive efficacy of the model in the follow-up period was evaluated by using the time-dependent receiver operating characteristic area under the curve (AUC) values. Based on the prediction model, two study participants were randomly selected for individual dynamic prediction of new-onset HPV infections of 9-valent type types.Results:MSM with at least two follow-up visits 579 individuals were included in the analysis. The results of the two joint models showed that being divorced/widowed [hazard ratio ( HR)=1.544, 95% CI: 1.033-2.233], having a sexual behavior style of being the inserted party ( HR=1.366, 95% CI: 1.053-1.764), and having a history of STDs ( HR=1.659, 95% CI: 1.057-2.558) increased the 9-valent types of new HPV infections risk. The results of the shared parameter of the joint model of the number of same-sex partners in the last six months showed that each 2.72 increase in the number of same-sex partners in the last six months was associated with a 28.2% increase in the risk of new 9-valent HPV infections in MSM individuals ( HR=1.282, 95% CI: 1.065-1.540). The time-dependent AUC results showed that the joint model for the number of same-sex sexual partners in the last six months (0.808 0) predicted better performance than the joint model for the number of anal intercourse in the last one week (0.750 0). The joint model based on the number of same-sex sexual partners in the last six months for the prediction of MSM individual dynamics was consistent with the real situation. Conclusion:The joint model based on the number of same-sex sexual partners in the last six months, sexual behavior, history of STDs, and other risk factors has high accuracy in predicting the risk of new MSM 9-valent HPV infections in Urumqi City, which can provide a scientific basis for the prediction of individual dynamics of new MSM 9-valent HPV infections.

Objective:To investigate the correlation between serum calcium binding protein S100A9 levels and lung function in patients with idiopathic pulmonary fibrosis (IPF).Method:A retrospective case-control study was conducted. Forty patients diagnosed with IPF in respiratory department from January 4, 2023, to January 30, 2024 were selected as the IPF group,with a mean age of (65.3±8.4) years old, including 29 males and 11 females. while 50 healthy volunteers receiving health examinations in our physical examination center were enrolled in this study, including 38 males and 12 females, with a mean age of (64.1±6.3) years. The levels of biochemical parameters were assayed with biochemical analyzer. S100A9 levels were determined by Enzyme linked immunosorbent assay. The lung function test results of all participants were recorded. SPSS 19.0 statistical software was used to compare the differences of biomarkers levels between the two groups , Using parameter testing (independent sample t-test) to compare the differences in serum S100A9 levels and lung function between the two groups, the enumeration data were treated with the chi-square test. Pearson correlation analysis was used to evaluate the correlation between S100A9 and lung function, the influencing factors of IPF were analyzed by using multivariate logistic regression model, and receiver operating characteristic (ROC) curve analysis was used to assess the value of Calprotectin S100A9 in predicting IPF. Results:The serum S100A9 levels in the IPF group were significantly higher than those in the healthy control group [(132.47±21.46) pg/ml,(44.75±8.84) pg/ml, t=3.544, P<0.05], forced expiratory volume in one second(FEV1,1.38±0.19) L, forced vital capacity (FVC, 2.38±0.59) L, FEV1/FVC (57.98±6.13), the maximum spontaneous ventilation (MVV, 57.48±7.66) L/min was lower than that of the control group [(3.24±0.65) L, (3.65±0.67) L, (88.77±7.97), (86.34±7.23) L/min, t=3.486,3.393,2.771,3.462, P<0.05]. Serum S100A9 was negatively correlated with FEV1, FVC, FEV1/FVC, and MVV ( r=-0.537,-0.458,-0.489,-0.511, P<0.05), S100A9 was positively correlated with S100A9 in bronchoalveolar lavage fluid and high-resolution CT fibrosis score ( r=0.632, r=0.517, P<0.05).The area under the curve (AUC) of S100A9 for predicting IPF was 0.691. Conclusion:The level of calcium binding protein S100A9 was significantly increased in IPF patients, and was closely related to decreased lung ventilation function and the occurrence of IPF, which might serve as a marker for evaluating pulmonary fibrosis.

Mechanical thrombectomy has established efficacy in treating acute ischemic stroke caused by large vessel occlusion.However,for acute ischemic stroke associated with distal medium vessel occlusion(MeVO),endovascular recanalization remains challenging due to small vessel diameter,tortuous anatomy,and limited distal perfusion territory.As there is insufficient evidence to support application of mechanical thrombectomy for distal MeVO,it is not currently established as a standard indication for endovascular therapy.With advancements in the miniaturization and navigability of interventional devices,distal MeVO is gradually emerging as a potential target for mechanical thrombectomy.Nevertheless,occlusion of perforating arteries remains unsuitable for this technique due to their excessively small vessel caliber.This article reviewed the anatomical features and classification,imaging diagnosis,relevant clinical research,and novel materials and technologies pertaining to distal MeVO,aiming to provide reference for recanalization strategies in patients with this condition.

Mechanical thrombectomy has established efficacy in treating acute ischemic stroke caused by large vessel occlusion.However,for acute ischemic stroke associated with distal medium vessel occlusion(MeVO),endovascular recanalization remains challenging due to small vessel diameter,tortuous anatomy,and limited distal perfusion territory.As there is insufficient evidence to support application of mechanical thrombectomy for distal MeVO,it is not currently established as a standard indication for endovascular therapy.With advancements in the miniaturization and navigability of interventional devices,distal MeVO is gradually emerging as a potential target for mechanical thrombectomy.Nevertheless,occlusion of perforating arteries remains unsuitable for this technique due to their excessively small vessel caliber.This article reviewed the anatomical features and classification,imaging diagnosis,relevant clinical research,and novel materials and technologies pertaining to distal MeVO,aiming to provide reference for recanalization strategies in patients with this condition.

The National Essential Medicines System could protect public health and ensure access to essential medications.Although the current selection methods for China's National Essential Medicines Lists(NEMLs)are becoming more scientific and standardized,there are still problems such as much emphasis on expert experience and the lack of transparency of decision-making basis.To address these issues,it proposes an evidence-based decision-making pathway for NEMLs selection guided by clinical value.This approach ensures a strong integration of evidence and decision-making,offering valuable insights for improving the adjustment procedures and selection criteria of the NEMLs in China.

Objective:To understand the factors influencing new infections of 9-valent vaccine-type human papillomavirus (9-valent type HPV) among men who have sex with men (MSM) in Urumqi City and to construct a prediction model of individual dynamics of new infections of 9-valent type HPV among MSM.Methods:In this study, a snowball method was adopted to recruit MSM in Urumqi City to establish a dynamic cohort, and participants were followed up every 6 months from 2016 to 2023, and perianal exfoliated cells were collected for HPV genotyping; joint models were established using the number of same-sex sexual partners in the last six months and the number of anal intercourse in the last one week as longitudinal variables, respectively, and joint models were utilized to analyze the influence factors of 9-valent HPV new infections in MSM individuals were analyzed by the joint model; the predictive efficacy of the model in the follow-up period was evaluated by using the time-dependent receiver operating characteristic area under the curve (AUC) values. Based on the prediction model, two study participants were randomly selected for individual dynamic prediction of new-onset HPV infections of 9-valent type types.Results:MSM with at least two follow-up visits 579 individuals were included in the analysis. The results of the two joint models showed that being divorced/widowed [hazard ratio ( HR)=1.544, 95% CI: 1.033-2.233], having a sexual behavior style of being the inserted party ( HR=1.366, 95% CI: 1.053-1.764), and having a history of STDs ( HR=1.659, 95% CI: 1.057-2.558) increased the 9-valent types of new HPV infections risk. The results of the shared parameter of the joint model of the number of same-sex partners in the last six months showed that each 2.72 increase in the number of same-sex partners in the last six months was associated with a 28.2% increase in the risk of new 9-valent HPV infections in MSM individuals ( HR=1.282, 95% CI: 1.065-1.540). The time-dependent AUC results showed that the joint model for the number of same-sex sexual partners in the last six months (0.808 0) predicted better performance than the joint model for the number of anal intercourse in the last one week (0.750 0). The joint model based on the number of same-sex sexual partners in the last six months for the prediction of MSM individual dynamics was consistent with the real situation. Conclusion:The joint model based on the number of same-sex sexual partners in the last six months, sexual behavior, history of STDs, and other risk factors has high accuracy in predicting the risk of new MSM 9-valent HPV infections in Urumqi City, which can provide a scientific basis for the prediction of individual dynamics of new MSM 9-valent HPV infections.

The National Essential Medicines System could protect public health and ensure access to essential medications.Although the current selection methods for China's National Essential Medicines Lists(NEMLs)are becoming more scientific and standardized,there are still problems such as much emphasis on expert experience and the lack of transparency of decision-making basis.To address these issues,it proposes an evidence-based decision-making pathway for NEMLs selection guided by clinical value.This approach ensures a strong integration of evidence and decision-making,offering valuable insights for improving the adjustment procedures and selection criteria of the NEMLs in China.

Objective:To investigate the correlation between serum calcium binding protein S100A9 levels and lung function in patients with idiopathic pulmonary fibrosis (IPF).Method:A retrospective case-control study was conducted. Forty patients diagnosed with IPF in respiratory department from January 4, 2023, to January 30, 2024 were selected as the IPF group,with a mean age of (65.3±8.4) years old, including 29 males and 11 females. while 50 healthy volunteers receiving health examinations in our physical examination center were enrolled in this study, including 38 males and 12 females, with a mean age of (64.1±6.3) years. The levels of biochemical parameters were assayed with biochemical analyzer. S100A9 levels were determined by Enzyme linked immunosorbent assay. The lung function test results of all participants were recorded. SPSS 19.0 statistical software was used to compare the differences of biomarkers levels between the two groups , Using parameter testing (independent sample t-test) to compare the differences in serum S100A9 levels and lung function between the two groups, the enumeration data were treated with the chi-square test. Pearson correlation analysis was used to evaluate the correlation between S100A9 and lung function, the influencing factors of IPF were analyzed by using multivariate logistic regression model, and receiver operating characteristic (ROC) curve analysis was used to assess the value of Calprotectin S100A9 in predicting IPF. Results:The serum S100A9 levels in the IPF group were significantly higher than those in the healthy control group [(132.47±21.46) pg/ml,(44.75±8.84) pg/ml, t=3.544, P<0.05], forced expiratory volume in one second(FEV1,1.38±0.19) L, forced vital capacity (FVC, 2.38±0.59) L, FEV1/FVC (57.98±6.13), the maximum spontaneous ventilation (MVV, 57.48±7.66) L/min was lower than that of the control group [(3.24±0.65) L, (3.65±0.67) L, (88.77±7.97), (86.34±7.23) L/min, t=3.486,3.393,2.771,3.462, P<0.05]. Serum S100A9 was negatively correlated with FEV1, FVC, FEV1/FVC, and MVV ( r=-0.537,-0.458,-0.489,-0.511, P<0.05), S100A9 was positively correlated with S100A9 in bronchoalveolar lavage fluid and high-resolution CT fibrosis score ( r=0.632, r=0.517, P<0.05).The area under the curve (AUC) of S100A9 for predicting IPF was 0.691. Conclusion:The level of calcium binding protein S100A9 was significantly increased in IPF patients, and was closely related to decreased lung ventilation function and the occurrence of IPF, which might serve as a marker for evaluating pulmonary fibrosis.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.