Clinical practice guidelines represent the best recommendations for patient care. They are developed through systematically reviewing currently available clinical evidence and weighing the relative benefits and risks of various interventions. However, clinical practice guidelines have to go through a long translation cycle from development and revision to clinical promotion and application, facing problems such as scattered distribution, high duplication rate, and low actual utilization. At present, the clinical practice guideline information platform can directly or indirectly solve the problems related to the lengthy revision cycles, decentralized dissemination and limited application of clinical practice guidelines. Therefore, this paper systematically examines different types of clinical practice guideline information platforms and investigates their corresponding challenges and emerging trends in platform design, data integration, and practical implementation, with the aim of clarifying the current status of this field and providing valuable reference for future research on clinical practice guideline information platforms.

Nipah virus (NiV) and related viruses form a distinct henipavirus genus within the Paramyxoviridae family. NiV continues to spillover into the humans causing deadly outbreaks with increasing human-bat interaction. NiV encodes the large protein (L) and phosphoprotein (P) to form the viral RNA polymerase machinery. Their sequences show limited homologies to those of non-henipavirus paramyxoviruses. We report two cryo-electron microscopy (cryo-EM) structures of the Nipah virus (NiV) polymerase L-P complex, expressed and purified in either its full-length or truncated form. The structures resolve the RNA-dependent RNA polymerase (RdRp) and polyribonucleotidyl transferase (PRNTase) domains of the L protein, as well as a tetrameric P protein bundle bound to the L-RdRp domain. L-protein C-terminal regions are unresolved, indicating flexibility. Two PRNTase domain zinc-binding sites, conserved in most Mononegavirales, are confirmed essential for NiV polymerase activity. The structures further reveal anchoring of the P protein bundle and P protein X domain (XD) linkers on L, via an interaction pattern distinct among Paramyxoviridae. These interactions facilitate binding of a P protein XD linker in the nucleotide entry channel and distinct positioning of other XD linkers. We show that the disruption of the L-P interactions reduces NiV polymerase activity. The reported structures should facilitate rational antiviral-drug discovery and provide a guide for the functional study of NiV polymerase.
Nipah Virus/chemistry* ; Cryoelectron Microscopy ; Viral Proteins/genetics* ; RNA-Dependent RNA Polymerase/genetics* ; Phosphoproteins/genetics* ; Humans ; Models, Molecular ; Protein Binding

ObjectiveTo systematically sort out the knowledge framework and conceptual logic relationship of "disease-syndrome-treatment-prescription-medicine" in the existing literature on traditional Chinese medicine（TCM） treatment of diabetic peripheral neuropathy（DPN）， to construct of the knowledge map of TCM treatment of DPN， and to promote the explicitation of the implicit knowledge in the literature on the treatment of DPN with TCM. MethodTaking the literature of China National Knowledge Infrastructure about TCM treatment of DPN as the main data source， TCM-related concepts and entities were constructed by manual citation， and the corresponding relationships between the entities were established. Structured data were formed by processing with Python 3.7， and the knowledge graph was constructed based on Neo4j 3.5.34 graph database. ResultThe resulting knowledge graph with TCM diagnosis and treatment logic， defined 12 node labels such as prescriptions， Chinese medicines and syndrome types at the schema layer， as well as 4 types of relationships， such as inclusion， correspondence， selection and composition. It could support the query and discovery of nodes（syndrome elements， syndrome types and treatment methods）， as well as the relationship between each node. ConclusionBased on the literature data， this study constructed a knowledge map for TCM treatment of DPN， which brought together various methods of TCM treatment of DPN， including internal and external treatment. The whole chain knowledge structure of syndrome differentiation and classification for DPN treatment is formed from syndrome element analysis， syndrome type composition to treatment method selection， which can provide new ideas and methods for literature data to serve clinical and scientific research work， as well as reference for visualization of TCM literature knowledge， intellectualization of TCM knowledge services and the standardization of TCM diagnosis and treatment.

Purpose/Significance To analyze the multidimensional interaction between the characteristics of traditional Chinese and western medicine in patients with type 2 diabetes mellitus and its influence on traditional Chinese medicine(TCM)syndrome differentia-tion.Method/Process Based on the real-world electronic medical record(EMR)data,the traditional association rule algorithm is im-proved,and the important TCM syndromes are screened out as dependent variables by increasing the respect index,and the logistic regres-sion algorithm is used to explore the influence of traditional Chinese and western medicine indexes on TCM syndromes.Result/Conclusion Based on 688 patients,112 association rules are obtained,of which 12 includes TCM syndromes.The respect of association rules between middle-earth stagnation syndrome and overweight/obesity is the highest,moreover,overweight/obesity patients have a higher prevalence rate of middle-earth stagnation syndrome.There is a strong correlation between middle-earth stagnation syndrome,peripheral neuropathy or hypertension and overweight/obesity.Patients with diabetic nephropathy are more likely to have qi and yin deficiency syndrome.

ObjectiveTo compare the differences in clinical characteristics between kidney deficiency and stasis obstruction syndrome and damp-heat stasis obstruction syndrome in patients with ankylosing spondylitis （AS）， thereby providing reference for clinical differentiation and treatment. MethodsThe clinical data of 2339 patients with AS were collected， including 1075 cases of kidney deficiency and stasis obstruction syndrome and 1264 cases of damp-heat stasis obstruction syndrome. The basic information including age， gender， course of disease， history of ophthalmia， family history and human leukocyte antigen B27 （HLA-B27） positive history， Bath ankylosing spondylitis disease activity index （BASDAI） score， Bath ankylosing spondylitis functional index （BASFI） score， Bath ankylosing spondylitis measurement index （BASMI） score， Depression Anxiety Stress Scale 21 （DASS-21） score， single symptom score in terms of spinal pain， peripheral joint pain， tendon tenderness， morning stiffness degree and morning stiffness time， patient-reported outcomes including patient global assessment （PGA） score， chronic disease therapy function-fatigue scale （FACIT-F） score and night pain visual analog scale （VAS） score， laboratory indicators including serum C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR）， and CT grading of sacroiliitis were measured and compared between groups. ResultsPatients with kidney deficiency and stasis obstruction syndrome were older and had a longer course of disease （P＜0.01）. The BASDAI， BASFI and BASMI scores of the patients with kidney deficiency and stasis obstruction syndrome were 3.84±1.79， 2.78±2.00 and 3.42±2.36， respectively， while those in patients with damp-heat stasis obstruction syndrome were 4.30±1.99， 3.43±2.12， and 2.92±1.76. The BASDAI score， BASFI score， PGA score， FACIT-F score， spinal pain score， peripheral arthralgia score， tendon tenderness score， morning stiffness degree score， depression score， anxiety score， and stress score in patients with damp-heat stasis obstruction syndrome were all higher than those with kidney deficiency and stasis obstruction syndrome， with longer duration of morning stiffness and higher CRP （P＜0.05 or P＜0.01）. BASMI score and night pain VAS score were more higher in patients with kidney deficiency and stasis obstruction syndrome （P＜0.01）. There was no significant difference in the ESR level and CT grading of the sacroiliac joint between the two groups （P＞0.05）. ConclusionAS patients with kidney deficiency and stasis obstruction syndrome have poorer spinal mobility， while those with damp-heat stasis obstruction syndrome have higher disease activity， poorer physical function， and are more prone to adverse psychological reactions.

As a kind of intervention measures of traditional Chinese medicine, acupuncture-moxibustion is highly adopted on global clinical practice. Even though the global clinical trial registration system was established more than 10 years ago, the proportion of acupuncture-moxibustion clinical trial registration is still very low; and it is very problematic on the methodological quality and report quality in the published acupuncture-moxibustion clinical trials. In order to manage particularly the acupuncture-moxibustion clinical trials, China Academy of Chinese Medical Sciences, collaborated with China Association of Acupuncture and Moxibustion and World Federation of Acupuncture Societies, established the Acupuncture-Moxibustion Clinical Trail Registry (AMCTR). AMCTR is a secondary registry platform affiliated to the Chinese Clinical Trial Registry (ChiCTR) and WHO International Clinical Trials Registry Platform (ICTRP), specifically for the acceptance and management of clinical trials in the field of acupuncture and moxibustion. It is a nonprofit academic organization, located in China Academy of Chinese Medical Sciences.

Through several thousand years’ inheritance and development by Chinese people, traditional Chinese medicine (TCM) has formed its unique theoretic system, whose efficacy has been widely accepted. However, because TCM theory focuses on the relationships among syndromes, treatment and efficacy, instead of the cause-and-effect relationship explored by modern natural science, the scientificity of TCM has always been questioned. In recent years, because virtual-world clinical research mode and the concept of “big data” were emphasized, increasing researchers began to put their research emphasis on the correlativity between intervening measures of diseases and outcome indicators. This change and the advancement of computer data mining and analysis technology, bring great opportunities for the further development of TCM theory and practice. This article concluded data mining technology used in TCM diagnosis and treatment in recent years, such as clustering analysis, decision tree, Bayesian network, neural network and multi-instance learning, which showed how to apply these methods to reveal rules of TCM diagnosis and treatment from a large number of TCM syndrome data, find knowledge hidden in data, and show TCM effectiveness supported by data.

Objective To study the scientificity and rationality in data management of the project of Chinese Chronic Disease Clinical Research System and its Achievements Application Mode;To provide evidence and reference for the improvement of follow-up work. Methods According to the relevant management regulations, guidelines, and other relevant documents of national and international clinical research data,“Questionnaire for Research Data Management Assessment of Chinese Chronic Disease Prevention” was designed. The questionnaires were used in 10 clinical topics during the on-site inspection survey, and 20 valid questionnaires were retrieved and analyzed statistically. Results 50-60 percentage of subjects in data management and statistics were performed by the third party;70 percentage of subjects were performed by their own central monitoring;50 percentage of the subjects adopted a cooperative manner with others to develop appropriate data management systems;7 centers had system and plan for data management;Data management was carried out;implementation degree of training, database, CRF tracing, and others 7 aspects was low. Conclusion Improving the quality of data management of TCM clinical research still needs to be perfected from many aspects, and quality mode of large-scale clinical trials should be improved.

This study was aimed to discuss the ways of converting clinical data entered in the Case Report Form (CRF) to Study Data Tabulation Model (SDTM) database format in clinical research of traditional Chinese medicine (TCM). Currently, there were three approaches for implementing SDTM, which were the pure SDTM approach, submission-only approach and database-only approach. This article compared and analyzed advantages and disadvantages of three approaches and introduced experiences of the Clinical Evaluation Center of China Academy of Chinese Medical Sciences using database-only approach for SDTM implementation. The results showed that pure SDTM approach can maximally embrace SDTM standards. However, the current process and software system should be modified. Therefore, it was time-consuming and expensive. The submission-only approach was the most economic way in the application of SDTM standards. However, the data quality and traceability may not be guaranteed. The database-only approach built the study database based on the SDTM standard by writing transformed program before data entry while the data collection system was not SDTM-compatible. It was concluded that database-only approach for implementation SDTM was a suitable and practical way to TCM clinical research.

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which em-bodies the concept of individualized diagnosis and dynamic treatment on a holistic view. RCT was frequently used in TCM clinical study. However, it cannot reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies (ATS) in clinical research can adjust therapy in patients according to the change of disease, so it can reflect personalized medicine and dynamic treatment. From this perspective, the process of treat-ment based on syndrome differentiation was a process of adaptive treatment decision. So the method for developing ATS can effectively evaluate the efficacy of different treatment strategies in TCM clinical study. ATS had been used in some clinical studies from published literatures abroad. However, the use of ATS in domestic clinical research was seldom been reported. This paper gave an outline of the concept of ATS. In addition, this paper focused on three methods which can take the delayed effects of current treatment action into consideration and can compare the over-all effect of different ATS. It was hoped to lay foundation for future scientific research of TCM in the implementation of SMART and provide a new idea.