Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

Objective:To explore the clinical efficacy of the posterior to anterior malleolar extended lateral approach (PAMELA) in the treatment of quadrimalleolar fractures.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with quadrimalleolar fracture who had been admitted to Foot and Ankle Surgery Department, Henan Luoyang Orthopaedic & Traumatological Hospital from June 2022 to June 2023. There were 5 males and 7 females, with an age of (37.3±12.2) years and a duration from injury to surgery of (8.8±3.5) d. Open reduction and internal fixation of displaced Chaput tubercle fractures, lateral and posterior malleolar fractures were conducted through the PAMELA for all patients. The incision exposure, operation time, intraoperative bleeding, and incision healing were noted. Postoperatively, the fracture reduction was evaluated using the Burwell-Charnley criteria. The clinical efficacy was evaluated at the final follow-up using the ankle-hindfoot score of American Orthopaedic Foot & Ankle Society (AOFAS), visual analogue scale (VAS), and range of motion (ROM) of the ankle joint.Results:Good exposure of the Chaput tubercle, anterolateral tibiotalar joint, and lateral and posterior malleoli was achieved during surgery in all patients. The follow-up time for the 12 patients was (14.3±1.8) months, the operation time (152.5±26.0) minutes, and the intraoperative bleeding (137.5±44.1) mL. All incisions healed at the first stage postoperatively without any complications. According to the Burwell-Charnley criteria, anatomic reduction was achieved in all patients. CT scans showed good reduction of the distal tibiofibular syndesmosis. At the final follow-up, their AOFAS score was (94.1±8.3) points, VAS 0 (0, 1) point, and ankle joint ROM 17.5°±9.0° for dorsiflexion and 35.2°±9.6° for plantarflexion.Conclusions:In the treatment of quadrimalleolar fractures, because the PAMELA can lead to good exposure of the anterolateral ankle joint, distal tibiofibular syndesmosis, and lateral and posterior malleolar fractures, it results in a high rate of anatomic reduction of the fractures, safe incisions and limited soft tissue complications. Therefore, it is a safe, simple, and effective surgical approach.

Objective:To explore the clinical efficacy of the posterior to anterior malleolar extended lateral approach (PAMELA) in the treatment of quadrimalleolar fractures.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with quadrimalleolar fracture who had been admitted to Foot and Ankle Surgery Department, Henan Luoyang Orthopaedic & Traumatological Hospital from June 2022 to June 2023. There were 5 males and 7 females, with an age of (37.3±12.2) years and a duration from injury to surgery of (8.8±3.5) d. Open reduction and internal fixation of displaced Chaput tubercle fractures, lateral and posterior malleolar fractures were conducted through the PAMELA for all patients. The incision exposure, operation time, intraoperative bleeding, and incision healing were noted. Postoperatively, the fracture reduction was evaluated using the Burwell-Charnley criteria. The clinical efficacy was evaluated at the final follow-up using the ankle-hindfoot score of American Orthopaedic Foot & Ankle Society (AOFAS), visual analogue scale (VAS), and range of motion (ROM) of the ankle joint.Results:Good exposure of the Chaput tubercle, anterolateral tibiotalar joint, and lateral and posterior malleoli was achieved during surgery in all patients. The follow-up time for the 12 patients was (14.3±1.8) months, the operation time (152.5±26.0) minutes, and the intraoperative bleeding (137.5±44.1) mL. All incisions healed at the first stage postoperatively without any complications. According to the Burwell-Charnley criteria, anatomic reduction was achieved in all patients. CT scans showed good reduction of the distal tibiofibular syndesmosis. At the final follow-up, their AOFAS score was (94.1±8.3) points, VAS 0 (0, 1) point, and ankle joint ROM 17.5°±9.0° for dorsiflexion and 35.2°±9.6° for plantarflexion.Conclusions:In the treatment of quadrimalleolar fractures, because the PAMELA can lead to good exposure of the anterolateral ankle joint, distal tibiofibular syndesmosis, and lateral and posterior malleolar fractures, it results in a high rate of anatomic reduction of the fractures, safe incisions and limited soft tissue complications. Therefore, it is a safe, simple, and effective surgical approach.

Objective:To develop the Suicide Outcomes Scale for Undergraduates with Suicidal Ideation(SO-SUSI)and test its validity and reliability.Methods:Based on semi-structured interview,literature review and expert discussion,main aspects and indicator system were defined.The initial version of SOSUSI was formed,and items were either modified from existing scales targeting the relevant constructs,or compiled according to previous inter-view results.A total of 607 undergraduates with suicidal ideation were enrolled.The sample was randomly divided in half,one half(n=317)was used for item analysis and exploratory factor analysis,and another half(n=290)for confirmatory factor analysis.All data were used for reliability analysis.The Self-rating Depression Scale(SDS)and Suicidal Intent(SI)were used for criterion validity.Results:The SOSUSI included 39 items in 4 dimensions(nega-tive reinforcement of suicide,negative consequences of suicide,loss of suicide,and positive reinforcement of sui-cide)which explained 50.10％of the total variance.Confirmatory factor analysis showed that the four-factor struc-ture model fitted well(x2/df=3.27,CFI=0.92,TLI=0.91,IFI=0.92,SRMR=0.09).The scores of negative re-inforcement and positive reinforcement of suicide were positively correlated with the SDS and SI scores(ICC=0.15-0.33,Ps＜0.05),while the scores of negative consequences and loss of suicide were negatively correlated with the SI scores(ICC=-0.42--0.56,Ps＜0.05).The Cronbach's α coefficients of each dimension ranged from 0.79 to 0.91.Conclusion:The Suicide Outcomes Scale for Undergraduates with Suicidal Ideation(SOSUSI)has good validity and internal consistency reliability.

Objective:To analyze the distribution of pathogenic bacteria in bile culture in patients with common bile duct stones and biliary tract infections, in order to guide clinical optimization of antibiotics application.Methods:From March 30, 2017 to December 31, 2021, at Affiliated Hospital of Qingdao University, 753 patients with common bile duct stones and biliary tract infections and received endoscopic retrograde cholangiopancreatography were selected. Bile samples were obtained for bacterial culture, strain type identification and drug sensitivity test in order to analyze bile pathogenic bacteria distribution, change trend and drug resistance. Chi-square test was used for statistical analysis.Results:From 2017 to 2021, the total positive rate of bile culture in 753 patients with choledocholithiasis complicated with biliary tract infection was 90.17% (679/753). From 2017 to 2021, the positive rates of bile culture were 82.05% (64/78), 88.81% (119/134), 88.03% (125/142), 93.87% (199/212), and 91.98% (172/187), respectively, and the difference was statistically significant ( χ2=10.78, P=0.029). The positive rate of bile culture in 2017 was lower than those in 2020 and 2021, and the differences were statistically significant ( χ2=9.43 and 5.57, P=0.002 and 0.018). There were no significant differences in the positive rates of bile culture among the other years (all P>0.05). A total of 1 033 pathogenic bacteria were detected in the 679 bile specimens with positive bile culture results. Among which the total proportion of Gram-negative bacilli was 57.02% (589/1 033), and from 2017 to 2021 the proportions were 66.38% (77/116), 66.47% (111/167), 59.43% (104/175), 54.75% (173/316), and 47.88% (124/259), respectively. The total proportion of Gram-positive cocci was 41.05% (424/1 033), and from 2017 to 2021 the proportions were 31.90% (37/116), 31.74% (53/167), 38.86% (68/175), 44.30% (140/316), and 48.65% (126/259), respectively. The total proportion of fungus was 1.94% (20/1 033), and from 2017 to 2021 the proportions were 1.72% (2/116), 1.80% (3/167), 1.71% (3/175), 0.95% (3/316), and 3.47% (9/259), respectively. From 2017 to 2021, the proportion of Gram-negative bacilli gradually decreased, while the proportion of Gram-positive cocci gradually increased, and the differences were statistically significant ( χ2=20.14 and 17.91, P<0.001 and =0.001). From 2017 to 2021, the change in the proportion of fungus was not statistically significant ( P>0.05). The main Gram-negative bacilli in the bile culture were Escherichia coli (31.36%, 324/1 033) and Klebsiella pneumoniae (12.68%, 131/1 033); the main Gram-positive cocci were Enterococcus faecalis (14.04%, 145/1 033) and Streptococcus salivarius (4.36%, 45/1 033). From 2017 to 2021, the proportions of Escherichia coli were 39.66% (46/116), 38.92% (65/167), 33.14% (58/175), 28.48% (90/316), and 25.10% (65/259), respectively, with gradual decrease and the difference was statistically significant ( χ2=14.34, P=0.006). From 2017 to 2021 the detection rates of extended-spectrum β-lactamase (ESBL) in Escherichia coli and Klebsiella pneumoniae were 30.43% (14/46), 26.15% (17/65), 29.31% (17/58), 38.89% (35/90), 40.00% (26/65), and 4/15, 20.00% (5/25), 20% (5/25), 24.32% (9/37), and 31.03% (9/29), and there were no significant differences in the detection rates of ESBL between different years (both P>0.05). Conclusions:From 2017 to 2021, the positive rate of bile culture in patients with choledocholithiasis complicated with biliary tract infection showed an overall increasing trend. Gram-negative bacilli were still dominated in bile pathogenic bacteria, while the proportion of Gram-positive cocci remarkably increased, and the bile bacterial spectrum significantly changed. Clinicians should adjust the antibiotic dosing regimens according to the variation of bacterial spectrum and drug resistance.

Objective To investigate the risk factors and clinical characteristics of gastric inflammatory fibroid polyp(GIFP)for gastrointestinal hemorrhage.Methods 66 patients(68 lesions in total)with GIFP diagnosed by endoscopic or surgical resection from January 1,2013 to September 30,2022 were collected.According to the presence or absence of gastrointestinal hemorrhage,the patients were divided into bleeding group(n = 16)and non-bleeding group(n = 50).Collect clinical data on gender,age,clinical manifestations,lesion location and size,endoscopic characteristics,Helicobacter pylori infection,surgical methods and pathological results of each group of patients.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of endoscopic characteristics of GIFP for gastrointestinal hemorrhage,and summarize the clinical characteristics of GIFP with gastrointestinal hemorrhage,then calculate the rate of correct diagnosis.Results The age of the bleeding group was significantly younger than that of the non-bleeding group,and the lesion size was significantly larger than that of the non-bleeding group,with statistically significant differences(P＜0.05).The incidences of endoscopic neoplasm-like elevation of lesions,surface with erosion or ulceration,accompanied by ballvalve syndrome and ultrasonic gastroscopy with blood flow signals in the bleeding group were significantly higher than those in the non-bleeding group,and the differences were statistically significant(P＜0.05),but there were no statistical differences in other indicators between the two groups(P＞0.05).In order to further investigate the relationship between endoscopic characteristics and gastrointestinal hemorrhage,multivariate Logistic regression analysis showed that neoplasm-like elevation,submucosal eminence,ulcer or erosion on the surface and ball valve syndrome were risk factors for gastrointestinal hemorrhage in GIFP(O(R)＞1,P＜0.05).The overall rate of GIFP correct diagnosis before surgery was 27.94%.The rate of diagnosis in patients echoendoscope before surgery was 38.78%,it was significantly higher than that without undergoing echoendoscope(χ2 = 20.82,P = 0.000).Conclusion The shape of the lesion,presence of ulcers or erosion on the surface,and presence of ball valve syndrome are risk factors for gastrointestinal hemorrhage.Preoperative endoscopic ultrasonography can improve the accuracy of preoperative diagnosis.When there is a risk of gastrointestinal hemorrhage in GIFP,early endoscopic diagnosis and therapeutic resection should be performed to avoid unnecessary surgical procedures,which can improve prognosis and improve patient quality of life.

Objective:To analyze the clinical features of bronchiectasis, in order to improve the diagnosis, treatment, and prognosis.Methods:The clinical data of 78 children with bronchiectasis at Qingdao Women and Children′s Hospital of Qingdao University from January 2010 to January 2020 were analyzed, including age, regional distribution, etiology, clinical manifestations, lung function characteristics, results of lung high-resolution CT, results of fiberbronchoscopy examination, treatment, and prognosis.Results:Among 78 children with bronchiectasis, there were 35 males(44.9%)and 43 females(55.1%), with a median age of 8.7(6.1, 9.0)years.There were 51 children in rural areas(65.4%)and 27 children in urban areas(34.6%). The incidence of children in rural areas was higher than that in urban areas.The top three causes of bronchiectasis were 40 (51.3%)cases after infection, nine cases(11.5%)of primary immunodeficiency and seven cases(9.0%)of inhalation.The main clinical manifestations were wet cough, expectoration, wheezing and repeated respiratory infection.High-resolution CT of the lungs showed 36(46.2%)cases with diffuse bronchiectasis and 37 (47.4%) cases with localized bronchiectasis.Forty-nine(62.8%) cases had abnormal pulmonary ventilation function.Sixty-one(78.2%)cases were treated with fiberoptic bronchoscopy, of which 49(80.3%)cases had "fishbone" changes.After anti-infection, fiberbronchoscopy examination, expectorant and physical therapy, 67 cases were discharged and followed up for more than one year.Among them, 55 cases had symptoms improved, 12 patients had recurrent respiratory tract infection, and three patients died.Conclusion:The clinical manifestations of bronchiectasis in children have no obvious specificity.Early diagnosis, identification of the cause and comprehensive management are critical to prognosis of bronchiectasis.

Objective To study the influencing factors of blood stasis constitution and provide a basis for treating blood stasis-related diseases by traditional Chinese medicine (TCM) constitution identification. Methods Data were collected using the self-developed TCM constitution identification platform based on B/S model by the project team. The obtained data were divided into blood stasis constitution and normal constitution groups. The differences of the categorical type influencing factors (gender, birth mode, feeding mode within four months of birth, family history, marital status, eating habits, sleeping habits, exercise habits, emotional state, stress situation, and living environment) and the quantitative type influencing factors (sleep time, age, and mother's age at birth) on the constitution of the two groups were analyzed. In the single-factor analysis, the Pearson's chi-square test was selected for the categorical variable, and the independent sample t test and Mann-Whitney U nonparametric test were selected for the quantitative variables according to whether they conformed to the positive-terrestrial distribution; the binary logistic stepwise regression method was selected for the multi-factor analysis. Results The data of 318 cases were collected from the TCM composition identification platform, and 159 cases of blood stasis constitution were used as the experimental group and 159 cases of normal constitution were used as the control group. The Pearson's chi-square test yielded significant differences (P < 0.05) in the effects of gender, pressure situation, family history, living environment, emotional state, exercise habits, and dietary habits on blood stasis constitution. The independent samples t test yielded differences in sleep duration between the blood stasis constitution and normal constitution populations (P < 0.05), which meant sleep duration of the blood stasis constitution population was less than that of the normal constitution population. The Mann-Whitney U nonparametric test results accepted the original hypothesis that there was no difference in the distribution of age and mother’s age at birth across constitution types (P > 0.05). Binary logistic regression analysis showed that gender, family history, marital status, living environment, exercise habits, and emotional state were risk factors for blood stasis constitution (P < 0.05). Conclusion Gender, family history, living environment, emotional state, and exercise habits were significant influencing factors of blood stasis constitution. Blood stasis constitution populations can pay more attention to these influencing factors in their daily life for the prevention and reconciliation of blood stasis constitution.

Objective:To investigate the correlation of centromere protein K (CENPK) expression in triple-negative breast cancer (TNBC) with epithelial-mesenchymal transformation (EMT) and its clinical significance.Methods:Immunohisochemical SABC method was used to detect the expressions of CENPK and EMT-related proteins (E-cadherin, Vimentin and N-cadherin) in 69 specimens of TNBC and cancer-adjacent tissues collected from patients in Binzhou People's Hospital Affiliated to Shandong First Medical University from January 2015 to December 2018. The correlations of CENPK expression with clinicopathological characteristics of patients and expressions of EMT-related proteins were analyzed.Results:The positive expression rates of CENPK in TNBC and cancer-adjacent tissues were 72.46% (50/69) and 14.49% (10/69), respectively, and the difference was statistically significant ( χ2 = 47.18, P<0.001). The CENPK expression in TNBC was related to pathological grade, clinical stage and lymphatic metastasis (all P<0.05). The CENPK expression in TNBC was negatively correlated with E-cadherin expression ( r = -0.447, P<0.01), but positively correlated with Vimentin and N-cadherin expressions ( r values were 0.503 and 0.415, both P<0.01). The median overall survival time of CENPK high-expression group was 24 months (95% CI 10-39 months), while that of CENPK low-expression group was 42 months (95% CI 19-50 months). The difference in overall survival between the two groups was statistically significant ( χ2 = 7.36, P = 0.016). Conclusions:CENPK may be involved in the occurrence and development of TNBC through EMT, and the expression of CENPK may be related to the prognosis of patients.

Objective: To understand the current status of the team structure of health personnel in primary and secondary schools, and to provide suggestions and references for strengthening and optimizing school health workforce. Methods: A nationwide stratified random cluster sampling method was adopted to select provinces for investigation in stratification from 2015-2016, a total of 16 provinces, autonomous regions, and municipalities directly under the Central Government, 26 survey sites, 10 027 primary and secondary schools, 9 536 questionnaires of health personnel were collected. Results: Among the 9 536 school health staffs, there were various types of positions, and different types of schools had different position types construction. Elementary schools had the most part time health care teachers, accounting for 77.6%, while full time school doctors only accounting 10.0%; high schools had the most full time school doctors, accounting for 65.7%, and part time health care teachers only accounting for 15.1 %. There were various employment channels, with the most transfer jobs in schools, accounting for 70.7%. The series of professional titles were diverse, with the teaching profession accounting for 67.4%. Most of school health teachers had junior and intermediate professional titles, accounting for 42.6%, respectively. Proportion of medium, medium low, and low level of salary accounted for 39.3%, 27.9% and 21.1% respectively. Conclusion The educational background and age distribution of school health personnel is reasonable, but the proportions of medical background and full time school doctors are relatively low. School health personnel have various job types, professional titles, salary level, and limited space of career development. Top level design from the policy level, and clearly defined improve the structure of school health personnel to meet the needs of high quality development of school health work in the new era.