To interpret the evidence-to-decision （EtD） framework and to illustrate its application in traditional Chinese medicine （TCM） guideline development using the example of the Pharmacovigilance Guideline of Chinese Patent Medicine， thereby providing methodological references for TCM guideline standardization. Based on the core three stages of the EtD framework （formulating the question， making an assessment of the evidence， and drawing conclusions）， critical decision points and evaluation evidence within the evidence-translation process were systematically addressed， aligning with the purpose， scope， and key questions of the guideline. Qualitative research methods， such as the nominal group technique， were employed to formulate recommendations. The analysis was conducted based on the EtD framework. During question formulation， the specific characteristics and practical needs of pharmacovigilance for Chinese patent medicines were clarified， focusing on the core objective of safety assurance throughout the product lifecycle. In the evidence assessment， multi-source evidence was integrated， including policy documents， literature research， and expert consensus， completing the evidence evaluation. Finally， in recommendation-forming， dispersed research evidence and expert experience were synthesized into consensus， culminating in the guideline's completion through solicitation of opinions and peer review. The EtD framework provides a structured tool for evidence-to-decision translation in TCM guideline development， effectively enhancing the transparency and scientific rigor of the process. Therefore， it is recommended that TCM guideline development adopt the EtD framework to improve the evidence-to-decision process with TCM characteristics.

To interpret the evidence-to-decision （EtD） framework and to illustrate its application in traditional Chinese medicine （TCM） guideline development using the example of the Pharmacovigilance Guideline of Chinese Patent Medicine， thereby providing methodological references for TCM guideline standardization. Based on the core three stages of the EtD framework （formulating the question， making an assessment of the evidence， and drawing conclusions）， critical decision points and evaluation evidence within the evidence-translation process were systematically addressed， aligning with the purpose， scope， and key questions of the guideline. Qualitative research methods， such as the nominal group technique， were employed to formulate recommendations. The analysis was conducted based on the EtD framework. During question formulation， the specific characteristics and practical needs of pharmacovigilance for Chinese patent medicines were clarified， focusing on the core objective of safety assurance throughout the product lifecycle. In the evidence assessment， multi-source evidence was integrated， including policy documents， literature research， and expert consensus， completing the evidence evaluation. Finally， in recommendation-forming， dispersed research evidence and expert experience were synthesized into consensus， culminating in the guideline's completion through solicitation of opinions and peer review. The EtD framework provides a structured tool for evidence-to-decision translation in TCM guideline development， effectively enhancing the transparency and scientific rigor of the process. Therefore， it is recommended that TCM guideline development adopt the EtD framework to improve the evidence-to-decision process with TCM characteristics.

Traditional Chinese medicine （TCM）， through its multi-target and systematic regulatory effects， has demonstrated unique advantages in the treatment of gastric precancerous lesions （GPL）. At present， TCM theoretical research on GPL is mainly reflected in three aspects， the integration of macroscopic syndrome differentiation， the inflammation-carcinoma transformation mechanism， as well as the systematization and scientization of theoretical inheritance from famous TCM practitioners. High-quality evidence-based research findings serve as the foundation for clinical practice guidelines on GPL， and TCM has gained international academic recognition in the field of GPL prevention and treatment. Research on TCM mechanisms has yielded a series of important outcomes in the aspects of signaling pathways， gene expression regulation， cellular epigenetics， histone modification， and intestinal microecology. It is proposed that future research on GPL should focus on four key directions， establishing multi-omics data， exploring targeted intervention strategies on key regulatory nodes， advancing the standardization process of integrated traditional Chinese and western medicine prevention and treatment technologies， and constructing stratified screening and intervention platforms. The in-depth integration of TCM microcosmic mechanism of action with its macroscopic syndrome differentiation and treatment system， coupled with interdisciplinary research， will provide valuable references for the clinical treatment and scientific research of GPL.

Objective: To explore the interrelationships between mental vulnerability, cognitive emotion regulation strategies, and positive psychological capital in medical postgraduates, so as to provide precise intervention targets for mental health services in universities. Methods: From April to June 2025, a convenience sampling method was used to select 1 461 medical postgraduates from three colleges in Hubei Province. Participants were assessed using the Mental Vulnerability Questionnaire (MVQ), the Cognitive Emotion Regulation Questionnaire-Chinese Version (CERQ-C) and the Positive Psychological Capital Questionnaire (PPQ). The network analysis model was constructed using a Gaussian graphical model. Results: The network analysis revealed that the edge connection between somatic symptoms and mental symptoms was the strongest, followed by the connection between refocus on planning and positive reappraisal within cognitive emotion regulation, with edge weights of 0.69 and 0.59, respectively. Interpersonal problems within psychological vulnerability exhibited the highest expected influence( EI =1.27), serving as the core node of the network. Rumination within cognitive emotion regulation demonstrated the highest bridge expected influence( BEI =0.33), playing a critical connecting role among psychological vulnerability, cognitive emotion regulation, and positive psychological capital. Conclusion In the mental health network of medical postgraduates, mental vulnerability, cognitive emotion regulation, and positive psychological capital interact through their respective key dimensions, jointly affect overall mental health.

Background Metals and metalloids in fine particulate matter (PM_2.5) may cause damage to the respiratory and circulatory systems of the human body, and long-term exposure is prone to causing chronic poisoning, cancer, and other adverse effects. Objective To assess the distribution characteristics of metals and metalloids in outdoor PM_2.5 in a southern city of China, conduct source apportionment, and evaluate the associated health risks, thereby providing theoretical support for further pollution control measures. Methods PM_2.5 samples were collected in districts A, B, and C of a southern China city, and the concentrations of 17 metals and metalloids were detected by inductively coupled plasma-mass spectrometry (ICP-MS). Pollution sources were assessed through enrichment factor and principal components analysis, and the main pollution sources were quantified using absolute principal component scores-multivariate linear regression (APCS-MLR). Health risks were evaluated based on the Technical guide for environmental health risk assessment of chemical exposure (WS/T777—2021). Results The ambient air PM_2.5 concentrations in the city were higher in winter and spring, and lower in summer and autumn. The annual average concentrations of ambient PM_2.5 in districts A, B, and C were 36.7, 31.9, and 24.4 μg·m⁻³, respectively. The ambient PM_2.5 levels in districts B and C were below the second-grade limit set by the Ambient air quality standards (GB 3095—2012). The enrichment factors of cadmium (Cd), aluminum (Al), and antimony (Sb) were greater than 10, those of copper (Cu), lead (Pb), arsenic (As), nickel (Ni), mercury (Hg), and molybdenum (Mo) fell between 1 and 10, and those of manganese (Mn), vanadium (V), chromium (Cr), cobalt (Co), barium (Ba), beryllium (Be), and uranium (U) were below or equal to 1. The comprehensive evaluation of source analysis showed that the main pollution sources in districts A and C and the whole city were coal-burning. In district B, the main pollution source was also coal combustion, followed by industrial process sources and dust sources. The carcinogenic risks of As and Cr were between 1×10⁻⁶ and 1×10⁻⁴. However, the hazard quotients for 15 metals and metalloids in terms of non-carcinogenic risk were below 1. Conclusion Cr and As in the atmospheric PM_2.5 of the city present a certain risk of cancer and should be paid attention to. In addition, preventive control measures should be taken against relevant pollution sources such as industrial emission, dust, and coal burning.

Objective To explore the effect of aerobic exercise on adipogenesis and insulin resis-tance(IR)in mice on high-fat diet,and to explore the mechanism of aerobic exercise regulating obe-sity-related long noncoding RNA(lnc-ORA)in this process.Methods Thirty-six 8-week-old male C57BL/6J mice,weighing 21.4±0.92 g,were randomized into a normal control group(NC),a high-fat control group(HC)and the high-fat exercise group(HE),each of 12,after one-week acclimatiz-ing feeding.Group NC was fed on normal diet,while the high-fat groups were given high-fat food for 4 weeks.Then,group HE underwent daily 45-minute aerobic exercise on a 6%-incline treadmill at a speed of 18 m/min,6 days per week,for 8-week.After the intervention,the body weight,body length,and epididymal fat weight of all groups were measured,and the adipocyte size was observed.Moreover,lipid levels,glucose tolerance,insulin sensitivity,and expression of genes related to adipo-genesis(FASN,FABP4,and PPARγ)were examined,together with the expression levels of the rele-vant signaling axes(IRS-1/PI3K/AKT/mTOR/GLUT4)and related metrics(lnc-ORA,TNFα),and en-richment levels of peroxisome proliferator-activated receptor γ(PPARγ)promoter region for histone H3 acetylation(H3ac)and histone H3K4 trimethylation(H3K4me3).Results The body weight,epidid-ymal adipose tissue weight,and body mass index(Lee's index)of group HC were significantly higher(P<0.05)than group NC,and the above indexes of group HE were significantly lower(P<0.05)than group HC after 8 weeks of aerobic exercise intervention.The levels of total cholesterol(TC),low-den-sity lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)of the HC group were significantly higher than the NC group(P<0.05),and the lipid levels of the HE group im-proved significantly compared to the HC group(P<0.05).Moreover,the expression of adipogenesis-re-lated genes PPARγ,fatty acid synthase(FASN)and fatty acid binding protein 4(FABP4)up-regulat-ed significantly in group HC compared with group NC(P<0.05),while that of adipogenesis-related genes in group HE was significantly lower than group HC(P<0.05),with the adipocytes'size of HC group larger than the other two groups.What's more,the expression level of insulin receptor substrate 1(IRS-1)/phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/mammalian target of rapamy-cin(mTOR)/glucose transporter type 4(GLUT4)pathway decreased significantly in group HC com-pared with group NC and HE(P<0.05;P<0.01,P<0.05).Meanwhile,both glucose tolerance and insu-lin sensitivity of group HC decreased significantly compared with the NC and HE groups(P<0.01,P<0.05;P<0.01,P<0.05).However,the expression of lnc-ORA and TNF-α increased significantly in group HC compared with group NC(P<0.01,P<0.05),but significantly down-regulated in group HE compared with group HC(P<0.05).The enriched levels of H3ac and H3K4me3 in the PPARγ promot-er region of group HC increased significantly compared with group NC(P<0.05),but decreased signifi-cantly in group HE compared with group HC(P<0.05).Conclusions Aerobic exercise reduces adipogen-esis via lnc-ORA/PPARγ and improves IR by modulating the IRS-1/PI3K/AKT/GLUT4 axis.

Objective Quantitatively evaluate the policies for high-quality development of public hospitals in China,an-alyze the strengths and weaknesses of policies in different provinces,and provide theoretical support and decision-making basis for further optimizing relevant policies for high-quality development of public hospitals.Methods Based on text mining and quanti-tative analysis,combined with existing research,a PMC index model is constructed to analyze the relevant policies for high-quali-ty development of public hospitals in China.Results Among the 32 policy texts included,11 are excellent policies and 21 are good policies.The average PMC index of the 32 policies is 6.66,indicating overall good performance.However,some policies have some problems in terms of reference basis,task list,and monitoring indicators.Conclusion The policy for high-quality de-velopment of public hospitals in our country is basically complete.The formulation of relevant policies in the future should consider further improvement of policy objectives,incentive measures,and rich content,in order to achieve alignment with national policies at the macro level and optimization and improvement based on the actual situation of each province and city at the micro level.

Objective To identify subtypes of lower-grade gliomas based on multi-omics data integration with consensus clustering ensemble(MICCE)method,and further assess prognosis risk across different subtypes and explore differentially expressed biomarkers and pathways.Methods We applied the consensus clustering ensemble method to integrate the subtype results of seven multi-omics data integration methods(SNF,joint SNF,CIMLR,ConsensusClusterPlus,MoCluster,NEMO,iClusterBayes)for mRNA,miRNA,and DNA methylation data from LGG patients,identifying a robust molecular subtyping.Then we performed survival analysis based on the subtype results,and Cox proportional risk models were fitted to assess the prognosis of patients with different subtypes.Differentially expressed genes(DEmiRNAs,DEmRNAs and DMGs)between different subtypes were screened,and GO(gene ontology)analysis and KEGG enrichment analysis were performed for overlapping genes among DEmiRNAs target genes,DEmRNAs,and DMGs.Ultimately,immune infiltration analysis and pathway activity analysis were conducted to quantify the biological differences among different subtypes.Results Patients were classified into three subtypes:a high-risk cluster,a moderate-risk cluster,and a low-risk cluster.The results showed that the high-risk cluster were 7.70 times more likely to die than patients in low-risk cluster.A total of 2512 DEmRNAs,14 DEmiRNAs and 255 DMGs were screened,the combined analysis genes yielded 665 genes which are regulated by mRNA,miRNA and DNA methylation and enriched 62 GO items and 52 KECG pathways with statistical differences.The analysis of immune infiltration and pathway activity indicates that there are two immune cells and four signaling pathways with statistically significant differences.Conclusion MICCE can effectively identify high-risk patients of LGG.Subsequent analysis reveals differential genes and pathways related to the progression of LGG with different subtypes,providing important clues for the personalized treatment of LGG.

Diagnosis-related groups (DRG) payment is an important component of deepening the reform of medical insurance payment methods. In June 2023, a tertiary hospital launched an intelligent DRG grouping audit system to enhance grouping accuracy. By establishing a multi departmental collaborative organizational structure, building a standardized knowledge base and a rule base covering five categories (diagnosis, fees, testing, nursing, and pathology), and integrating electronic medical records, medical orders, testing, and imaging data throughout the entire diagnosis and treatment process, the intelligent DRG grouping audit system with data collection, identification, extraction, comparison, and output modules was constructed to achieve intelligent audit. At the same time, it was formed a closed-loop management system for pre reporting quality control, in-process group entry control, and post data analysis and assessment, which would prevent the risk of differentiated behaviors such as high coding and high sets, and ensure the reasonable use of medical insurance funds. By January 2024, the system had covered 89 ADRG groups, and improved the efficiency and quality of DRG grouping audit. Compared with February to May 2023, the monthly average rejection rate of medical records on the first page decreased by 9.4% after the system was put into operation (June to December 2023), and core medical indicators such as the number of DRG groups, medical insurance settlement cases, and time consumption index continued to improve. The practical experience could provide reference and inspiration for other hospitals in China.

Objective:To investigate the clinical efficacy and safety of needle-free and needle-based injections of recombinant human interferon (IFN) -α2a in the treatment of palmoplantar warts.Methods:Patients aged 6 to 75 years with palmoplantar warts were prospectively enrolled from the Department of Dermatology, Zhongda Hospital, Southeast University between March and September 2023, and baseline data were collected. The patients were randomly and equally divided into a needle-free injection group and a needle-based injection group by using a random number table method, and received needle-free and needle-based injections of recombinant human IFN-α2a once every 2 to 3 weeks, respectively, with a maximum of 4 treatment sessions. Efficacy was assessed based on changes in wart size and skin lines under a dermoscope. Pain degrees and adverse reactions were recorded, and patients were followed up for 6 months after the end of treatment. Chi-square test was used to compare the cure rates, recurrence rates, and incidence rates of adverse reactions between the two groups. Logistic regression analysis was employed to identify factors related to the clearance of palmoplantar warts.Results:A total of 160 patients with palmoplantar warts were included, with 80 patients in each group. In the needle-free injection group, there were 45 females (56.2%) and 35 males (43.8%) ; their ages ( M[ Q1, Q3]) were 27 (23, 40) years, and the duration of disease ( M[ Q1, Q3]) was 12 (3, 24) months; warts were located on the hands in 12 cases (15.0%), on the feet in 60 cases (75.0%), and on both sites in 8 cases (10.0%) ; warts measuring ≤ 1 cm in diameter were observed in 71 cases (88.8%), and those measuring > 1 cm were observed in 9 cases (11.3%). In the needle-based injection group, there were 37 females (46.2%) and 43 males (53.8%) ; their ages were 28 (22, 39) years, and the duration of disease was 6 (2, 12) months; warts were located on the hands in 23 cases (28.7%), on the feet in 55 cases (68.8%), and on both sites in 2 cases (2.5%) ; warts measuring ≤ 1 cm in diameter were observed in 67 cases (83.8%), and those measuring > 1 cm in diameter were observed in 13 cases (16.3%). There were no significant differences in gender distribution, age, wart diameters, prior treatment status, or number of warts between the two groups (all P > 0.05). The duration of disease was longer in the needle-free injection group than in the needle-based injection group ( P = 0.041), and the dose of interferon was lower in the needle-free injection group than in the needle-based injection group ( P < 0.001). After treatment, 44 patients (55.0%) were cured in the needle-free injection group, and 39 (48.8%) in the needle-based injection group, with no significant difference in the cure rates between the two groups ( χ2 = 0.63, P = 0.429). Among patients with multiple warts, 54.8% (23/42) were cured in the needle-free injection group, and 47.4% (18/38) in the needle-based injection group, with no significant difference in cure rates between the two groups ( χ2 = 1.28, P = 0.509). The most common adverse reaction was fever or flu-like symptoms (186 instances), which resolved spontaneously in 141 instances and resolved after treatment with oral ibuprofen in 45 instances; the incidence rate of flu-like symptoms was significantly lower in the needle-free injection group (57 instances, 21.6%) than in the needle-based injection group (129 instances, 53.3%; χ2 = 54.63, P < 0.001). The pain score was significantly lower in the needle-free injection group (3.65 ± 1.25 points) than in the needle-based injection group (5.16 ± 1.17 points, t = -7.90, P < 0.001). The logistic regression analysis showed that the duration of disease, lesion sites, patient age, and previous treatment history had no impact on the efficacy in either the needle-free injection group or the needle-based injection group (all P > 0.05) . Conclusions:The efficacy of needle-free and needle-based injections of interferon was similar in the treatment of palmoplantar warts, whereas needle-free injections resulted in less pain and a lower incidence of interferon-related adverse reactions. None of the duration of disease, lesion sites, patient age, or prior treatment status showed significant impact on the efficacy in the two groups.