This paper introduces the "eight-dimensional materia medica framework" theory proposed by Professor TONG Xiaolin and， in light of his academic perspectives and clinical experience， explores its inheritance and innovation of the concept of "four pillars of medicinals" by ZHANG Jiebin of Ming-dynasty from multiple angles. Building upon the four foundational medicinals， Renshen （Panax ginseng）， Shudihuang （Rehmannia glutinosa Praeparata）， Fuzi （Aconitum carmichaelii Praeparata）， and Dahuang （Rheum palmatum）， as the "four pillars of medicinals"， and using eight-principle pattern differentiation framework， this theory expands the representative medicinals to eight. It establishes the "eight-dimensional materia medica framework"， i.e. exterior-Mahuang （Ephedra sinica）， interior-Rougui （Cinnamomum cassia）， cold-Huanglian （Coptis chinensis）， heat-Ganjiang （Zingiber officinale）， deficiency-Renshen （Panax ginseng）， excess-Dahuang （Rheum palmatum）， yin-Shudihuang （Rehmannia glutinosa Praeparata）， and yang-Fuzi （Aconitum carmichaelii Praeparata）. This framework highlights the pivotal roles of these eight medicinals in the treatment of exterior and interior patterns， cold and heat syndromes， deficiency and excess conditions， as well as yin deficiency and yang deficiency. Integrated with the state-target differentiation and treatment theory， this approach enriches the traditional actions of the eight representative medicinals by incorporating findings from modern pharmacological research， achieving a transition from macroscopic regulation of pathological states to microscopic target-oriented intervention. Furthermore， through investigations into dose-effect relationships and the expansion of principles for herbal compatibility， the clinical practicality of the "eight-dimensional materia medica framework" is further demonstrated， promoting the integrative development of Chinese and western medicine at the level of clinical application of Chinese materia medica.

By reconstructing the integrated Chinese and western medicine diagnostic and treatment system， the "Two Reconstructions" theoretical framework establishes a standardized pathway of "classification-staging-syndrome differentiation"， which improves the accuracy of disease identification and strengthens the capacity for full-course intervention； in addition， by reconstructing the modern materia medica system， it innovatively integrates the traditional properties and efficacy of Chinese herbal medicinals with modern pharmacological mechanisms， forming a "state-target co-regulation" precise medication model， and builds a dose-effect theoretical system for prescriptions and medicinals， thereby enhancing both the targeting accuracy and dosage precision of therapeutic interventions. The "Two Reconstructions" theorecitcal framework is a key strategy for enhancing clinical efficacy. It can precisely identify "states" and "targets" for directed intervention， shift the focus of prevention and treatment earlier to enable full-cycle management， establish standardized paradigms for reproducible and evaluable efficacy， and expand the scope of clinical practice to address conditions without typical syndromes and critical illnesses. As a systematic pathway for innovation in TCM， this theoretical framework provides valuable insights and references for promoting the high-quality development of integrative Chinese and western medicine.

Based on the traditional Chinese medicine （TCM）'s understanding of consumptive thirst disease and modern medicine's understanding of the etiology of diabetes mellitus and the evolution of the disease， this article discussed the rationality and clinical significance of using "sugar collateral disease" as the name of diabetes mellitus in TCM， to provide a reference for modernization and development of TCM diseases' names. It is argued that the clinical manifestations described in the TCM disease name of consumptive thirst disease are only at a certain stage of diabetes mellitus， and it is difficult to cover the clinical characteristics of modern diabetes mellitus comprehensively. In 2003， academician TONG Xiaolin proposed to use "sugar collateral disease" as the TCM disease name of diabetes mellitus， which on the one hand can reflect the essence of diabetes mellitus， and on the other hand can embody the disease location， disease mechanism and the evolution of the disease， highlight the harms of complications， and serve as a warning for the early diagnosis and treatment of the disease， which can help to enhance the level of diagnosis and treatment of diabetes mellitus in TCM.

Objective:Distribution and antibiotic resistance of pathogen isolated from children with intra-abdominal infection (IAI) associated sepsis in the intensive care unit (ICU) were analyzed to provide a reference for the empirical anti-infective treatment of IAI in children.Methods:We retrospectively analyzed the data of 116 children with culture-positive IAI-associated sepsis admitted to Children's Hospital of Zhejiang University School of Medicine from January 2019 to December 2021. Clinical isolation and drug resistance analysis were conducted based on different years of onset, locations of onset, and primary diseases.Results:A total of 186 strains of pathogens causing children with IAI-associated sepsis in ICU were collected. The distribution and antibiotic resistance of pathogen were as follows: the percentages of gram-positive bacteria, gram-negative bacteria, and fungi were 53.2%, 40.9%, and 5.9%, respectively; the top four strains were Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, accounting for 57.0% of all isolates; Enterococcus faecium(19.9%) and Enterococcus faecalis (10.2%) were the dominating gram-positive bacteria; Escherichia coli (13.4%) and Klebsiella pneumoniae (13.4%) were more common gram-negative bacteria; Fungi were dominated by Candida albicans (3.8%).Fifty-seven strains of gram-positive bacteria were detected in 61 children with infectious diseases, mainly Enterococcus faecium (28 strains). There were 53 gram-negative strains, mainly Klebsiella pneumoniae (21 strains). Thirty-two strains of gram-positive bacteria were detected in 40 children with digestive tract malformation, and Enterococcus faecalis (six strains) were the most common. There were 14 gram-negative strains, mainly Escherichia coli (six strains). In 13 children with malignant tumors of digestive system, nine strains of gram-positive bacteria were cultured, and Enterococcus faecium (four strains) was the most common. There were eight gram-negative strains, mainly Escherichia coli (four strains).In the 46 community-acquired IAI patients,30 gram-positive isolates were cultured,mainly including Enterococcus faecium (12 strains), Staphylococcus epidermidis (seven strains), and Viridans streptococci (six strains); Forty gram-negative isolates mainly contained Escherichia coli (16 strains), Klebsiella pneumoniae (14 strains), and Enterobacter cloacae (five strains). In the 70 hospital-associated IAI patients, 69 gram-positive isolates such as Enterococcus faecium (25 strains), Enterococcus faecalis (17 strains), Enterococcus gallinarum (eight strains), and Staphylococcus aureus (seven strains) were cultured;Tirty-six gram-negative isolates were dominated by Klebsiella pneumoniae (11 strains), Escherichia coli (nine strains), Pseudomonas aeruginosa (four strains), and Acinetobacter baumannii (four strains). The mixed infection rate of clinical pathogens was up to 46.6%, and the overall resistance rate was 43.4%, in which gram-negative bacteria had high sensitivity to piperacillin/tazobactam, cefoperazone/sulbactam, imipenem, and tigecycline.The detection rates of Klebsiella pneumoniae and Escherichia coli producing extended-spectrum β-lactamases were 36.0% and 24.6%, respectively, with 100% sensitivity to tigecycline. Gram-positive bacteria showed 100% sensitivity to vancomycin, linezolid, and tigecycline. Conclusion:Pathogen isolated from children with IAI-associated sepsis in ICU were dominated by Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis,respectively. Before confirmation of pathogenic bacteria, antibacterial agents can be selected according to the infection type. It is important to note that a single broad-spectrum antibacterial agent or combination medication can be considered the initial empirical choice due to the large variety of pathogens, high rates of mixed infections, and high overall resistance.

Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.

OBJECTIVE: To perform prenatal diagnosis, pedigree analysis, and genetic counseling of a pregnant woman who gave birth to a child with Kleefstra syndrome. METHODS: Karyotype analysis, chromosomal microarray analysis (CMA), multiplex ligation-dependent probe amplification (MLPA) and fluorescence in situ hybridization (FISH) were used of peripheral blood and amniotic fluid to find causes. Recurrence risk assessment was performed later. RESULTS: The amniotic fluid sample showed a 9q34.3 microduplication of arr (hg19) 9q34.3 (140 168 806-141 020 389)× 3, which overlapped the 9q34.3 microdeletion region of proband. The pregnant woman was detected with a balanced translocation of ish, t(9;17)(9q34.3; qter) (9p+; 17p+,9q+, 17q+). No other abnormal results were found in the family. CONCLUSION Offspring who share the same chromosome segment deletion or duplication are always from parent who carries balanced chromosomal structural aberration.
Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Human, Pair 9/genetics* ; Female ; Genetic Testing ; Humans ; In Situ Hybridization, Fluorescence ; Pregnancy

Objective:To investigate the safety of selective feticide by radiofrequency ablation (RFA) in dichorionic triamniotic (DCTA) triplets and factors related to the clinical outcome.Methods:A retrospective cohort study was designed to review the clinical records and pregnancy outcome of DCTA triplets patients who underwent RFA for selective feticide performed at the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital from January 1,2016 to January 1,2020. Placentas were collected after delivery for gross examination and perfusion study with the mixture of vinylidene chloride and self-curing denture acrylic.Results:A total of 12 DCTA cases were recruited. Selective feticide by RFA were performed at a mean gestational age of 15.6 weeks, and cases delivered at a mean gestational age of 36.9 weeks (34 +4-38 +2 weeks). Eight of the cases undertook invasive prenatal diagnosis weeks after RFA. The interval between RFA to delivery and gestational ages at delivery were similar between women undertook prenatal diagnosis and those who did not ( P>0.05). Six of the 23 newborns (26%) were small for gestational age. The average birth weight of either monochorionic singleton fetus or the remained co-twin of the monochorionic diamniotic (MCDA) twin as lower than that of singleton pregnancy ( P<0.001). One case of DCTA (8.3%) underwent intrauterine fetal death of the MCDA co-twin 4 h after RFA. Fetal tachycardia and cessation of fetal movement of the co-twin were observed before death. By the time of delivery, placental examination revealed the pale anemia look of the placental part of the co-twin and the reddish appearance of the part of the reduced fetus, which suggested a hypovolemic shock after an uncompleted RFA as the cause of co-twin death. A total of 10 MCDA placentas from cases with a living MCDA co-twins were collected. Various degree of placental perfusion on the reduced fetal side of placenta was noticed in nine cases. The co-twin with the placenta which did not have such kind of perfusion had a birth weight at the lowest percentile. Conclusion:Selective feticide by RFA is a safe procedure for DCTA triplet, and prenatal diagnosis has no adverse impact on pregnancy outcome. Ultrasound monitoring of fetal heart rate and fetal movement of the MCDA co-twin after RFA is helpful for predicting clinical outcome. Postnatal placental examination provides clues for adverse outcome, and the growth potential of the MCDA co-twin might be related to the type of anastomosis between the two fetuses.

Objective:To investigate the safety of selective feticide by radiofrequency ablation (RFA) in dichorionic triamniotic (DCTA) triplets and factors related to the clinical outcome.Methods:A retrospective cohort study was designed to review the clinical records and pregnancy outcome of DCTA triplets patients who underwent RFA for selective feticide performed at the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen People's Hospital from January 1,2016 to January 1,2020. Placentas were collected after delivery for gross examination and perfusion study with the mixture of vinylidene chloride and self-curing denture acrylic.Results:A total of 12 DCTA cases were recruited. Selective feticide by RFA were performed at a mean gestational age of 15.6 weeks, and cases delivered at a mean gestational age of 36.9 weeks (34 +4-38 +2 weeks). Eight of the cases undertook invasive prenatal diagnosis weeks after RFA. The interval between RFA to delivery and gestational ages at delivery were similar between women undertook prenatal diagnosis and those who did not ( P>0.05). Six of the 23 newborns (26%) were small for gestational age. The average birth weight of either monochorionic singleton fetus or the remained co-twin of the monochorionic diamniotic (MCDA) twin as lower than that of singleton pregnancy ( P<0.001). One case of DCTA (8.3%) underwent intrauterine fetal death of the MCDA co-twin 4 h after RFA. Fetal tachycardia and cessation of fetal movement of the co-twin were observed before death. By the time of delivery, placental examination revealed the pale anemia look of the placental part of the co-twin and the reddish appearance of the part of the reduced fetus, which suggested a hypovolemic shock after an uncompleted RFA as the cause of co-twin death. A total of 10 MCDA placentas from cases with a living MCDA co-twins were collected. Various degree of placental perfusion on the reduced fetal side of placenta was noticed in nine cases. The co-twin with the placenta which did not have such kind of perfusion had a birth weight at the lowest percentile. Conclusion:Selective feticide by RFA is a safe procedure for DCTA triplet, and prenatal diagnosis has no adverse impact on pregnancy outcome. Ultrasound monitoring of fetal heart rate and fetal movement of the MCDA co-twin after RFA is helpful for predicting clinical outcome. Postnatal placental examination provides clues for adverse outcome, and the growth potential of the MCDA co-twin might be related to the type of anastomosis between the two fetuses.

Gegen Qinlian Decoction (GQD), a traditional Chinese medicine (TCM) formula, has long been used for the treatment of common metabolic diseases, including type 2 diabetes mellitus. However, the main limitation of its wider application is ingredient complexity of this formula. Thus, it is critically important to identify the major active ingredients of GQD and to illustrate mecha-nisms underlying its action. Here, we compared the effects of GQD and berberine, a hypothetical key active pharmaceutical ingredient of GQD, on a diabetic rat model by comprehensive analyses of gut microbiota, short-chain fatty acids, proinflammatory cytokines, and ileum transcriptomics. Our results show that berberine and GQD had similar effects on lowering blood glucose levels, modulating gut microbiota, inducing ileal gene expression, as well as relieving systemic and local inflammation. As expected, both berberine and GQD treatment significantly altered the overall gut microbiota structure and enriched many butyrate-producing bacteria, including Faecalibacterium and Roseburia, thereby attenuating intestinal inflammation and lowering glucose. Levels of short-chain fatty acids in rat feces were also significantly elevated after treatment with ber-berine or GQD. Moreover, concentration of serum proinflammatory cytokines and expression of immune-related genes, including Nfkb1, Stat1, and Ifnrg1, in pancreatic islets were significantly reduced after treatment. Our study demonstrates that the main effects of GQD can be attributed to berberine via modulating gut microbiota. The strategy employed would facilitate further stan-dardization and widespread application of TCM in many diseases.

Objective To investigate the positive rates and susceptibility of Ureaplasma urealyticum(Uu) and Mycoplasma hominis(Mh) in urogenital mycoplasma infection under three years.Methods Culture,identification and susceptibility test were performed on 4 414 specimens collected from suspected patients with mycoplasma infection by using Antu mycoplasma kits.Results In the 4 414 patients,2 295 cases with mycoplasma infection were detected and the positive rate was 51.99％.The infection rates of Uu and Mh respectively were 40.69％ and 2.08％,and the both infection rate was 9.22％.Antibiotic sensitive rates of josamycin(JOX),doxycycline(DOX),clarithromycin(CLA),gatifloxacin(GAT) and erythromycin(ERY) were 96.03％,95.51 ％,78.69 ％％,77.21 ％ and 72.55 ％.Drug resistant rates of roxithromycin(RXT),thiamphenicol (THI),clindamycin (CLI) and clarithromycin(CLA) were 16.90％,22.27％,41.96％ and 17.60％.Conclusion Uu is the predominant mycoplasma in urogenital tract infection in the study.DOX,JOS,GAT and ERY can be chosen as the fist line drugs for the treatment of urogenital tract infection.RXT,THI,CLI and CLA with high drug resistant rates are not recommended to be used.