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 analyze the 2011-to-2023 baseline data on, and the variations theirin, malignant tumor mortality for the surrounding residents prior to operation of the Jin-Qimen nuclear power plant at Xiangshan county, Zhejiang province, for pursose of providing scientific basis for evaluating the health impacts of nuclear power plant operation.Methods:Data on malignant tumor mortality and population in Xiangshan county from 2011 to 2023 were collected from the Ningzhou Cause of Death Monitoring System and the Ningzhou Public Security Bureau. Crude death rates and standardized rates (China standard population) were calculated. The Joinpoint regression model was used to analyze annual percentage change (APC) and average annual percentage change (AAPC).Results:The average annual malignant tumor mortality from 2011 to 2023 was 212.42 deaths per 100 000 population (age-standardized rate: 133.16 deaths per 100 000 population), with males at 287.41 deaths per 100 000 and females at 135.40 deaths per 100 000 population. The crude mortality exhibited an upward trend (AAPC=1.264%, t=5.07, P<0.05), while the age-standardized rate showed a significant downward trend (AAPC=-2.753%, t=-10.50, P<0.05). Mortality increased with age ( χ2=23 903.91, P<0.05), peaking in the ≥85 age group (1 693.11 per 100 000), and rising trends were observed in males ( χ2=16 982.46, P<0.05) and females ( χ2=7 329.05, P<0.05). Leading causes included lung cancer, liver cancer, gastric cancer, colorectal cancer, and pancreatic cancer. Liver cancer, gastric cancer, and esophageal cancer showed declining trends, whereas prostate cancer increased. Radiation-sensitive tumors (e.g., leukemia, breast cancer, thyroid cancer) displayed no significant trends. Among individuals under the age of 30, leukemia and brain/nervous system cancers predominated; for those aged 30-79, the lung, liver, and gastric cancers were dominant; and for the group aged 80 and above, the lung, gastric, and colorectal cancers were dominant. Malignant tumor mortality increased with distance from the nuclear facility ( χ2=6.90, P<0.05), significantly in males ( χ2=10.42, P<0.05) but not in females ( P>0.05). Leukemia, breast cancer, and thyroid cancer mortality showed no significant trends ( P>0.05). Conclusions:The age-standardized mortality rate for malignant tumors in Xiangshan county demonstrated an overall declining trend, with notable changes in specific cancers. Leukemia, breast cancer, and thyroid cancer mortality remained relatively stable. These baseline findings provide a scientific basis for health impact assessments of nuclear power plants and sustainable nuclear energy development.

This article systematically summarized the clinical experience of Professor Han Mingxiang,a national TCM master,in treating chronic obstructive pulmonary disease(COPD)from the perspective of the"qi monism"theory,proposing an innovative"three stages,three strategies"diagnostic and treatment approach.Under the guidance of"qi monism",Professor Han believes that the core pathological mechanisms of COPD progress are through three successive stages:dysfunction in the ascent and descent of qi,deficiency of yang qi,and prolapse of the great qi,all of which stem from the disruption of the dynamic balance of qi.In response to this chain of qi imbalance,Professor Han develops three strategies:"strengthening the foundation","illuminating the central yang",and"lifting and correcting",which aim to regulate qi flow,support yang qi,and coordinate the three energizers in a phased manner.This approach seeks to achieve dynamic restoration and holistic balance of qi,with prescriptions carefully aligned with the dynamic balance and pathological changes of qi,yielding distinctive therapeutic effects.

Objective:To analyze the 2011-to-2023 baseline data on, and the variations theirin, malignant tumor mortality for the surrounding residents prior to operation of the Jin-Qimen nuclear power plant at Xiangshan county, Zhejiang province, for pursose of providing scientific basis for evaluating the health impacts of nuclear power plant operation.Methods:Data on malignant tumor mortality and population in Xiangshan county from 2011 to 2023 were collected from the Ningzhou Cause of Death Monitoring System and the Ningzhou Public Security Bureau. Crude death rates and standardized rates (China standard population) were calculated. The Joinpoint regression model was used to analyze annual percentage change (APC) and average annual percentage change (AAPC).Results:The average annual malignant tumor mortality from 2011 to 2023 was 212.42 deaths per 100 000 population (age-standardized rate: 133.16 deaths per 100 000 population), with males at 287.41 deaths per 100 000 and females at 135.40 deaths per 100 000 population. The crude mortality exhibited an upward trend (AAPC=1.264%, t=5.07, P<0.05), while the age-standardized rate showed a significant downward trend (AAPC=-2.753%, t=-10.50, P<0.05). Mortality increased with age ( χ2=23 903.91, P<0.05), peaking in the ≥85 age group (1 693.11 per 100 000), and rising trends were observed in males ( χ2=16 982.46, P<0.05) and females ( χ2=7 329.05, P<0.05). Leading causes included lung cancer, liver cancer, gastric cancer, colorectal cancer, and pancreatic cancer. Liver cancer, gastric cancer, and esophageal cancer showed declining trends, whereas prostate cancer increased. Radiation-sensitive tumors (e.g., leukemia, breast cancer, thyroid cancer) displayed no significant trends. Among individuals under the age of 30, leukemia and brain/nervous system cancers predominated; for those aged 30-79, the lung, liver, and gastric cancers were dominant; and for the group aged 80 and above, the lung, gastric, and colorectal cancers were dominant. Malignant tumor mortality increased with distance from the nuclear facility ( χ2=6.90, P<0.05), significantly in males ( χ2=10.42, P<0.05) but not in females ( P>0.05). Leukemia, breast cancer, and thyroid cancer mortality showed no significant trends ( P>0.05). Conclusions:The age-standardized mortality rate for malignant tumors in Xiangshan county demonstrated an overall declining trend, with notable changes in specific cancers. Leukemia, breast cancer, and thyroid cancer mortality remained relatively stable. These baseline findings provide a scientific basis for health impact assessments of nuclear power plants and sustainable nuclear energy development.

This article systematically summarized the clinical experience of Professor Han Mingxiang,a national TCM master,in treating chronic obstructive pulmonary disease(COPD)from the perspective of the"qi monism"theory,proposing an innovative"three stages,three strategies"diagnostic and treatment approach.Under the guidance of"qi monism",Professor Han believes that the core pathological mechanisms of COPD progress are through three successive stages:dysfunction in the ascent and descent of qi,deficiency of yang qi,and prolapse of the great qi,all of which stem from the disruption of the dynamic balance of qi.In response to this chain of qi imbalance,Professor Han develops three strategies:"strengthening the foundation","illuminating the central yang",and"lifting and correcting",which aim to regulate qi flow,support yang qi,and coordinate the three energizers in a phased manner.This approach seeks to achieve dynamic restoration and holistic balance of qi,with prescriptions carefully aligned with the dynamic balance and pathological changes of qi,yielding distinctive therapeutic effects.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.

Objective:The emergence of polymyxin-resistant Klebsiella pneumoniae(KPN)in clinical settings necessitates an analysis of its antibiotic resistance characteristics,epidemiological features,and risk factors for its development.This study aims to provide insights for the prevention and control of polymyxin-resistant KPN infections. Methods:Thirty clinical isolates of polymyxin-resistant KPN were collected from the Third Xiangya Hospital of Central South University.Their antibiotic resistance profiles were analyzed.The presence of carbapenemase KPC,OXA-48,VIM,IMP,and NDM was detected using colloidal gold immunochromatography.Hypervirulent KPN was initially screened using the string test.Biofilm formation capacity was assessed using crystal violet staining.Combination drug susceptibility tests(polymyxin B with meropenem,tigecycline,cefoperazone/sulbactam)were conducted using the checkerboard method.Polymyxin-related resistance genes were detected by PCR.Multi-locus sequence typing(MLST)was performed for genotyping and phylogenetic tree construction.The study also involved collecting data from carbapenem-resistant(CR)-KPN polymyxin-resistant strains(23 strains,experimental group)and CR-KPN polymyxin-sensitive strains(57 strains,control group)to analyze potential risk factors for polymyxin-resistant KPN infection through univariate analysis and multivariate Logistic regression.The induction of resistance by continuous exposure to polymyxin B and colistin E was also tested. Results:Among the 30 polymyxin-resistant KPN isolates,28 were CR-KPN,all producing KPC enzyme.Four isolates were positive in the string test.Most isolates showed strong biofilm formation capabilities.Combination therapy showed additive or synergistic effects.All isolates carried the pmrA and phoP genes,while no mcr-1 or mcr-2 genes were detected.MLST results indicated that ST11 was the predominant type.The phylogenetic tree suggested that polymyxin-resistant KPN had not caused a hospital outbreak in the institution.The use of two or more different classes of antibiotics and the use of polymyxin were identified as independent risk factors for the development of polymyxin-resistant strains.Continuous use of polymyxin induced drug resistance. Conclusion:Polymyxin-resistant KPN is resistant to nearly all commonly used antibiotics,making polymyxin-based combination therapy a viable option.No plasmid-mediated polymyxin-resistant KPN has been isolated in the hospital.Polymyxin can induce resistance in KPN,highlighting the need for rational antibiotic use in clinical settings to delay the emergence of resistance.

ObjectiveTo provide technical support for the molecular surveillance of pathogenic bacteria strains carrying mobile colistin resistance-1 （mcr⁃1） gene isolate from inlet of wastewater treatment plants （WWTP）. MethodsThe Enterobacteriaceae strains carrying mcr⁃1 resistance gene isolate from inlet of WWTP during April 1 to June 30， 2023 in Shanghai were cultured on blood-rich and SS culture medium and were identified using a mass spectrometry analyzer. The mcr⁃1 gene and copy number were detected by real-time fluorescence quantitative PCR. Drug susceptibility test was performed by microbroth dilution method. The copy numbers of Escherichia coli carrying mcr⁃1 gene isolated from wastewater and human fecel were statistically analyzed by SPSS 25.0. ResultsA total of 14 strains carrying the mcr⁃1 gene were isolated from 49 WWTP samples， and the positive isolation rate was 28.6%， including 12 non-diarrheal E. coli strains and 2 Klebsiella pneumoniae strains. The drug susceptibility results showed that all 14 strains were multi-drug resistant bacteria. They were all sensitive to imipenem and tigecycline， but were ampicillin- and cefazolin-resistant. There was no significant difference in the copy number between human-sourced diarrheal E. coli and wastewater-sourced non-diarrheal E. coli （t=0.647， P>0.05）. ConclusionThe isolation and identification of strains carrying the mcr⁃1 gene from inlet of WWTP samples were firstly established in Shanghai. The multi-drug resistance among the isolated strains is severe. To effectively prevent and control the spread of colistin-resistant bacteria， more attention should be paid to the surveillance of mcr⁃1 gene.

Objective:To analyze the clinical characteristics of patients with nocardiosis, so as to improve the diagnosis and treatment of nocardia infection in the future.Methods:From May 2016 to October 2020, 24 patients with nocardiosis in Xiangya Hospital, Central South University were enrolled, and their clinical data including clinical features, laboratory examinations, imaging findings, diagnosis and treatment process, and outcome were retrospectively analyzed.Results:Among the 24 patients with nocardiosis, 18 cases (75.0%) were males, and the median age was 54.5 years.Twenty-three patients had underlying diseases, of which the most common disease was antineutrophil cytoplasmic antibody-related vasculitis (16.7%(4/24)). Of nine species of Nocardia identified from the 24 patients, Nocardia farcinica was the most common species (seven cases). The lesion sites were mainly lungs (70.8%(17/24)), skin and soft tissues (42.0%(10/24)), brain (25.0%(6/24)) and blood system (17.0%(4/24)). There were 12 cases (50.0%) of patients with more than two lesion sites. The clinical manifestations, imaging examinations and laboratory tests of the 24 patients were not specific. The diagnosis depended on the etiology. Nineteen patients received trimethoprim-sulfamethoxazole-based combination therapy, and two were discontinued due to adverse reactions of sulfa drugs. After treatment, 19 cases (79.2%) were improved and five cases (20.8%) died. Conclusions:Patients with nocardiosis often have atypical clinical manifestations, and multiple organs are easily affected.Early and accurate identification and rapid and effective anti-biotic therapy are the keys to improve the overall prognosis of these patients.

Genomic studies of cancer cell alterations,such as mutations,copy number variations(CNVs),and translocations,greatly promote our understanding of the genesis and development of cancers.However,the 3D genome architecture of cancers remains less studied due to the complexity of cancer genomes and technical difficulties.To explore the 3D genome structure in clin-ical lung cancer,we performed Hi-C experiments using paired normal and tumor cells harvested from patients with lung cancer,combining with RNA sequenceing analysis.We demonstrated the feasibility of studying 3D genome of clinical lung cancer samples with a small number of cells(1×104),compared the genome architecture between clinical samples and cell lines of lung cancer,and identified conserved and changed spatial chromatin structures between normal and cancer sam-ples.We also showed that Hi-C data can be used to infer CNVs and point mutations in cancer.By integrating those different types of cancer alterations,we showed significant associations between CNVs,3D genome,and gene expression.We propose that 3D genome mediates the effects of cancer genomic alterations on gene expression through altering regulatory chromatin structures.Our study highlights the importance of analyzing 3D genomes of clinical cancer samples in addition to cancer cell lines and provides an integrative genomic analysis pipeline for future larger-scale studies in lung cancer and other cancers.