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 compare the different therapeutic efficacies between radiofrequency and cryoballoon ablation in atrial fibrillation(AF)patients with enlarged left atrium.Methods A total of 106 AF patients with enlarged left atrium(LAVI)>34ml/m2 who visited our center between December 2016 and May 2022 for catheter ablation were enrolled.They were divided into radiofrequency group(R-group)and cryoballoon group(C-group)according to the procedure.The recurrence of AF was compared between the two groups.Results The median follow-up time was 12 months and no death occurred.The rate of loss of follow-up was 3.8%.The overall recurrence rate of AF after ablation was 36.8%.There was no significant difference in clinical baseline between the two groups(P>0.05).The radiofrequency group had longer operation time(P<0.001),shorter X-ray time and less exposure(P<0.05);There was no significant difference in clinical baseline and postoperative complications between the two groups(P>0.05).The results of survival analysis showed that there was no significant difference in the survival rate of patients without atrial fibrillation/atrial flutter/atrial tachycardia between the two groups(P>0.05).Conclusion For AF patients with enlarged left atrium,the clinical effects of the two methods were similar.Cryoballoon takes a shorter time,while radiofrequency has a lower X-ray time and exposure dose for physicians and patients.Therefore,appropriate ablation methods should be selected according to the actual situation.

Objective:To analyze the prognostic outcomes of 1 147 patients who underwent liver transplantation at Qingdao University Affiliated Hospital and to summarize measures to enhance the efficacy of liver transplantation.Methods:A retrospective analysis was conducted on the clinical and follow-up data of 1 147 liver transplant patients at Qingdao University Affiliated Hospital.Results:The overall postoperative 1-, 3-, and 5-year survival rates for the 1 147 liver transplant patients were 87.20%, 73.40%, and 65.60%, respectively. The survival rates for benign disease liver transplant recipients were 88.01%, 84.98%, and 81.39% at 1, 3, and 5 years post-transplant, respectively, compared to recipients transplanted for malignancies of 78.11%, 64.41%, and 60.06% (all P<0.001). Among the mid vs more recent period, patients' 1-year and 3-year postoperative survival rates were 84.20%, 70.80% vs 90.50%, 71.70%, respectively,significantly in favor of recently enrolled patients ( P=0.022). In the complex surgery group, patients' 1-, 3-, and 5-year survival rates were 82.70%, 65.50%, 56.70%, while in less complicated group, it was 89.00%, 76.50%, 69.20% ( P<0.001). The primary causes of death for benign disease recipients were multi-organ failure (4.1%), while in recipients with malignant disease primary cause of death was tumor recurrence (23.7%). Postoperative complications included primary graft dysfunction, delayed graft function recovery, portal vein thrombosis, hepatic artery thrombosis, biliary stricture, post-transplant lymphoproliferative disorder, and graft-versus-host disease, with occurrence rates of 1.05%, 6.89%, 1.92%, 0.44%, 2.00%, 0.61%, and 0.44%, respectively. Conclusions:With the continuous improvement in surgical techniques and perioperative care levels, the 3-year survival rate of recipients at our center has increased. Malignant diseases and complex liver transplantation remain crucial factors affecting recipient prognosis, highlighting the need to further enhance comprehensive treatment capabilities for patients with malignant diseases and complex surgeries.

Inflammation-driven endothelial dysfunction is the major initiating factor in atherosclerosis, while the underlying mechanism remains elusive. Here, we report that the non-canonical stimulator of interferon genes (STING)-PKR-like ER kinase (PERK) pathway was significantly activated in both human and mice atherosclerotic arteries. Typically, STING activation leads to the activation of interferon regulatory factor 3 (IRF3) and nuclear factor-kappa B (NF-κB)/p65, thereby facilitating IFN signals and inflammation. In contrast, our study reveals the activated non-canonical STING-PERK pathway increases scaffold protein bromodomain protein 4 (BRD4) expression, which encourages the formation of super-enhancers on the proximal promoter regions of the proinflammatory cytokines, thereby enabling the transactivation of these cytokines by integrating activated IRF3 and NF-κB via a condensation process. Endothelium-specific STING and BRD4 deficiency significantly decreased the plaque area and inflammation. Mechanistically, this pathway is triggered by leaked mitochondrial DNA (mtDNA) via mitochondrial permeability transition pore (mPTP), formed by voltage-dependent anion channel 1 (VDAC1) oligomer interaction with oxidized mtDNA upon cholesterol oxidation stimulation. Especially, compared to macrophages, endothelial STING activation plays a more pronounced role in atherosclerosis. We propose a non-canonical STING-PERK pathway-dependent epigenetic paradigm in atherosclerosis that integrates IRF3, NF-κB and BRD4 in inflammatory responses, which provides emerging therapeutic modalities for vascular endothelial dysfunction.

Objective:To investigate the application value of CT and MRI imageomics based on machine learning method in the diagnosis of pancreatic cancer.Methods:The clinical data of 62 patients with surgically resected and pathologically confirmed pancreatic cancer, who underwent enhanced CT scan, MRI plain or enhanced scan in Shanghai General Hospital between January 2014 and December 2021 were collected. According to the chronological order of surgery, 49 patients from January 2014 to December 2020 were enrolled in the training set and 13 patients from January 2021 to December 2021 were enrolled in the validation set. 3D-slicer 4.8.1 software was used to draw the region of interest in each layer of CT and MRI images for cancerous and paracancerous tissue segment. Image features were extracted by Python and the optimal feature set from the training set data was obtained by using Lasso regression model. The machine learning decision tree model was constructed. The receiver operating characteristic curve(ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the value of these three kinds of imageomics models in the diagnosis of pancreatic cancer.Results:The 1 767 CT features and 1 674 MRI features were obtained from enhanced CT scan, MRI plain scan and enhanced MRI scan, respectively. For the differential diagnosis model of cancerous tissue and paracancerous tissue, the enhanced CT scan data model obtained the optimal feature set involving 6 features, the MRI plain scan model obtained the optimal feature set involving 16 features, and the enhanced MRI scan model obtained the optimal feature set involving 15 features. The diagnostic model based on enhanced CT scan had an AUC of 0.98 in the training set and 1 in the verification group. The AUC of the MRI plain scan and enhanced MRI scan models in both the training set and the validation set was 1. The specificity and sensitivity of machine learning decision tree model based on the three kinds of imageomics models in the diagnosis of cancerous tissue and paracancerous tissue were 100%. For the differential diagnosis model of splenic artery wrapping, the enhanced CT scan model didn′t obtain the optimal features and had no diagnostic efficacy. The MRI plain scan model and enhanced MRI scan model obtained the optimal feature set involving 5 and 4 features, respectively. The AUC of the MRI plain scan model in the training set and the validation set were 0.862 and 0.750, respectively, with diagnostic sensitivity of 93.8% and 50.0%, and specificity of 78.6% and 100%, respectively. The AUC of the enhanced MRI scan model in the training set and the validation set were 0.950 and 0.861, respectively, with diagnostic sensitivity of 90.0% and 93.6%, and specificity of 100% and 78.6%, respectively.Conclusions:Based on the radiomics of CT enhanced, MRI plain scan and enhanced MRI scan, the machine learning diagnostic model has an accuracy of more than 90% in differentiating pancreatic cancer from paracancerous tissue. For the differentiation of splenic artery wrapping in pancreatic cancer, the diagnostic model based on enhanced MRI scan haS the best diagnostic efficiency.

ObjectiveTo investigate the relationship between lower limb muscle strength and walking speed in older adults, and to analyze the mediating role of flexibility and dynamic balance. MethodsFrom November to December, 2021, a total of 155 older adults at the Shanghai Senior Sports and Health Home were included. Their basic health information was collected, and the lower limb muscle strength, flexibility, dynamic balance and walking speed were tested. A mediated effects analysis was conducted. ResultsThere was a pairwise correlation among lower limb muscle strength, flexibility, dynamic balance and walking speed in older adults (r > 0.210, P < 0.01). In the mediated effects model, after controlling for age and gender, lower limb muscle strength did not directly predict walking speed in older adults (β = 0.029, P = 0.699), however, lower limb muscle strength could influence walking speed through the partial mediation of dynamic balance (effect = 0.0130, 95% CI 0.0073~0.0197) and the chain mediation of lower flexibility and dynamic balance (effect = 0.0019, 95% CI 0.0003~0.0043). ConclusionLower limb muscle strength can indirectly affect walking speed in older adults through the mediators of flexibility and dynamic balance, or the dynamic balance alone.

Objective: To analyze the effects of twirling reinforcing and reducing manipulations on protein expres-sion in parietal cortex of spontaneously hypertensive rats (SHRs), and elucidate the main mechanisms and differences between two manipulations in hypertension treatment. Methods: Rats were randomly divided into the control, model, twirling reinforcing manipulation (TRFM), and twirling reducing manipulation (TRDM) groups. The control and model groups received catch and fixation stimulations once a day for 14 days. The TRFM and TRDM groups were intervened once a day for 20 min for 14 days. On days 0, 2, 6, 10, and 14 after acupuncture, rat systolic blood pressures (SBPs) were measured. Differential protein (DP) expression in the rat parietal cortices was detected. Thereafter, GO functional significance and KEGG pathway enrichment analyses were performed. Results: Compared with the model group, SBP of rats in the TRDM and TRFM groups decreased on days 6 and 10 of acupuncture, respectively (P=.009; P<.001). Moreover, SBP of the TRDM group was signif-icantly lower than that of the TRFM group on days 10 and 14 of acupuncture (P = .015; P = .013). Compared with control group, 601 and 1040 DPs were up-and downregulated, respectively, in the model group. Compared with model group, 44 and 28 up-and downregulated DPs were expressed, respectively, in the TRFM group. Compared with model group, expression of 616 and 427 up-and downregulated DPs, respectively, was found in the TRDM group. After combining the results of GO and KEGG enrichment analyses, five and one pathways were found to be related to the central antihypertensive mechanism of the parietal cortex during twirling reducing and reinforcing manipulations, respectively. Conclusion: TRDM showed a more effective antihypertensive effect on SHRs than TRFM; this antihy-pertensive effect was related to the regulation of different proteins and their biological functions.

Objective To determine the predictive parameters of impacted ureteral stones and evaluate the predictive value of ureteral wall thickness for impacted ureteral stones.Methods A total of 93 patients with proximal ureteral stones from January 2017 to December 2017 were included in the study [71 males and 22 females,aged 30-80 years,and body mass index (23.7 ± 2.7) kg/m2].Both clinical and computed tomography urography (CTU) data were compared between patients with or without impacted ureteral stone,including sex,age,body mass index,renal pelvic diameter,longitudinal size of stone,transverse size of stone,stone surface area,stone volume,hounsfield units of stone,diameter of the ureter proximal to the stone,and ureteral wall thickness at the impacted ureteral stone site.The receiver operating characteristic curve (ROC) was used to analyze the performance of each of the above-mentioned parameters for predicting the impacted ureteral stones.Multivariate logistic regression analysis was used to select the independent risk factors of impacted ureteral stones.Results Among 93 patients,38 (40.8％) patients were with impacted stones and 55 (59.1％) without impacted stones.Univariate analysis showed significant difference in ureteral wall thickness (t =6.344,P ＜ 0.001),diameter of the ureter proximal to the stone (U =607.5,P =0.001),longitudinal size of stone(U =580.5,P ＜0.001),transverse size of stone(t =4.172,P ＜0.001),stone surface area(U =508.5,P ＜ 0.001),stone volume (U =508.5,P ＜ 0.001) and hounsfield units of stone (t =6.344,P =0.006) between patients with or without impacted stones.Ureteral wall thickness(UWT)showed the largest area under curve (AUC) among those parameters (AUC =0.825,P ＜ 0.001),followed by stone surface area and stone volume.The optimal cut-off value of ureteral wall thickness was 3.16 mm,with sensitivity of 71.1％ and specificity of 85.5％.Multivariate analysis showed that ureteral wall thickness (Wald =18.709,P ＜ 0.001) and stone volume (Wald =8.391,P =0.004) were independent predictors of impacted stones.Conclusion Ureteral wall thickness was related to the presence of impacted ureteral stones and could be used for predicting impacted ureteral stones.

Objective To understand the patients of congenital microtia malformation families knowledge of skin expander and influencing factors. Methods Self-made questionnaire to sample survey of 500 cases of our department (Plastic Surgery Hospital, Chinese Academy of Medical Sciences, the second microtia concer) patients′ families. Results 47.8％(239/500) of 500 patients of expander knowledge level is high, 41.2％(206/500) pass the exam, 11.0％(55/500) fall the exam, only 13.4％(67/500) really have a comprehensive understanding on expander achieve excellent. Scores of male and female were (16.06 ± 1.99) points and (16.39 ± 2.16) points, t = 1.752, P > 0.05, there was no statistically significant difference comparing the 2 group. Patients′ families score of different cultural levels, respectively (14.06 ± 2.36), (14.98 ± 2.02), (16.54 ± 2.00), (16.73 ± 1.88) points, F = 21.736, P < 0.01, difference of four groups was statistically significant. Different age patients′families score ( 16.21 ± 1.96), (16.62 ± 2.14), (14.86 ± 2.11), (13.98 ± 2.02), (13.73 ± 1.88) points, F = 15.685, P > 0.05, there was no statistically significant difference comparing the 5 groups. Patients with different professional families score (13.25 ± 2.19), (13.79±2.27), (16.08±1.89), (14.10±2.08), (14.13±2.35), (14.45±2.09), (14.56±1.75), (16.84± 1.81) points, F = 2.737, P < 0.01, difference of eight groups was statistically significant. Conclusions Congenital microtia patients′families skin expander knowledge needs to be improved, it is necessary to take various forms, conduct for families of expander knowledge through propaganda and education.

Glycosylation is the key step of the synthesis of GM3 ,its reaction conditions are very harsh ,the stereoselec‐tivities are usually poor ,and the configuration of anomeric carbon is difficult to control .Whetherαglycosidic bond can be con‐structed efficiently in sialylation reactions is an important criteria used to evaluate the reaction quality .Studies of GM3 and de‐rivatives methods generally relates to following areas :the choice of the donor compounds and receptor compounds ,the control of stereoselectivity ,and the development of some new glycosidic reaction catalyst .In recent years ,important progress has been made in this research area .Now ,we predominately make a summary and review on the progress of methods for the synthesis of GM3 and derivatives .