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In recent years, the number of clinical practice guidelines for the integration of traditional Chinese medicine (TCM) and western medicine(WM) has been increasing year by year. However, there are obvious problems of "knot without compatibility". The recommendations of TCM and WM are mostly independent, inconsistent with the actual clinical diagnoses and treatment processes, and lacking in important information. All the above issues are unable to bring the role of the cooperation between TCM and WM in improving clinical practice. In order to achieve the organic integration of Chinese and western medicine, the research team has carried out methodological research in response to the above-mentioned problems. In November 2023, China Association for Standardization released the Specifications for Developing Clinical Practice Guidelines for Organic Integration of Traditional Chinese and Western Medicine at the 6th-8th Academic Annual Meeting of the Clinical Research Branch of China Information Association of Traditional Chinese Medicine. Therefore, this paper interprets the formulation process, scope of application and main content of the specification, with the aim of improving the overall quality of related research and promoting the collaborative development of the integration of TCM and WM.

Objective To explore the construction of a real-world data annotation platform, and compare the real-world data extraction performance of retrieval augmented generation (RAG) combined with large language models and pre-training fine-tuning methods for pre-trained language models.Methods Taking the pathological records of bladder cancer in the real world electronic medical record data as an example, a real-world data annotation platform was built. Based on the platform annotation data, the effects of automatic extraction of cancer typing and staging of bladder cancer using RAG combined with GPT-3.5, and the pre- training fine tuning method based on BERT and RoBERTa models were compared. Results The extraction effects of the pre-training and fine-tuning model based on the fine-tuning of the full-training set were better than that of RAG combined with large model method and pre-training and fine-tuning model with the few-shot fine-tuning, and the effects of RoBERTa model were generally better than that of BERT model, but the extraction effects of these methods needs to be improved totally. The F1 scores for extracting bladder cancer typing, T staging, and N staging in the test set, using the RoBERTa model fine-tuned with the entire training set, were 71.06%, 50.18%, and 73.65% respectively. Conclusion Pre-trained language models have the application potential in processing clinical unstructured data, but there is still room for improvement in the information extraction effect of existing methods. Future work requires further optimization of models or training strategies to accelerate data empowerment.

Abstract Background Mycoplasma pneumoniae (MP) is a common respiratory pathogen affecting the longevity of the elderly and the health of children. However, the human vaccine against MP has not been successfully developed till now due to the poor immunogenicity and side effects of MP inactivated or attenuated vaccine. Therefore, it is necessary to develop a MP genetic engineering vaccine with influenza virus strain as vector. Methods In this study, the major antigen genes P1a of MP adhesion factor P1(3862‐4554 bases) and P30a of P30(49‐822 bases) were inserted into the nonstructural protein (NS) gene of Influenza A virus strain A/Puerto Rio/8/34(H1N1), PR8 for short, to construct the recombinant vectors NS‐P1a or NS‐P30a. The recombinant pHW2000 plasmids containing NS‐P1a or NS‐P30a were cotransfected with the rest 7 fragments of PR8 into HEK293T cells. After inoculating chicken embryos, the recombinant influenza viruses rFLU‐P1a and rFLU‐P30a were rescued. RT‐PCR and sequencing were used to identify the recombinant viruses. The hemagglutination titers of rFLU‐P1a and rFLU‐P30a were determined after five successive generations in chicken embryos so as to indicate the genetic stability of the recombinant viruses. The morphology of recombinant influenza viruses was observed under electron microscopy. Results P1a or P30a was designed to be inserted into the modified NS gene sequence separately and synthesized successfully. RT‐PCR identification of the recombinant viruses rFLU‐P1a and rFLU‐P30a showed that P1a (693 bp), P30a (774 bp), NS‐P1a (1992bp) and NS‐P30a (2073 bp) bands were found, and the sequencing results were correct. After five successive generations, each virus generation has a certain hemagglutination titer (from 1:32 to 1:64), and the band of P1a or P30a can be seen in the corresponding positions. The virus particles under the electron microscope appeared as spheres or long strips connected by several particles, revealing a complete viral membrane structure composed of virus lipid bilayer, hemagglutinin, neuraminidase, and matrix proteins. Conclusion The recombinant viruses rFLU‐P1a and rFLU‐P30a which carried the advantaged immune regions of the P1 and P30 genes in MP were successfully constructed and identified. And the genetic stability of rFLU‐P1a or rFLU‐P30a was relatively high. The typical and complete morphology of influenza virus was observed under the electron microscope. Our research provided a foundation for the further development of MP vaccines for human.

With the development of medical big data, the real-world study (RWS) has received increasing attention in recent years, and has a good promising prospect. However, there are still some challenges in the implementation of RWS that has led to extensive discussion among scholars. The most urgent issue currently to be addressed is the unstructured nature of real-world data (RWD). Based on regular expressions, this study used rule-based information extraction method to extract structured information from admission records, pathological reports, surgical records, and image records of bladder cancer patients in Zhongnan Hospital of Wuhan University in recent years, and evaluated the extraction effects with accuracy and recall as indicators, aiming to provide reference for subsequent research.

Objective To analyze the characteristics of the terminology of clinical practice guidelines and learn the expression of terminology of guidelines, to provide some reference for the research and construction of the guidelines ontology.Methods UMLS, SNOMED-CT, MeSH, OBI, schema.org, CMeSH, TCM clinical terminology, and TCMLS were systematically searched to identify and extract the terms of the guidelines and analyze the classification structure and mapping relationship of the terms of the guidelines in the ontology.Results The terms "guideline", "level of evidence" and "recommendation" were retrieved, and the hierarchical relationship, conceptual representation, and mapping relationship between the terms were analyzed.Conclusion The relevant terms of the guidelines still need to be further improved. Standardized terminology of the guidelines can eliminate the uncertainty of concepts, facilitate the development of the guidelines, and promote the sharing and utilization of guidelines' evidence and recommendations among different countries and regions.

Clinical practice guidelines are an important basis for clinical decision-making, but there are still many factors that prevent physicians from following the guidelines. One of the problems, the limited external validity of the guidelines, ultimately prevents the guidelines from providing an adequate basis for clinical decision-making, thus forming the gap between the guidelines and clinical decisions. Real-world research can enhance the external validity of the guidelines, provide a basis for clinical decision-making, and offer localized evidence for the guidelines, evidence of cost-effectiveness and other evidence for the guidelines. It can also monitor the implementation of the guidelines and help to make up for the lack of evidence in the formulation of traditional guidelines. Therefore, high-quality real-world studies and real-world evidence may be considered in the guideline development process to facilitate guideline optimization and serve as an aid to guideline quality improvement.

In this study, the influence of two distinct reactive aggregate dosages on the alkali–silica reaction (ASR) of concrete was investigated. The expansion ratio, axial compressive strength, splitting tensile strength, and relative dynamic elastic modulus (RDEM) of concrete were considered as the main parameters to study the failure criteria of concrete induced by ASR at 40°C. Microscopic experiments, such as scanning electron microscopy and X-ray computed microtomography, were applied to analyze the damage induced by ASR on the concrete prisms and the propagation of internal cracks of the reactive aggregates in nanospace. The results showed that the two ranges can be used as the failure criteria produced by the ASR of concrete containing 3 and 6% dosages of reactive aggregates at 40°C, respectively, when the RDEM of concrete was reduced to 70‒75% and 85‒90%. Additionally, the results of CT indicated that microcracks tended to extend from the initial defects of aggregate to the cement slurry. Meanwhile, ASR gel packed with the pores, which reduced the porosity. It was noteworthy that the adhesive force between the ASR gel and the cement matrix after filling pores could not make up for the loss of the mechanical properties of concrete.

The significance of the existence of clinical practice guidelines lies in their implementation, however, there are still many problems in the implementation of guidelines and bottlenecks in the translation of clinical evidence. The introduction of knowledge graph technology provides a solid foundation for guideline intel-ligence and a good tool for solving guideline implementation problems. The combined Traditional Chinese Medi-cine (TCM)/ Integrated Traditional Chinese and Western Medicine (IM) reflect the characteristics of the healthcare system in China. Using the current status of TCM/IM diagnosis and treatment of cardiovascular diseases and the current problems in the application of TCM/IM guidelines for cardiovascular diseases, this study defined the objectives of constructing a knowledge graph for TCM/IM clinical guidelines for cardiovascular diseases, and accordingly designed a knowledge graph framework for TCM/IM clinical guidelines that is con-sistent with professional knowledge and practical application. We analyzed the scope of the guidelines, ar-ranged their content and summarized their knowledge structure. We then established concept structure tables and entity semantic relationship tables. The design of the knowledge graph framework for TCM/IM guidelines proposed in this paper provides a basis for the digitization and communication of guidelines, and is conducive to promoting their implementation and dissemination.

Background/Aim. Macroangiopathy is the major cause of death and disability in type 2 diabetic patients. Studies have shown that liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, can protect cardiovascular system by inhibiting chronic inflammation of diabetes. However, a study about the effects of liraglutide on peripheral blood vessels and peripheral blood leukocytes has not been reported yet. The aim of this study was to determine vasculoprotective effect, vascular protection and mechanism of action of liraglutide in addition to its hypoglycemic effect. Methods. A total of 60 hospitalized patients with type 2 diabetes were recruited from December 2013 to December 2014 at the First Affiliated Hospital of Dalian Medical University, PR China. Before the treatment with liraglutide, height and weight were measured to calculate body mass index (BMI). Blood urea nitrogen (BUN) and so on were detected. Homeostasis model assessment of insulin resistance (HOMA-IR) and islet β cell function (HOMA-β) were computed. After applying liraglutide for three months, all indexes were measured again. The effects of liraglutide on these indexes were analyzed by paired sample t-test. Results. After the treatment with liraglutide, values of glycosylated hemoglobin ‒ HbA1c (8.46 ± 1.62 vs. 7.26 ± 1.40%) and 2h postprandial blood glucose ‒ 2hPBG (11.95 vs. 9.6 mmol/L) decreased significantly (p < 0.05). Body weight (87.3 vs. 82.5 kg) and BMI (30.37 vs. 28.63 kg/m2) decreased by 5.5% and 5.7%, respectively (p < 0.05). Also, levels of triglycerides (TG) (2.57 ± 1.54 vs. 1.81 ± 0.70 mmol/L) and LDL-cholesterol (2.92 ± 0.78 vs. 1.89 ± 0.66 mmol/L) reduced significantly (p < 0.05). Ankle-brachial index (ABI) decreased from 1.24 ± 0.10 to 1.14 ± 0.06 cm/s by 8%, while brachial-ankle pulse wave velocity (ba-PWV) decreased from 1,442.15 ± 196.26 to 1,316.85 ± 146.63 cm/s by 8.7%, and both differences were statistically significant (p < 0.001). Conclusion. Liraglutide, with a good hypoglycemic effect, can significantly reduce postprandial blood glucose and HbA1c, but cannot significantly improve fasting plasma glucose, insulin resistance and islet β cell function. It also considerably decreased body weight, BMI and TG. Liraglutide can significantly lower ba-PWV and ABI to protect peripheral blood vessels.

Glutamine synthetase (GS) catalyzes de novo synthesis of glutamine that facilitates cancer cell growth. In the liver, GS functions next to the urea cycle to remove ammonia waste. As a dysregulated urea cycle is implicated in cancer development, the impact of GS's ammonia clearance function has not been explored in cancer. Here, we show that oncogenic activation of β-catenin (encoded by CTNNB1) led to a decreased urea cycle and elevated ammonia waste burden. While β-catenin induced the expression of GS, which is thought to be cancer promoting, surprisingly, genetic ablation of hepatic GS accelerated the onset of liver tumors in several mouse models that involved β-catenin activation. Mechanistically, GS ablation exacerbated hyperammonemia and facilitated the production of glutamate-derived nonessential amino acids, which subsequently stimulated mechanistic target of rapamycin complex 1 (mTORC1). Pharmacological and genetic inhibition of mTORC1 and glutamic transaminases suppressed tumorigenesis facilitated by GS ablation. While patients with hepatocellular carcinoma, especially those with CTNNB1 mutations, have an overall defective urea cycle and increased expression of GS, there exists a subset of patients with low GS expression that is associated with mTORC1 hyperactivation. Therefore, GS-mediated ammonia clearance serves as a tumor-suppressing mechanism in livers that harbor β-catenin activation mutations and a compromised urea cycle.

Objective: To compare the electroencephalogram power spectrum of patients with primary insomnia and good sleep controls in multiple brain areas and different frequency bands during non-rapid eye movement sleep. Methods: 48 primary insomnias and 30 age-and gender-matched good sleep controls were recorded overnight with polysomnography. Power spectral analysis was performed in six brain areas (F3, F4, C3, C4, O1 and O2) and across seven frequency bands (delta, sigma, alpha, theta, beta1, beta2, and gamma) during non-rapid eye movement sleep between primary insomnias and good sleep controls. Results: In primary insomnias, there were significant differences in frequency bands and areas. Compared to good sleep controls, delta power was lower in primary insomnias, while beta1, beta2, and gamma were higher. Beta2 power was substantially higher in all areas, sigma power was significantly higher on the right side, and gamma power was considerably higher on the left side in primary insomnias. The Beta1 power was positively correlated the number of awakenings (r = 0.3291, p = 0.02) in primary insomnias on the right side. Conclusion: This study marked the first specialized comparison of power spectral analysis during non-rapid eye movement sleep in different areas and across different frequency bands. The result suggested that primary insomnias had reduced deep sleep (lower delta power) and hyperarousal state (higher beta 2 power). Primary insomnia was associated with significant fragmented sleep, and an increase in beta1 power was related to the number of awakenings. Significance: These findings revealed the hemispheric lateralization characteristics of power spectral disturbances during non-rapid eye movement sleep in primary insomnias and provided valuable insights for selecting electrode placements in future power spectral analyses of primary insomnias. [ABSTRACT FROM AUTHOR]

Background: Medical decision-making is a complex multi-stage process. Chinese cancer patients' preference for participation in decision-making stages, family involvement and influencing factors remain unclear. Methods: A total of 1,422 cancer patients from four tertiary hospitals in China were included in the cross-sectional survey. Patient Expectation for Participation in Medical Decision-making Scale was used to measure patients' information, deliberation and decisional control preferences. The patient-family Control Preferences Scale was used to measure expected and actual levels of family involvement. Generalized estimation equation was performed to explore factors associated with patients' preferences. Results: 93.0% of patients had a high preference for information exchange, 95.8% for treatment deliberation, and 61.7% for decisional control. Equal participation was most common in family involvement in decision-making, followed by family-led and patient-led. 15.5% of patients reported a discrepancy between expected and actual family involvement. Age, education, marital status, number of adult children, occupation, family income, regular residence, health insurance and time since diagnosis were related to patient preference. Compared to patients with other cancer sites, those with breast [odds ratio (OR) 2.02, 95%CI: 1.47–2.77] and thyroid cancer [OR 2.37, 95%CI: 1.82–3.10] had higher information preference, those with breast [OR 2.98, 95%CI: 2.73–3.26] and esophagus cancer [OR 2.86, 95%CI: 1.13–7.22] had higher deliberation preference, and thyroid cancer patients [OR 1.50, 95%CI: 1.07–2.10] had higher decisional control preference. Patients who expected or experienced equal participation had higher preference at all stages of decision-making than those with family-led involvement. Patients with inconsistent expected and actual family involvement had lower preferences for the deliberation [OR 0.53, 95%CI: 0.36–0.77] and decisional control stages [OR 0.67, 95%CI: 0.56–0.79]. Conclusions: Chinese cancer patients generally have high preference for information exchange and treatment deliberation, but varied preferences for decision control, influenced by patients' sociodemographic factors, cancer types, time since diagnosis and family involvement. The findings underscore the importance of tailoring medical decision-making processes to individual patient preferences and ensuring family involvement aligns with patient expectations to enhance patient-centered care in China. [ABSTRACT FROM AUTHOR]