Evidence-based Clinical Chinese Medicine:What Has Changed Over the Past 20 Years

Chinese medicine has been used for centuries to treat a range of health conditions.This history has produced a wealth of classical literature,case studies and clinical research data detailing its use and effectiveness.However,high-quality and conclusive evidence that meets modern requirements for clinical decision support is lacking.This evidence gap limits the integration of Chinese medicine with contemporary medicine,which in turn limits global access and acceptance of Chinese medicine as a form of safe and effective health care.Over the past 20 years,researchers and organisations around the world,including the World Health Organization(WHO)and United Nations,have worked to support the integration of traditional medicines,such as Chinese medicine,with conventional medicines to improve global health care.This paper provides an overview of Chinese medicine studies published in the top four general medical journals(BMJ,JAMA,Lancet and New England Journal of Medicine)from February 2005 to February 2024 in the past 20 years to highlight the progress in the development of this evidence base.It also highlights key actions taken to promote evidence-based clinical Chinese medicine,including product and practitioner regulation,formalising education standards,and international collaborations.Research conducted at the China-Australia International Research Centre for Chinese Medicine demonstrates the benefits of such a collaboration.Through development of its unique and inclusive‘whole-evidence’approach,plus clinical studies and systematic reviews,the Centre has significantly contributed to the evidence base for clinical Chinese medicine.In addition,its high-impact papers and groundbreaking monographs have been cited in international conventional medicine guidelines.While progress has certainly been made during the past 20 years to build a stronger evidence base for clinical Chinese medicine,there is still a considerable gap that limits its integration with conventional medicine.Future funding and research are needed to continue this work and achieve to safe,effective and accessible traditional medicine as part of the WHO’s Universal Health Coverage strategy.

新《证据规定》:对虚假陈述当事人作出处罚

5月6日,北京市昌平区人民法院(以下简称昌平法院)在一起民间借贷纠纷案件中对作出虚假陈述的当事人罚款五万元,有力制裁了其不诚信诉讼的行为。5月1日,新修订的《最高人民法院关于民事诉讼证据的若干规定》(以下简称新《证据规定》)正式施行,其第六十六条明确规定了当事人的真实陈述义务。该案系北京法院首例适用此规定对虚假陈述当事人作出处罚的案件。本文结合该案对当事人虚假陈述的类型与法律规制进行阐述。

Bayesian network model for traffic flow estimation using prior link flows

In order to estimate traffic flow a Bayesian network BN model using prior link flows is proposed.This model sets link flows as parents of the origin-destination OD flows. Under normal distribution assumptions the model considers the level of total traffic flow the variability of link flows and the violation of the conservation law.Using prior link flows the prior distribution of all the variables is determined. By updating some observed link flows the posterior distribution is given.The variances of the posterior distribution normally decrease with the progressive update of the link flows. Based on the posterior distribution point estimations and the corresponding probability intervals are provided. To remove inconsistencies in OD matrices estimation and traffic assignment a combined BN and stochastic user equilibrium model is proposed in which the equilibrium solution is obtained through iterations.Results of the numerical example demonstrate the efficiency of the proposed BN model and the combined method.

Temporal-Spatial Variances of Holocene Precipitation at the Marginal Area of the East Asian Monsoon Influences from Pollen Evidence

The woodland-steppe ecotone in the. southern Nei Mongol Plateau is located at the northern edge of the east Asian monsoon influences. A marked southeastern - northwestern (SE - NW) precipitation gradient exists in this region. Quantitative reconstruction of palaeo-precipitation of this region is helpful to reveal the development of monsoon climate and to predict die future desertification. Based on modern vegetation and surface pollen studies, a pollen-precipitation transfer function in the study region was established. Pollen data from three sediment sequences within the ecotone were used to reconstruct palaeo-precipitation during the Holocene. The processes of precipitation changes in the three sequences were quite different. There was a tendency of precipitation declined from the onset of the Holocene to 1 100 a BP in Haoluku. But, in Liuzhouwan and Xiaoniuchang, both located south of Haoluku, the annual precipitation reached highest values during 7 800 - 6 200 a BP and 7 200 - 5 000 a BP, respectively. The influences of southwestern (SW) monsoon and the variances of topographical conditions have possibly caused these temporal-spatial variances.

Structural damage detection method based on information fusion technique

Multi-source information fusion （MSIF） is imported into structural damage diagnosis methods to improve the validity of damage detection. After the introduction of the basic theory, the function model, classifications and mathematical methods of MSIF, a structural damage detection method based on MSIF is presented, which is to fuse two or more damage character vectors from different structural damage diagnosis methods on the character-level. In an experiment of concrete plates, modal information is measured and analyzed. The structural damage detection method based on MSIF is taken to localize cracks of concrete plates and it is proved to be effective. Results of damage detection by the method based on MSIF are compared with those from the modal strain energy method and the flexibility method. Damage, which can hardly be detected by using the single damage identification method, can be diagnosed by the damage detection method based on the character-level MSIF technique. Meanwhile multi-location damage can be identified by the method based on MSIF. This method is sensitive to structural damage and different mathematical methods for MSIF have different preconditions and applicabilities for diversified structures. How to choose mathematical methods for MSIF should be discussed in detail in health monitoring systems of actual structures.

INTELLIGENT FUSION FOR AEROENGINE WEAR FAULT DIAGNOSIS

Four common oil analysis techniques, including the ferrography analysis （FA）, the spectrometric oil analysis （SOA）, the particle count analysis （PCA）, and the oil quality testing （OQT）, are used to implement the military aeroengine wear fault diagnosis during the test drive process. To improve the precision and the reliability of the diagnosis, the aeroengine wear fault fusion diagnosis method based on the neural networks （NN） and the Dempster-Shafter （D-S） evidence theory is proposed. Firstly, according to the standard value of the wear limit, original data are pre-processed into Boolean values. Secondly, sub-NNs are established to perform the single diagnosis, and their training samples are dependent on experiences from experts. After each sub-NN is trained, diagnosis results are obtained. Thirdly, the diagnosis results of each sub-NN are considered as the basic probability allocation value to faults. The improved D-S evidence theory is applied to the fusion diagnosis, and the final fusion results are obtained. Finally, the method is verified by a diagnosis example.

Evidence That the Auxin Signaling Pathway Interacts with Plant Stress Response

Auxin influences a variety of developmental and physiological processes. Early reports, suggested that auxin might affect plant stress response. We have identified a number of auxin responsive genes in Arabidopsis thaliana (L.) Heynh. by using cDNA an-ay and found that stress responsive genes, such as,Arabidopsis homolog of MEK kinase 1 (ATMEKK1), ReL/SpoT homolog 3 ( At-RSH3), Catalase 1 ( Cat1) and Ferritin 1 (Fer1), were down-regulated by auxin, indicating that auxin regulates ale expression of stress responsive genes. We also demonstrated that nitrilase genes, nitrilase I ( NIT]) and nitrilase 2 (NIT2) involving in indole-3-acetic acid (IAA) biosynthesis, were induced by salinity stress, suggesting that the level of IAA might increase in response to salinity stress. To dissect the signal pathway involved in the interaction, two auxin insensitive mutants, auxin resistant 2 (axr2) and auxin resistant 1-3 (axrl-3) were used. Stress responsive genes were induced by salt stress in wild type and axr2, but not in axr1-3. The result suggests that die interaction between auxin and stress responses may be linked in the ubiquitin pathway.

Security of Application System

A safe and reliable application system frame based on Internet and Intranet for Stock Supervision and Administration Council of China is built up. An all sided, multi tier and multi technical security method has been adopted, which includes identity recognition, data encryption, digital signature, Domino and WWW servers, access control list, directory service, certificate authorization server, IC card and so on. The recognition system based on CA server is a high efficient, convenient and reliable system. The encryption technology and security method are proved to be reliable. The recognition system is of high security and is worthy of being popularized in some places where some special security requirements need meeting. Multi tier technology can improve the security of database. Double keys method is a useful data encryption method.

对我国释明权相关民事规则的评析

通过弥补辩论主义下当事人形式平等的弊端,促进真实的发现和实质正义的实现,释明权制度在民事诉讼中发挥着其不可取代的价值。对我国民事诉讼规则层面有关释明权的相关规定评析后发现:我国目前在释明权制度构建上存在着释明权规范的表现位阶低,对法官释明权的行使缺乏原则性的规范,现有释明权规定的条文不完善、不明确、可操作性差等一系列问题。要配合当下民事审判改革的方向,充分发挥释明权在我国民事诉讼中的作用,现有这些规定就有待进一步的精致化和具体化。

Application of seismic multi-attribute fusion method based on D-S evidence theory in prediction of CBM-enriched area

D-S evidence theory provides a good approach to fuse uncertain inlbrmation. In this article, we introduce seismic multi-attribute fusion based on D-S evidence theory to predict the coalbed methane （CBM） concentrated areas. First, we choose seismic attributes that are most sensitive to CBM content changes with the guidance of CBM content measured at well sites. Then the selected seismic attributes are fused using D-S evidence theory and the fusion results are used to predict CBM-enriched area. The application shows that the predicted CBM content and the measured values are basically consistent. The results indicate that using D-S evidence theory in seismic multi-attribute fusion to predict CBM-enriched areas is feasible.

Nutrition and physical activity in NAFLD:An overview of the epidemiological evidence

Nonalcoholic fatty liver disease(NAFLD)has been recognized as a major health burden.The high prevalence of NAFLD is probably due to the contemporary epidemics of obesity,unhealthy dietary pattern,and sedentary lifestyle.The efficacy and safety profile of pharmacotherapy in the treatment of NAFLD remains uncertain and obesity is strongly associated with hepatic steatosis;therefore,the first line of treatment is lifestyle modification.The usual management of NAFLD includes gradual weight reduction and increased physical activity(PA)leading to an improvement in serum liver enzymes,reduced hepatic fatty infiltration,and,in some cases,a reduced degree of hepatic inflammation and fibrosis.Nutrition has been demonstrated to be associated with NAFLD and Non-alcoholic steatohepatitis(NASH)in both animals and humans,and thus serves as a major route of prevention and treatment.However,most human studies are observational and retrospective,allowing limited inference about causal associations.Large prospective studies and clinical trials are now needed to establish a causal relationship.Based on available data,patients should optimally achieve a 5%-10%weight reduction.Setting realistic goals is essential for long-term successful lifestyle modification and more effort must be devoted to informing NAFLD patients of the health benefits of even a modest weight reduction.Furthermore,all NAFLD patients,whether obese or of normal weight,should be informed that a healthy diet has benefits beyond weight reduction.They should be advised to reduce saturated/trans fat and increase polyunsaturated fat,with special emphasize on omega-3 fatty acids.They should reduce added sugar to its minimum,try to avoid soft drinks containing sugar,including fruit juices that contain a lot of fructose,and increase their fiber intake.For the heavy meat eaters,especially those of red and processed meats,less meat and increased fish intake should be recommended.Minimizing fast food intake will also help maintain a healthy diet.PA should be integrated into behavioral therapy in NAFLD,as even small gains in PA and fitness may have significant health benefits.Potentially therapeutic dietary supplements are vitamin E and vitamin D,but both warrant further research.Unbalanced nutrition is not only strongly associated with NAFLD,but is also a risk factor that a large portion of the population is exposed to.Therefore,it is important to identify dietary patterns that will serve as modifiable risk factors for the prevention of NAFLD and its complications.

Pancreaticobiliary reflux in patients with a normal pancreaticobiliary junction:Pathologic implications

Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years.This editorial reviews the current knowledge on this condition and its pathological implications on gallbladder diseases.The following aspects were def ined appropriate for discussion:(1) Evidence of carcinogenesis associated with pancreaticobiliary reflux;(2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction;and(3) Evidence of sphincter of Oddi(SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary junction.The articles reviewed were selected and classif ied according to f ive levels of evidence:Level-this condition.Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance,the current evidence does not fully support what has been suggested.Studies with evidence level Ι have not been undertaken.This is a fascinating subject of study,and if finally supported by evidence level Ι,the importance of this condition will constitute a major breakthrough in biliary pathology.

Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences

Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Here, we review the management of women with breast cancer during pregnancy(BCP), focusing on biology, diagnosis and staging, local and systemic treatments, obstetric care and long-term follow-up of children with prenatal exposure to anticancer treatments.

A new fusion approach based on distance of evidences

Based on the framework of evidence theory, data fusion aims at obtaining a single Basic Probability Assignment (BPA) function by combining several belief functions from distinct information sources. Dempster’s rule of combination is the most popular rule of combinations, but it is a poor solution for the management of the conflict between various information sources at the normalization step. Even when it faces high conflict information, the classical Dempster-Shafer’s (D-S) evidence theory can involve counter-intuitive results. This paper presents a modified averaging method to combine conflicting evidence based on the distance of evidences; and also gives the weighted average of the evidence in the system. Numerical examples showed that the proposed method can realize the modification ideas and also will provide reasonable results with good convergence efficiency.

Canadian Agility and Movement Skill Assessment(CAMSA):Validity, objectivity, and reliability evidence for children 8–12 years of age

Purpose: The primary aim of this study was to develop an assessment of the fundamental, combined, and complex movement skills required to support childhood physical literacy. The secondary aim was to establish the feasibility, objectivity, and reliability evidence for the assessment.Methods: An expert advisory group recommended a course format for the assessment that would require children to complete a series of dynamic movement skills. Criterion-referenced skill performance and completion time were the recommended forms of evaluation. Children, 8–12 years of age, self-reported their age and gender and then completed the study assessments while attending local schools or day camps. Face validity was previously established through a Delphi expert(n = 19, 21% female) review process. Convergent validity was evaluated by age and gender associations with assessment performance. Inter-and intra-rater(n = 53, 34% female) objectivity and test–retest(n = 60, 47% female) reliability were assessed through repeated test administration.Results: Median total score was 21 of 28 points(range 5–28). Median completion time was 17 s. Total scores were feasible for all 995 children who self-reported age and gender. Total score did not differ between inside and outside environments(95% confidence interval(CI) of difference:-0.7 to 0.6;p = 0.91) or with/without footwear(95%CI of difference:-2.5 to 1.9; p = 0.77). Older age(p < 0.001, η2= 0.15) and male gender(p < 0.001, η2= 0.02)were associated with a higher total score. Inter-rater objectivity evidence was excellent(intraclass correlation coefficient(ICC) = 0.99) for completion time and substantial for skill score(ICC = 0.69) for 104 attempts by 53 children(34% female). Intra-rater objectivity was moderate(ICC = 0.52) for skill score and excellent for completion time(ICC = 0.99). Reliability was excellent for completion time over a short(2–4 days; ICC = 0.84) or long(8–14days; ICC = 0.82) interval. Skill score reliability was moderate(ICC = 0.46) over a short interval, and substantial(ICC = 0.74) over a long interval.Conclusion: The Canadian Agility and Movement Skill Assessment is a feasible measure of selected fundamental, complex and combined movement skills, which are an important building block for childhood physical literacy. Moderate-to-excellent objectivity was demonstrated for children 8–12 years of age. Test–retest reliability has been established over an interval of at least 1 week. The time and skill scores can be accurately estimated by 1 trained examiner.

Advanced gastric cancer:Is there enough evidence to call second-line therapy standard?

Gastric cancer and cancer of the gastro-oesophageal junction(GOJ) are the 4th most common cancer diagnoses worldwide with regional differences in incidence rates.The treatment of gastric and GOJ cancers is complex and requires multimodality treatment including chemotherapy treatment,surgery,and radiotherapy.During the past decade considerable improvements were achieved by advanced surgical techniques,tailored chemotherapies/radiotherapy and technical innovations in clinical diagnostics.In patients with advanced or metastatic gastric/GOJ cancer systemic chemotherapy with fluoropyrimidine/platinum-based regimens(+/-human epidermal growth factor receptor-2 antibody) is the mainstay of treatment.Despite these improvements,the clinical outcome for patients with advanced or metastatic disease is generally poor with 5-year survival rates ranging between 5%-15%.These poor survival rates may to some extent be related that standard therapies beyond first-line therapies have never been defined.Considering that this patient population is often not fit enough to receive further treatments there is an increasing body of evidence from phase-2 studies that in fact second-line therapies may have a positive impact in terms of overall survival.Moreover two recently published phase-3 studies support the use of second-line chemotherapy.A South Korean study compared either,irinotecan or docetaxel with best supportive care and a German study compared irinotecan with best supportive care-both studies met their primary endpoint overall survival.In this "Field of Vision" article,we review these recently published phase-3 studies and put them into the context of clinical prognostic factors helping to guide treatment decisions in patients who most likely benefit.

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis.METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed.RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitisin the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.

Review of salt consumption and stomach cancer risk:Epidemiological and biological evidence

Stomach cancer is still the fourth most common cancer;thus,it remains an important public health burden worldwide,especially in developing countries.The remarkable geographic variations in the rates of stomach cancer indicate that dietary factors,including a range of food groups to which salt and/or nitrates have been added,may affect stomach cancer risk.In this paper,we review the results from ecologic,case-control and cohort studies on the relationship between salt or salted foods and stomach cancer risk.The majority of ecological studies indicated that the average salt intake in each population was closely correlated with gastric cancer mortality.Most case-control studies showed similar results,indicating a moderate to high increase in risk for the highest level of salt or salted food consumption.The overall results from cohort studies are not totally consistent,but are suggestive of a moderate direct association.Since salt intake has been correlated with Helicobacter pylori(H pylori) infection,it is possible that these two factors may synergize to promote the development of stomach cancer.Additionally,salt may also cause stomach cancer through directly damaging gastric mucus,improving temporary epithelial proliferation and the incidence of endogenous mutations,and inducing hypergastrinemia that leads to eventual parietal cell loss and progression to gastric cancer.Based on the considerable evidence from ecological,case-control and cohort studies worldwide and the mechanistic plausibility,limitation on salt and salted food consumption is a practical strategy for preventing gastric cancer.

Early warning of rock mass instability based on multi-field coupling analysis and microseismic monitoring

In order to overcome the limitation that rock mass instability warnings are caused by a lack of deep consideration of the inherent mechanism of disaster formation, early warning signs of rock mass instability were detected and multi-field coupling was analyzed. A multi-field coupling model of a damaged rock mass was established. The relationship between microseismic activity parameters and rock mass stability was analyzed, and a multi-parameter early warning index system was established and its solution program was compiled. Based on the D-S data fusion theory,an early warning model of rock mass instability combining multi-field coupling analysis and microseismic monitoring was constructed. Taking an underground mine stope as an object, the multi-field coupling model and its solution program were used to analyze mining response characteristics. The seismic field data were used to verify the accuracy of the multi-field coupling analysis. The early warning model was used to predict the instability of stope rock mass,and the early warning result is consistent with a real-world scenario.

Anti-angiogenesis in hepatocellular carcinoma treatment: Current evidence and future perspectives

Hepatocellular carcinoma(HCC) is among the most common cancer diseases worldwide.Arterial hypervascularisation is an essential step for HCC tumorigenesis and can be targeted by transarterial chemoembolization(TACE).This interventional method is the standard treatment for patients with intermediate stage HCC,but is also applied as "bridging" therapy for patients awaiting liver transplantation in many centers worldwide.Usually the devascularization effect induced by TACE is transient,consequently resulting in repeated cycles of TACE every 4-8 wk.Despite documented survival benefits,TACE can also induce the up-regulation of proangiogenic and growth factors,which might contribute to accelerated progression in patients with incomplete response.In 2007,sorafenib,a multi-tyrosine kinase and angiogenesis inhibitor,was approved as the first systemic treatment for advanced stage HCC.Other active targeted compounds,either inhibitors of angiogenesis and/or growth factors,are currently being investigated in numerous clinical trials.To overcome revascularisation or tumor progression under TACE treatment it seems therefore attractive to combine TACE with systemic targeted agents,which might theoretically block the effects of proangiogenic and growth factors.Over the last 12 mo,several retrospec-tive or prospective cohort studies combining TACE and sorafenib have been published.Nevertheless,robust results of the efficacy and tolerability of such combination strategies as proven by randomized,controlled trials are awaited in the next two years.