As the core vehicle for preserving and transmitting traditional Chinese medicine（TCM） academic thought and clinical experience， the establishment of a robust quality evaluation system for TCM clinical case reports is a crucial component in the current standardization and modernization of TCM. Based on the practical experience of constructing the China Clinical Cases Library of Traditional Chinese Medicine by the China Association of Chinese Medicine， this study conducted a comprehensive analysis of critical challenges， including insufficient authenticity and unfocused evaluation criteria. It proposed a three-dimensional evaluation framework grounded in the structure-process-outcome logic， encompassing three dimensions of authenticity and standardization， characteristics and advantages， application and translational impact. This framework integrated 12 key evaluation indicators in a systematic manner. The model preserved the academic characteristics of TCM syndrome differentiation and treatment， while aligning with modern scientific research standards， achieving a balance between individualized TCM experience and standardized evaluation. Concurrently， this study provided theoretical foundations and methodological guidance for evaluating the quality of TCM clinical cases， contributing significantly to the inheritance of TCM knowledge， evidence-based practice， and the reform of talent evaluation mechanisms.

ObjectiveTo explore the clinical and phenomics characteristics of patients with phlegm-stasis binding syndrome and its accompanied patterns in stable angina pectoris （SAP） of coronary heart disease （CHD）. MethodsA multicenter cross-sectional study design was adopted. A total of 300 patients with SAP of CHD were enrolled and classified into 120 cases of phlegm-stasis binding syndrome， 125 cases of qi deficiency-accompanied syndrome， 38 cases of qi stagnation-accompanied syndrome， and 17 cases of toxin accumulation-accompanied syndrome according to traditional Chinese medicine （TCM） patterns. Data of patients with different TCM patterns were collected， including general condition， TCM symptoms， blood lipids， coagulation function， immune indicators， and serum metabolomics. Metabolic pathway enrichment analysis was used to compare differences in phenomics characteristics among groups. Metabolites with variable importance in projection （VIP） ≥1 and fold change （FC） ≥2 were considered as representative differential metabolites. ResultsPatients in each TCM pattern type were most commonly in the 60-75 years age group， with a relatively high proportion of males. Regarding TCM symptoms， patients with phlegm-stasis binding syndrome most commonly presented with wiry-choppy or wiry-slippery pulse， chest pain， and chest tightness； in patients with qi deficiency-accompanied syndrome， fatigue， chest pain， and weak pulse were most common； in patients with qi stagnation-accompanied sydnrome， wiry-choppy or wiry-slippery pulse， chest pain， and symptoms that increase or decrease with emotional changes， belching， or flatulence were most common； in patients with toxin accumulation-accompanied syndrome， bitter taste in the mouth， chest tightness， irritability， restlessness or manic delirium， and dry and hard stools or foul-smelling diarrhea were most common. Comparisons among the different TCM patterns showed statistically significant differences in coagulation parameters （P＜0.05）， whereas no statistically significant difference was found in blood lipid levels and immune indicators （P＞0.05）.Metabolomics analysis suggested that disorders of glycerophosphate metabolism and valine， leucine， and isoleucine metabolism are characteristic features of phlegm-stasis binding syndrome and its accompanied patterns. The representative differential metabolites between phlegm-stasis binding syndrome and qi deficiency-accompanied syndrome were 7,8-dihydrobiopterin （FC = 3.58） and oxypurinol （FC = 124.50）. Those between phlegm-stasis binding syndrome and qi stagnation-accompanied syndrome were cytidine 5′-diphosphocholine （FC = 2.62） and D-mannosamine （FC = 2.99）. Those between phlegm-stasis binding syndrome and toxin accumulation-accompanied syndrome were anserine （FC = 7.83） and canrenone （FC = 8.94）. ConclusionThere are certain differences in the clinical characteristics and phenomics characteristics among patients with SAP due to CHD exhibiting phlegm-stasis binding syndrome and its accompanied patterns. The phenomics characteristics mainly involve biological alterations such as lipid metabolism disorders， amino acid metabolism abnormalities， and multiple immune indicators activation， which may provide a reference for precise differentiation and treatment of SAP of CHD in TCM clinical practice.

ObjectiveTo explore the clinical and phenomics characteristics of patients with phlegm-stasis binding syndrome and its accompanied patterns in stable angina pectoris （SAP） of coronary heart disease （CHD）. MethodsA multicenter cross-sectional study design was adopted. A total of 300 patients with SAP of CHD were enrolled and classified into 120 cases of phlegm-stasis binding syndrome， 125 cases of qi deficiency-accompanied syndrome， 38 cases of qi stagnation-accompanied syndrome， and 17 cases of toxin accumulation-accompanied syndrome according to traditional Chinese medicine （TCM） patterns. Data of patients with different TCM patterns were collected， including general condition， TCM symptoms， blood lipids， coagulation function， immune indicators， and serum metabolomics. Metabolic pathway enrichment analysis was used to compare differences in phenomics characteristics among groups. Metabolites with variable importance in projection （VIP） ≥1 and fold change （FC） ≥2 were considered as representative differential metabolites. ResultsPatients in each TCM pattern type were most commonly in the 60-75 years age group， with a relatively high proportion of males. Regarding TCM symptoms， patients with phlegm-stasis binding syndrome most commonly presented with wiry-choppy or wiry-slippery pulse， chest pain， and chest tightness； in patients with qi deficiency-accompanied syndrome， fatigue， chest pain， and weak pulse were most common； in patients with qi stagnation-accompanied sydnrome， wiry-choppy or wiry-slippery pulse， chest pain， and symptoms that increase or decrease with emotional changes， belching， or flatulence were most common； in patients with toxin accumulation-accompanied syndrome， bitter taste in the mouth， chest tightness， irritability， restlessness or manic delirium， and dry and hard stools or foul-smelling diarrhea were most common. Comparisons among the different TCM patterns showed statistically significant differences in coagulation parameters （P＜0.05）， whereas no statistically significant difference was found in blood lipid levels and immune indicators （P＞0.05）.Metabolomics analysis suggested that disorders of glycerophosphate metabolism and valine， leucine， and isoleucine metabolism are characteristic features of phlegm-stasis binding syndrome and its accompanied patterns. The representative differential metabolites between phlegm-stasis binding syndrome and qi deficiency-accompanied syndrome were 7,8-dihydrobiopterin （FC = 3.58） and oxypurinol （FC = 124.50）. Those between phlegm-stasis binding syndrome and qi stagnation-accompanied syndrome were cytidine 5′-diphosphocholine （FC = 2.62） and D-mannosamine （FC = 2.99）. Those between phlegm-stasis binding syndrome and toxin accumulation-accompanied syndrome were anserine （FC = 7.83） and canrenone （FC = 8.94）. ConclusionThere are certain differences in the clinical characteristics and phenomics characteristics among patients with SAP due to CHD exhibiting phlegm-stasis binding syndrome and its accompanied patterns. The phenomics characteristics mainly involve biological alterations such as lipid metabolism disorders， amino acid metabolism abnormalities， and multiple immune indicators activation， which may provide a reference for precise differentiation and treatment of SAP of CHD in TCM clinical practice.

Malignant hyperthermia(MH)is a rare perioperative disease with autosomal dominant inheritance,and its pathogenesis involves specific gene mutations.Its clinical feature is that conventional anesthetics can trigger abnormally high metabolic reactions in skeletal muscles.Although the incidence of this disease is low,the condition is dangerous,progresses rapidly,and has a high mortality rate;Its treatment relies on early diagnosis,timely application of the specific drug Dantrolene Sodium,and rapid and orderly comprehensive symptomatic supportive treatment.MH is a critical perioperative emergency that can occur during surgery.It presents with symptoms such as hyperpyrexia,metabolic acidosis,rhabdomyolysis,and dysfunction of multiple organ systems.If not treated promptly,it can quickly lead to life-threatening arrhythmias and cardiac arrest.This condition serves as an essential teaching example in anesthesia crisis resource management.As an effective teaching method,scenario simulation exercises can comprehensively enhance medical staff's personal technical,non-technical,and teamwork abilities through simulating emergency scenarios,teaching assessments,and retrospective discussions,especially suitable for comprehensive management training of fatal diseases.Many countries internationally have incorporated simulation exercises for MH into their routine teaching and training systems.The effectiveness of teaching and training for anesthesiologists in MH and their ability to handle anesthesia crisis events have been continuously improved through a periodic training model.This article systematically reviews the research progress and practical experience of scenario simulation exercises in emergency training for MH,with a focus on exploring how to establish a scenario simulation exercise plan for emergency application and comprehensive symptomatic support treatment of Dantrolene Sodium based on the actual situation in China,providing reference for improving the teaching and training quality of MH and other clinical crisis events.

Osteosarcoma is the most common primary malignant bone tumor,typically treated with a combination of surgery and chemotherapy in clinical practice.However,the increasing prevalence of chemotherapy resistance poses a significant challenge.Chemotherapy resistance can lead to a sharp decline in patients'survival rates.Traditional Chinese medicine,known for its low cost,wide-ranging efficacy,and diverse varieties,has attracted significant attention from researchers.Their attempts to investigate the sensitizing effect of extracted ingredients on osteosarcoma chemoresistance both in vitro and in vivo have yielded promising results.This review has summarized the studies of single traditional Chinese medicine ingredients on reversing osteosarcoma chemoresistance by the mechanisms of chemoresistance,and found that the current research of the clinical mechanism of traditional Chinese medicine ingredients in reversing osteosarcoma chemoresistance is still lacking,indicating significant potential for future development.Utilizing the theory of herbal medicine properties as the theoretical basis for ingredient development may provide novel strategies for the development of new therapeutic approaches.

Objective To investigate the distribution of dense fine speckled(DFS)antinuclear antibody(ANA)in different ages,genders,and diseases,and to explore its clinical significance in the diagnosis of auto-immune disease(AID).Methods A retrospective summary was conducted on the clinical basic data of 53520 patients who visited the hospital from January 2022 to April 2024,as well as the results of indirect immunoflu-orescence(IIF)ANA fluorescence karyotype and titer,and immunoblotting ANA spectrum,and the relation-ship between DFS positivity and AID was analyzed.Results Of the 53 520 serum samples,the rate of ANA fluorescence positivity was 32.40％,with DFS-positive samples accounting for 1.18％of all ANA fluores-cence-positive samples.The male-to-female ratio of DFS positives was 1∶1.94,with the highest percentage of 51.9％in the 21-40 age group.Among DFS positive individuals,only 12.14％were clinically diagnosed with AID disease,significantly lower than other ANA fluorescent karyotype positive individuals(23.31％,P＜0.001).The overall positivity rate of ANA spectra using immunoblotting in DFS-positive individuals was 23.54％,which was significantly lower than that in other fluorescent karyotype positive ANA individuals(73.26％,P＜0.001).Moreover,DFS positive individuals were mainly accompanied by antibody positivity such as anti-Ro52 antibodies,which had no diagnostic specificity in AID diagnosis.When comparing DFS posi-tive individuals with similar fluorescence morphology to those with homogeneous nuclear granules and nuclei,at an ANA titer of 1∶100,the proportion of AID patients in homogeneous nuclear granules and nuclei was 20.04％,significantly higher than the proportion of AID patients in DFS positive individuals(9.44％,P=0.001).With the increase of ANA titer,the proportion of AID diseases significantly increased in both karyo-type samples.When the ANA titer of DFS positive samples was increased to ≥ 1∶320,the proportion of AID diseases significantly increased to 30.77％(P=0.002).Conclusion DFS is a rare ANA fluorescent karyo-type,and DFS positive individuals are mainly found in females aged 21-40,mostly non AID patients.Howev-er,high titers of DFS cannot rule out the possibility of AID.In clinical work,special attention should be paid to distinguishing it from the homogeneous nuclear granule type to avoid misdiagnosis.

Objective:To explore the clinical characteristics of hydrocephalus patients with delayed intracranial hemorrhage (DICH) after ventriculo-peritoneal shunt (VPS) and independent influencing factors for DICH after VPS, and construct a nomogram model for predicting the incidence of DICH after VPS.Methods:A retrospective analysis was performed; clinical data of 168 patients with hydrocephalus who underwent VPS at Department of Neurosurgery, Lihuili Hospital Affiliated to Ningbo University from January 2016 to December 2023 were collected. Based on the postoperative DICH occurrence, these patients were categorized into a non-DICH group and a DICH group. Clinical characteristics of patients from the DICH group were analyzed. Differences in clinical data between patients from the non-DICH group and DICH group were compared. Multivariate Logistic regression analysis was performed to screen the independent influencing factors for DICH after VPS, and a nomogram model for predicting DICH incidence after VPS was constructed. Receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test and Bootstrap resampling method were used to evaluate the predictive efficiency and stability of the nomogram model.Results:(1) Among the 168 patients, 36 (21.43%) developed DICH, which occurred (6.06±2.77) days after VPS (ranged 2-13 days). Seven patients presented with symptoms as vomiting, epilepsy, and decreased consciousness, while 29 patients had no hemorrhage-related complication. The hemorrhage volume in these 36 DICH patients was 0.85(0.30, 3.54) mL. Regarding the hemorrhage sites, 12 patients had simple puncture tract hemorrhage, 14 had simple intraventricular hemorrhage, 7 had both puncture tract hemorrhage and intraventricular hemorrhage, and 3 had puncture tract hemorrhage combined with hemorrhage in other sites. At discharge, 8 patients had a good prognosis, and 28 had a poor prognosis. (2) Compared with the non-DICH group, the DICH group had statistically older age, higher proportion of patients with hypertension or craniotomy history, lower preoperative neutrophil-to-lymphocyte ratio (NLR), higher postoperative NLR, and higher ratio of postoperative to preoperative NLR (NLRR), with significant differences ( P<0.05). Results of multivariate Logistic regression analysis indicated that age ( OR=1.077, 95% CI: 1.022-1.135, P=0.005), history of craniotomy ( OR=3.547, 95% CI: 1.384-9.092, P=0.008), and NLRR ( OR=1.744, 95% CI: 1.179-2.581, P=0.005) were independent influencing factors for DICH in hydrocephalus patients after VPS ( P<0.05). (3) A nomogram model for predicting DICH in hydrocephalus patients after VPS was constructed based on age, history of craniotomy and NLRR. ROC curve analysis showed that area under the curve (AUC) of the nomogram model for predicting DICH in hydrocephalus patients after VPS was 0.812 (95% CI: 0.735-0.890, P<0.001); Hosmer-Lemeshow test indicated that the model had good calibration, and no significant difference was noted between the predicted probabilities and actual probabilities ( χ2=10.487, P=0.233); decision curve analysis results showed that the nomogram model could generate good clinical net benefits with risk threshold of 0%-60%; AUC of the internal validation ROC curve was 0.805 (95% CI: 0.785-0.816) and the C-index was 0.82 by Bootstrap resampling method, suggesting good stability of the model. Conclusion:Hydrocephalus patients with advanced age, history of craniotomy, and elevated NLRR trend to have DICH following VPS; the nomogram model constructed based on age, history of craniotomy and NLRR has good predictive performance and clinical practicability.

Malignant hyperthermia(MH)is a rare perioperative disease with autosomal dominant inheritance,and its pathogenesis involves specific gene mutations.Its clinical feature is that conventional anesthetics can trigger abnormally high metabolic reactions in skeletal muscles.Although the incidence of this disease is low,the condition is dangerous,progresses rapidly,and has a high mortality rate;Its treatment relies on early diagnosis,timely application of the specific drug Dantrolene Sodium,and rapid and orderly comprehensive symptomatic supportive treatment.MH is a critical perioperative emergency that can occur during surgery.It presents with symptoms such as hyperpyrexia,metabolic acidosis,rhabdomyolysis,and dysfunction of multiple organ systems.If not treated promptly,it can quickly lead to life-threatening arrhythmias and cardiac arrest.This condition serves as an essential teaching example in anesthesia crisis resource management.As an effective teaching method,scenario simulation exercises can comprehensively enhance medical staff's personal technical,non-technical,and teamwork abilities through simulating emergency scenarios,teaching assessments,and retrospective discussions,especially suitable for comprehensive management training of fatal diseases.Many countries internationally have incorporated simulation exercises for MH into their routine teaching and training systems.The effectiveness of teaching and training for anesthesiologists in MH and their ability to handle anesthesia crisis events have been continuously improved through a periodic training model.This article systematically reviews the research progress and practical experience of scenario simulation exercises in emergency training for MH,with a focus on exploring how to establish a scenario simulation exercise plan for emergency application and comprehensive symptomatic support treatment of Dantrolene Sodium based on the actual situation in China,providing reference for improving the teaching and training quality of MH and other clinical crisis events.

Osteosarcoma is the most common primary malignant bone tumor,typically treated with a combination of surgery and chemotherapy in clinical practice.However,the increasing prevalence of chemotherapy resistance poses a significant challenge.Chemotherapy resistance can lead to a sharp decline in patients'survival rates.Traditional Chinese medicine,known for its low cost,wide-ranging efficacy,and diverse varieties,has attracted significant attention from researchers.Their attempts to investigate the sensitizing effect of extracted ingredients on osteosarcoma chemoresistance both in vitro and in vivo have yielded promising results.This review has summarized the studies of single traditional Chinese medicine ingredients on reversing osteosarcoma chemoresistance by the mechanisms of chemoresistance,and found that the current research of the clinical mechanism of traditional Chinese medicine ingredients in reversing osteosarcoma chemoresistance is still lacking,indicating significant potential for future development.Utilizing the theory of herbal medicine properties as the theoretical basis for ingredient development may provide novel strategies for the development of new therapeutic approaches.

Objective:To explore the clinical characteristics of hydrocephalus patients with delayed intracranial hemorrhage (DICH) after ventriculo-peritoneal shunt (VPS) and independent influencing factors for DICH after VPS, and construct a nomogram model for predicting the incidence of DICH after VPS.Methods:A retrospective analysis was performed; clinical data of 168 patients with hydrocephalus who underwent VPS at Department of Neurosurgery, Lihuili Hospital Affiliated to Ningbo University from January 2016 to December 2023 were collected. Based on the postoperative DICH occurrence, these patients were categorized into a non-DICH group and a DICH group. Clinical characteristics of patients from the DICH group were analyzed. Differences in clinical data between patients from the non-DICH group and DICH group were compared. Multivariate Logistic regression analysis was performed to screen the independent influencing factors for DICH after VPS, and a nomogram model for predicting DICH incidence after VPS was constructed. Receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow test and Bootstrap resampling method were used to evaluate the predictive efficiency and stability of the nomogram model.Results:(1) Among the 168 patients, 36 (21.43%) developed DICH, which occurred (6.06±2.77) days after VPS (ranged 2-13 days). Seven patients presented with symptoms as vomiting, epilepsy, and decreased consciousness, while 29 patients had no hemorrhage-related complication. The hemorrhage volume in these 36 DICH patients was 0.85(0.30, 3.54) mL. Regarding the hemorrhage sites, 12 patients had simple puncture tract hemorrhage, 14 had simple intraventricular hemorrhage, 7 had both puncture tract hemorrhage and intraventricular hemorrhage, and 3 had puncture tract hemorrhage combined with hemorrhage in other sites. At discharge, 8 patients had a good prognosis, and 28 had a poor prognosis. (2) Compared with the non-DICH group, the DICH group had statistically older age, higher proportion of patients with hypertension or craniotomy history, lower preoperative neutrophil-to-lymphocyte ratio (NLR), higher postoperative NLR, and higher ratio of postoperative to preoperative NLR (NLRR), with significant differences ( P<0.05). Results of multivariate Logistic regression analysis indicated that age ( OR=1.077, 95% CI: 1.022-1.135, P=0.005), history of craniotomy ( OR=3.547, 95% CI: 1.384-9.092, P=0.008), and NLRR ( OR=1.744, 95% CI: 1.179-2.581, P=0.005) were independent influencing factors for DICH in hydrocephalus patients after VPS ( P<0.05). (3) A nomogram model for predicting DICH in hydrocephalus patients after VPS was constructed based on age, history of craniotomy and NLRR. ROC curve analysis showed that area under the curve (AUC) of the nomogram model for predicting DICH in hydrocephalus patients after VPS was 0.812 (95% CI: 0.735-0.890, P<0.001); Hosmer-Lemeshow test indicated that the model had good calibration, and no significant difference was noted between the predicted probabilities and actual probabilities ( χ2=10.487, P=0.233); decision curve analysis results showed that the nomogram model could generate good clinical net benefits with risk threshold of 0%-60%; AUC of the internal validation ROC curve was 0.805 (95% CI: 0.785-0.816) and the C-index was 0.82 by Bootstrap resampling method, suggesting good stability of the model. Conclusion:Hydrocephalus patients with advanced age, history of craniotomy, and elevated NLRR trend to have DICH following VPS; the nomogram model constructed based on age, history of craniotomy and NLRR has good predictive performance and clinical practicability.