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.

ObjectiveThe widespread adoption of portable fundus cameras for primary care and community screening is hindered by limitations in current autofocus(AF) technologies. Image-based methods relying on sharpness evaluation require iterative searches, resulting in slow convergence, while projection-based techniques are susceptible to optical artifacts and calibration errors. To address these challenges, this study introduces a novel AF system based on direct wavefront sensing, designed to deliver simultaneous high speed, high precision, and operational robustness within the compact form factor essential for portable ophthalmic devices. MethodsOur approach fundamentally reimagines the AF process by directly measuring the ocular wavefront aberration. We developed a custom portable fundus camera integrating a miniaturized Shack-Hartmann wavefront sensor (SHWS) into the optical path. An 850 nm laser diode projects a point source onto the retina via oblique illumination to minimize corneal reflections. Light scattered from this spot carries the eye’s refractive error through the imaging optics and is directed to the SHWS, positioned at a plane optically conjugate to the primary color CMOS imaging sensor. A microlens array within the SHWS samples the incident wavefront, generating a pattern of focal spots on a CCD. Real-time centroid analysis of these spots provides a map of local wavefront slopes. These measurements are processed through a singular value decomposition (SVD) algorithm to fit a Zernike polynomial basis set, enabling real-time reconstruction of the wavefront phase. The defocus component (S) is extracted from the second-order Zernike coefficients, providing a direct, quantitative measure of the refractive error in diopters. This value serves as a precise error signal in a closed-loop control system, which commands a voice-coil actuated focusing lens to its null position in a single, deterministic step, eliminating the need for iterative search algorithms. ResultsComprehensive evaluation demonstrated the system’s high performance. Testing on a calibrated model eye (OEMI-7) established a highly linear relationship between the computed defocus S and the focusing lens position across a ±20 Diopter (D) compensation range, achievable within a 5 mm mechanical travel. The system achieved a focusing precision of 0.08 D, corresponding to an 18-fold improvement over a conventional projection spot-size method tested under identical conditions. The total focus acquisition time, encompassing wavefront measurement, computation, and lens actuation, averaged under 0.5 s. Clinical validation with 25 human volunteers (50 eyes, refractive range -15 D to +10 D) confirmed practical efficacy. The wavefront-sensing AF succeeded in 92% of attempts with a mean time of 0.5 s, substantially outperforming a projection-based benchmark which achieved only a 32% success rate with an average time of 4.25 s. The system provided instantaneous directional guidance and maintained stability during minor ocular movements. Objective assessment of image quality, via amplitude contrast of retinal vasculature, showed consistent and significant enhancement following AF correction across the entire tested diopter range. ConclusionThis work successfully implements and validates a direct wavefront-sensing autofocus paradigm for portable fundus cameras. By directly quantifying and compensating for the optical defocus aberration, this method bypasses the fundamental limitations of image-processing and projection-based techniques, enabling rapid, precise, and deterministic diopter compensation. The developed system delivers an exceptional combination of a wide operational range (±20 D), high accuracy (0.08 D), fast convergence (0.5 s), and a compact physical footprint. This technology provides a practical and high-performance focusing solution capable of enhancing the reliability, throughput, and diagnostic utility of portable retinal imaging in large-scale screening applications. Future efforts will be directed towards system cost optimization and performance adaptation for diverse ocular conditions.

Objective To determine the clinical effect of warmed iodophor for preoperative disinfection in elderly patients undergoing laparoscopic hysterectomy.Methods A total of 84 elderly patients who underwent laparoscopic hysterectomy were selected and randomly divided into the room temperature group(disinfected with iodophor at a temperature of 24℃)and the warmed group(disinfected with iodophor at a temperature of 39℃),with 42 cases in each group.The disinfection qualification status,incision infection status,nasopharyngeal temperature,awakening time,adverse reactions,intraoperative blood loss,incision drainage volume,and hidden blood loss of patients in the two groups were compared.Results There was no statistically significant difference in the disinfection qualification rate or incision infection rate between the two groups(P>0.05).At 10 minutes,30 minutes,60 minutes after disinfection and the end of the operation,the nasopharyngeal temperatures of patients in the warmed group were significantly higher than those in the room temperature group(P<0.05).The awakening time of patients in the warmed group was significantly shorter than that in the room temperature group(P<0.05),and the incidences of intraoperative hypothermia and shivering reaction after awakening were significantly lower than those in the room temperature group(P<0.05).There was no statistically significant difference in the intraoperative blood loss or incision drainage volume of patients between the two groups(P>0.05),while the hidden blood loss of patients in the room temperature group was significantly higher than that in the warmed group(P<0.05).Conclusion The iodophor at a temperature of 39℃for preoperative disinfection in elderly patients undergoing laparoscopic hysterectomy can not only ensure the disinfection effect and surgical safety,but also effectively maintain intraoperative body temperature stability,promote postoperative awakening,and reduce hidden blood loss.

Objective:To assess the safety,efficacy and potential impact of stem cell therapy(SCT)in improving erectile dys-function(ED).Methods:A comprehensive search strategy was used to search the literatures on safety and efficacy evaluation of stem cell(SC)in the treatment of ED by human clinical trials from PubMed,Embase and Web of science databases with a search time frame from database creation to July 4,2024.The exclusion criteria were as follows:reviews,conference abstracts,animal experi-ments,and duplicate sample literature.Results:The study initially screened 1 773 papers,and 17 were included in the final analy-sis.These studies involved a total of 269 ED patients,and a variety of sources of stem cells had been used in the treatment of ED,in-cluding adipose-derived stem cells,bone marrow-derived stem cells,placental stroma-derived stem cells,umbilical cord-derived stem cells,dental pulp-derived stem cells,and oral mucosa-derived stem cells.All studies were conducted by injecting stem cells into the cavernous body of the penis,but there is no fixed standard for the amount of injection,injection site and number of injections.The op-timal treatment mode was still being explored.Patients' International Index of Erectile Function(IIEF)scores and Erection Hardness Score(EHS),peak systolic velocity(PSV),and end diastolic velocity(EDV)improved after treatment.But some studies showed that the efficacy of the treatment diminished with increasing time.No serious adverse effects were reported in any of the studies and none of the adverse effects persisted for a long period of time.The most common adverse effects included injection site reactions,and SCT showed a good safety and tolerability profile.Conclusion:SCT has the potential to be a promising and innovative regenerative therapy option for ED patients.In the future,with the advancement of stem cell technology,larger randomized controlled studies should continue to be conducted to explore standardized treatments,so as to further evaluate the long-term efficacy and safety of SCT for ED.

Objective:To investigatetheclinicalefficacy and satetyoflaparoscopic abdominoperineal resection with pelvicperitoneum colsure for low rectal cancer.Methods:A comprehesive search was conducted across multiple da-tabases,including the Cochrane Library、PubMed、Embase、CBM、VIP、CNKI、and WanFang Data,focusing on studies re-lated to pelvic peritoneum colsure(PPC)-oriented laparoscopic abdominoperineal resection from database inception to July,2024.Then,meta-analysis was performed using RevMan 5.3 software.Results:A total of 12 studies involving 999 patients were included.The results showed that there was no significant difference in intraoperative blood loss.The laparoscopic pelvicperitoneum colsure takes a longer time,with a statistically significant difference(WMD=12.37,95%CI=2.27～22.46,P=0.02),but the postoperative exhaust time and hospitalization time are shorter,with a statistically significant difference(WMD=0.40,95%CI=0.07～0.72,P=0.02;WMD=-2.36,95%CI=-3.33～-1.38,P＜0.00001).In terms of postoperative complications,the overall complication rate was higher in the group that did not undergo pelvic-peritoneum colsure,with a statistically significant difference(OR=0.12,95%CI=0.08～0.18,P＜0.00001).The incidence of postoperative intestinal obstruction,perineal incisional hernia,pelvic effusion infection,and radiation enteritis was higher,and the differences were statistically significant(OR=0.24,95%CI=0.13～0.45,P＜0.00001,OR=0.23,95%CI=0.11～0.49,P=0.0001,OR=0.27,95%CI=0.14～0.51,P＜0.0001,OR=0.24,95%CI:0.07～0.81,P=0.03).Conclusion:In lapa-roscopic abdominoperineal resection,closing the pelvicperitoneum has lower postoperative complications,shorter post-operative exhaust time and hospitalization time,and longer operation time,which has better clinical efficacy and safety.

Objective To explore the epidemiological characteristics and magnetic resonance angiography(MRA)features of duplicated and accessory middle cerebral artery(DMCA and AMCA),and to raise awareness of this vascular variation.Methods Imaging data of 8131 patients underwent cranial MRI and MRA examinations in Anyang People's Hospital from April 2023 to August 2023 were collected,and DMCA or AMCA variation were investigated.The epidemiological characteristics,MRA features and classification of DMCA and AMCA were analyzed.Meanwhile the concurrent other cerebrovascular variations were observed.Results Totally 113 of 8131 patients were detected to have 119 DMCA or AMCA vascular variants.There were 64 DMCA including 24 type A and 40 type B,and there were 55 AMCA including 38 of type 1 and 17 of type 2.The relative diameter of type A DMCA was larger than that of type B DMCA,type 1 and type 2 AMCA.The difference was statistically significant(P＜0.05).The incidence of DMCA and AMCA combined with other cerebrovascular variations was 54.69％and 34.69％,respectively.Conclusion MRA is simple and practicable,and can intuitively display DMCA or AMCA.So,it can be used as an important method for the diagnostic of DMCA or AMCA.The DMCA and AMCA variation make related surgeries more complex,and it plays an undeniable role in the prognosis of related cerebral infarction.This vascular variation has important clinical significance for guiding neurosurgeons and neurologists to formulate reasonable treatment plans.

Objective:To evaluate the accuracy of a self-developed extraoral scanning system based on photogrammetry technology, and to provide evidence for advancing the development and clinical application evaluation of domestically produced scanning devices.Methods:This research group developed a photogrammetry-based implant extraoral scanning system with customized scan bodies. Two distinct edentulous implant resin models were designed and three-dimensional (3D)-printed by Center of Digital Dentistry, Peking University School and Hospital of Stomatology, containing 6 (Model 1) and 8 (Model 2) abutment analogs respectively. Reference data acquisition was performed using a high-precision denture 3D scanner with scan caps mounted on the analogs. Specialized scan bodies were then mounted on the analogs for 3D positional data acquisition using both the self-developed system (experimental group) and the clinically established system (control group). Each system conducted 10 repeated scans per model. Trueness was assessed through root mean square error (RMSE), linear deviation (LD), and angular deviation (AD) relative to reference data, while precision was determined through intra-group RMSE analysis. Systematic comparisons included inter-group performance on identical models and intra-group variability across different models.Results:For Model 1, the experimental group showed statistically significant advantages over controls in intra-group RMSE [(3.10±0.71) μm vs (4.61±1.51) μm, P<0.001], reference-data RMSE [(21.48±0.60) μm vs (32.50±0.63) μm, P<0.001], linear deviation [23.64 (32.35) μm vs 44.86 (55.73) μm, P<0.001], and angular deviation [0.29° (0.29°) vs 0.23° (0.33°), P<0.001]. In Model 2, significant improvements were observed in intra-group RMSE [(4.47±1.58) μm vs (6.21±2.07) μm, P<0.001], reference-data RMSE [(38.84±0.86) μm vs (43.69±1.34) μm, P<0.001], and linear deviation [37.95 (50.68) μm vs 49.71 (58.89) μm, P<0.001]. Both groups exhibited model-dependent variability, with RMSE of precision and trueness of both groups, linear deviation of experimental group, angular deviation of control group showing statistically significant increases (all P<0.001) corresponding to abutment analog quantity. Conclusions:The self-developed scanning system demonstrates superior accuracy in 3D positional acquisition of abutment analogs compared to the contral group system, with implant number identified as a critical determinant of extraoral scanning accuracy.

Objective:To investigatetheclinicalefficacy and satetyoflaparoscopic abdominoperineal resection with pelvicperitoneum colsure for low rectal cancer.Methods:A comprehesive search was conducted across multiple da-tabases,including the Cochrane Library、PubMed、Embase、CBM、VIP、CNKI、and WanFang Data,focusing on studies re-lated to pelvic peritoneum colsure(PPC)-oriented laparoscopic abdominoperineal resection from database inception to July,2024.Then,meta-analysis was performed using RevMan 5.3 software.Results:A total of 12 studies involving 999 patients were included.The results showed that there was no significant difference in intraoperative blood loss.The laparoscopic pelvicperitoneum colsure takes a longer time,with a statistically significant difference(WMD=12.37,95%CI=2.27～22.46,P=0.02),but the postoperative exhaust time and hospitalization time are shorter,with a statistically significant difference(WMD=0.40,95%CI=0.07～0.72,P=0.02;WMD=-2.36,95%CI=-3.33～-1.38,P＜0.00001).In terms of postoperative complications,the overall complication rate was higher in the group that did not undergo pelvic-peritoneum colsure,with a statistically significant difference(OR=0.12,95%CI=0.08～0.18,P＜0.00001).The incidence of postoperative intestinal obstruction,perineal incisional hernia,pelvic effusion infection,and radiation enteritis was higher,and the differences were statistically significant(OR=0.24,95%CI=0.13～0.45,P＜0.00001,OR=0.23,95%CI=0.11～0.49,P=0.0001,OR=0.27,95%CI=0.14～0.51,P＜0.0001,OR=0.24,95%CI:0.07～0.81,P=0.03).Conclusion:In lapa-roscopic abdominoperineal resection,closing the pelvicperitoneum has lower postoperative complications,shorter post-operative exhaust time and hospitalization time,and longer operation time,which has better clinical efficacy and safety.

OBJECTIVE: This study aimed to investigate the effect of Astragalus (AST) on osteoporosis (OP) and the downstream mechanisms. METHODS: Human bone marrow-derived mesenchymal stem cells (hBMSCs) were induced to differentiate into osteogenic cells. After transfection with relevant plasmids, cell proliferation, cell cycle progression, and apoptosis were assessed. Alizarin red staining was used to detect calcium nodules in the cells, alkaline phosphatase (ALP) staining was used to detect ALP activity in the cells, and quantitative reverse transcription-polymerase chain reaction and western blotting were used to determine RUNX2 and Osterix expression levels. An OP rat model was established using ovariectomy and micro-computed tomography scanning. Hematoxylin and eosin staining and Masson's trichrome staining were used to evaluate the pathological conditions of bone tissues, while immunohistochemistry was conducted to detect RUNX2 in bone tissues. RESULTS: AST promoted the osteogenic differentiation of BMSCs, reduced miR-181d-5p expression levels, and increased SOX11 expression levels. Restoring miR-181d-5p expression or reducing SOX11 expression levels reversed the effects of AST on the osteogenic differentiation of hBMSCs. miR-181d-5p was found to target SOX11 in hBMSCs. AST improved OP in rats, and miR-181d-5p overexpression or SOX11 inhibition reversed the therapeutic effects of AST on OP in rats. CONCLUSION AST promoted the osteogenic differentiation of hBMSCs and alleviated OP by targeting SOX11 via miR-181d-5p.
Osteogenesis/drug effects* ; Animals ; MicroRNAs/genetics* ; Mesenchymal Stem Cells/drug effects* ; Osteoporosis/drug therapy* ; Humans ; Cell Differentiation/drug effects* ; Astragalus Plant/chemistry* ; Rats ; Rats, Sprague-Dawley ; Female ; SOXC Transcription Factors/genetics* ; Plant Extracts/pharmacology* ; Cells, Cultured ; Drugs, Chinese Herbal/pharmacology*

Immature permanent teeth refer to those that have erupted but have not yet formed and matured in terms of shape and structure. The characteristics of their disease onset and treatment methods are different from those of ordinary permanent teeth. Children with special healthcare needs often lack the capacity to cooperate during routine dental procedures, making treatment under general anesthesia (GA) the preferred option. With social advancements, the demand for pediatric dental GA has considerably increased. This study discuss the treatment strategies for immature permanent teeth under GA, including diagnosis, therapeutic principles, key considerations, and clinical approaches for dental caries, pulpitis periapical periodontitis, etc.
Child ; Humans ; Anesthesia, General ; Dental Caries/diagnosis* ; Dentition, Permanent ; Periapical Periodontitis/therapy* ; Pulpitis/therapy*