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.

Objective:To analyze the reoperation rate and causes during the early adoption phase of unilateral biportal endoscopy (UBE).Methods:The clinical data of 180 patients who underwent UBE performed by a single surgeon at Beijing Friendship Hospital, Capital Medical University from October 2021 to June 2023 were retrospectively analyzed. Clinical and imaging data of patients who underwent reoperation were collected to analyze the causes of reoperation, and the clinical efficacy of the reoperations was also followed up. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used before and after treatment. Results:A total of 180 patients who underwent UBE were included in this study, of which 6 patients underwent reoperation, and the reoperation rate was 3.33%. Among them, 3 cases occurred in the first 90 surgeries and the other 3 occurred in the subsequent 90 surgeries. The causes of reoperation were as follows: recurrent lumbar disc herniation at the same segment postoperatively in 2 cases, insufficient decompression in 2 cases, disc herniation following isolated decompression in 1 case, and immediate postoperative perianal numbness in 1 case. The time between the initial surgery and reoperation ranged from 0 to 187 days, with an average of 63.3 days. The average follow-up time after reoperation was 18.3 months. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores of the patients at the last follow-up were significantly improved compared with those before operation (VAS score of low back pain: 5.2 ± 1.7 before operation, 1.2 ± 0.8 at the last follow-up, P<0.001; VAS score of leg pain: 7.2 ± 1.5 before operation, 1.2 ± 1.2 at the last follow-up, P<0.001; ODI score: 67.3 ± 5.7 before operation, 20.2 ± 8.2 at the last follow-up, P<0.001). The postoperative modified MacNab scores were generally satisfactory (4 cases were rated as excellent, accounting for 66.7%; 2 cases were rated as good, accounting for 33.3%). Except for one patient who experienced dural injury during open revision surgery, there were no serious complications such as nerve damage. Conclusions:In the early stages of UBE surgery, recurrent lumbar disc herniation and inadequate decompression are the primary reasons for reoperation, typically occurring within the first three months postoperatively. Reoperation does not significantly increase the risk of nerve injury. Enhanced early postoperative follow-up is recommended. For symptomatic patients, a second surgery with thorough decompression can yield satisfactory treatment outcomes.

ObjectiveTo analyze the application of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in China. MethodsResearches using ISNCSCI in the spinal cord injury were retrieved from CNKI, from January 1st, 2020 to December 31st, 2022. The authors and the keywords of the included literatures were analyzed using VOSviewer and CiteSpace to generate a collaboration network graph of authors and a theme distribution map of keywords. The objects, purposes, causes of spinal cord injury, distribution of researchers' departments, ISNCSCI version used, corresponding publication time and other information of the included studies were manual searched and analyzed. ResultsA total of 285 literatures were finally included, involving 1 279 authors, out of whom 111 published 97.19% of the total number of articles. The main keywords included spinal cord injury, spinal fractures, neurological function, thoracolumbar fractures and spinal tuberculosis, which classified in seven clusters, and the topics of spinal cord injury, efficacy, spinal fractures, quality of life and prognosis were the hotspots in the field. With manual searching, the main topic was spinal cord injury; the main object was traumatic spinal cord injury; the main purpose was to evaluate the surgical efficacy; the research institutions were mostly the comprehensive hospitals or specialized hospitals focusing on orthopedics (spinal surgery); the clinical departments that used ISNCSCI the most were orthopedics (including spinal surgery) and rehabilitation medicine, and nursing teams were paying more attention to ISNCSCI; the most commonly used versions of ISNCSCI were 2011 (7th edition) and 2000 (6th edition), however, for a large number of articles, the versions were not clear or earlier than 2000. ConclusionThe application of ISNCSCI in China should be improved in the standardization.

Objective To explore the optimal time for starting to drink plenty of water after 131I treatment in differentiated thyroid carcinoma(DTC) patients.Methods Totally 83 cases of DTC patients were randomly divided into three groups,and started to drink plenty of water at 12 h(group A),24 h(group B),and 36 h(group C) after treatment with 131I therapy.We measured and compared equivalent dose rate using the Inspector Alert gamma ray monitor at 1 meter in front of the patient's abdomen and neck at 6 h,12 h,24 h,36 h,48 h,72 h after taking 131I.We compared the discharge rate at different time and evaluated the curative effect.Results Equivalent dose rate of the abdomen at 24 h and 36 h after treatment and the discharge rate at 36 h and 48 h after treatment among three groups showed significant differences(P＜0.05).There were no statistically significant differences in the curative effect(P＞0.05).Conclusion Starting to drink plenty of water at 12 h after taking 131I can accelerate the decreasing of equivalent dose rate with no influence on the curative effect and improve the discharge rate at early.

Objective To explore the effect of oral-muscle biofeedback system training on the rehabilitation of cognitive dysfunction in patients with obstructive sleep apnea (OSA) after ischemic stroke.Methods A total of 60 cases of poststroke OSA patients with cognitive dysfunction admitted to the rehabilitation center of deAn hospital in changzhou city from June 2017 to March 2018 were selected.On the basis of routine rehabilitation treatment,the control group was given positive pressure ventilation treatment,and the observation group was given oral muscle biofeedback system training.The changes of polysomnography (PSG) parameters,Montreal cognitive assessment (MoCA) score,serum matrix metalloproteinase-9 (MMP-9) and plasma homcysteinemia (Hcy) expression levels in the two groups before and after treatment were compared.Results Apnea hypopnea index and maximum apnea time of the two groups were significantly decreased after treatment compared with those before treatment,and the lowest SpO2 and average SpO2 were significantly higher than those before treatment(P＜0.05).After treatment,MoCA total score and the dimensions score of patients in the observation group were significantly higher than those in the control group at the same time (P＜0.05).After treatment,the levels of Hcy((12.38±4.54) μmol/L) and MMP-9((124.52± 12.94) μg/L) in the observation group were significantly lower than those in the control group at the same time(Hcy(17.52±6.27) μmol/L,MMP-9(268.25±20.5 7)μg/L),and the difference was statistically significant (Hcy:t=3.637,P＜0.05;MMP-9:t =32.395,P＜0.05).Conclusions Positive pressure ventilation and oral muscle biofeedback system training have the same effect on OSA after stroke,but oral muscle biofeedback system training can also effectively improve patients' cognitive function.

Objective: This study aims at the review result of Guangzhou occupational health examination from 2012-2016 to analyze the distribution of crowd and to discover the occupational health hazard factors and key Protection object by finding the situation of the goal of occupational hazard factor diseases through review examination. Methods: By using retrospective study method, to choose those people who have accepted occupational health review examination handled by the review examination group of Guangzhou Occupational Prevention and Treatment Hospital from 2012 to 2016. And comprehensively analyze the review result of occupational health examination in 5 years. Results: There are 8618 cases of occupational health review examination handled by Guangzhou Occupational Prevent and Treatment Hospital and with complete data. From the Personnel structure, it refers that they are Predominantly male and their ages are mainly distributed under 40-year-old. Most of them work under the occupational disease inductive factors less than 5 years and most of the factor is contacting with noise. In the recent 5 years, we found out 1906 cases of occupational contraindications through total review, which takes 22.12% of total number of review People, including noise occupational contraindication in 61.59%. And we found 435 cases of suspected occupational disease which takes 5.05% of total number of review People, including suspected occupational noise deafness which takes the property of 60.23% and appears the most common disease. Suspected occupational diseases and occupational taboos are mainly male patients, and the age is mainly in the 30-49 age group, the working age is mainly less than 5 years. Conclusion Occupational health examination is an important Part in occupational health, occupational health examination review is the most Prior Part in the occupational health examination, which Plays a key role to discover the target disease of the occupational hazard factors in time, Prevent the development of occupational diseases and protect laborer occupational health.

Objective To study the effects of dexmedetomidine on the swallowing reflex. Methods Sixty adult volunteers (ASAⅠ-Ⅱ) were randomly divided into two groups, dexmedetomidine sedation group and propofol sedation group respectively. The BIS value was maintained between 60-65 in both groups. Swallowing reflex was induced by water injection in the pharynx at different depths of sedation, and the swallowing movements were observed. Meanwhile, the RR, SpO2 and OAA/S scores were recorded. Results The swallowing reflex existed in dexmedetomidine sedation group when BIS values was maintained at 60, which had significant difference compared with that in propofol sedation group. The RR, SpO2, OAA/S score in dexmedetomidine sedation group also had statistical difference compared with that in propofol sedation group during swallowing reflex test. Conclusions Slow infusion of dexmedetomidine to maintain the BIS value above 60 will not affect swallowing reflex, and can obtain satisfactory hemodynamic stability. It′clinical safety is high.

Objective:To explore the diagnostic value of CD26 expression in endometrial carcinoma (EC) by testing CD26 expression in normal proliferative phase, in secretory phase, and in the tissues of different pathological grades of EC;and by investigating the solu-ble CD26 (sCD26) expression in the serum of non-EC patients and EC patients. Methods:Endometrial tissue specimens were collected from patients who received diagnostic curettage or surgical treatment for other reasons in the Affiliated Hospital of Nantong Universi-ty from January 2014 to December 2015. The above endometrial specimens, included 30 specimens of normal proliferative phase, 30 specimens of secretory phase, and 120 type I EC tissue samples of G1, G2, and G3 grades. The expression of CD26 among these speci-mens were detected by immunohistochemistry. After the expression level of the CD26 protein was verified at the tissue, we continued to collect blood specimens from the outpatients. These patients received physical examination, and included healthy women of child-bearing age and type I EC patients. The patients received treatment in our hospital from January 2016 to September 2017. Of the blood samples collected, 20 cases were in proliferative phase and 20 cases were in secretory phase. Samples were also collected from patients with different grades of EC, including 20 cases of type I EC G1 grades, 20 cases of G2 grades, and 15 cases of G3 grades. The expression level of sCD26 in serum was detected by enzyme-linked immunosorbent assay (ELISA). Results:According to the results of immunohistochemistry, the order of the CD26 expression levels in normal endometrial tissues were as follows:secretory phase>prolif-erative phase, with a statistically significant difference observed among these groups (P<0.05). The order of the CD26 expression level among different type 1 EC grades were as follows: G3>G2>G1, with statistically significant differences also observed among these groups (P<0.05). The results of ELISA suggested that the expression level of CD26 in serum was associated with tumor progression, with statistically significant differences observed among the groups (P<0.05). Conclusion:The expression of CD26 in EC tissue and se-rum is associated with disease progression. The expression of CD26 in serum could be used as a marker for the diagnosis of EC.

Objective To observe and compare the control effect of monitored anesthesia care on stress reaction of operation under local anesthesia.Methods Fourty-five patients who undered ophthalmology and otolaryngology operation and ASA Ⅰ or Ⅱ class,aged 20-55 years were enrolled.They were randomly divided into 3 groups:monitored anesthesia care(M group),general anesthesia (G group),and local anesthesia (L group).All of three groups were performed local nerve block anesthesia.Mean arterial blood pressure (MAP)、heart rate (HR) were recorded at enter room (T1),the strongest operation stimulation (T2),the end of operation (T3).At the same time,the levels of blood glucose,plasma cortisol (Cor) were assayed.The scores of state of anxiety (S-AI) before operation and after operation in two groups were compared.Results The levels of MAP and Cor at T2,T3 and HR at T2 in G group and M group were significantly lower than those at T1:(68.1 ± 8.2),(78.8 ± 12.8) mmHg (1 mmHg =0.133 kPa) vs.(95.7 ± 11.3) mmHg;(80.8 ± 11.7),(86.2 ± 9.0)mmHg vs.(94.7 ± 11.5) mmHg;(207.0 ±71.8),(135.2 ± 60.9) nmol/L vs.(336.7 ± 121.4) nmol/L;(220.8 ± 113.2),(190.4 ± 149.0) nmol/L vs.(347.8 ± 154.6) nmol/L;(68.1 ± 10.6) beats/min vs.(79.9 ± 14.2)beats/min;(70.3 ± 10.1) beats/min vs.(80.6 ± 12.2) beats/min,there were significant differences (P ＜0.05).The level of blood glucose at T3 was significantly lower than that at T1 in G group [(4.9 ± 0.7) mmol/L vs.(5.5 ± 0.6) mmol/L],there was significant difference (P ＜ 0.05).The levels of MAP,Cor at T2 in G group and M group,at T3 in G group were significantly lower than those at the same point in L group:[(68.1 ± 8.2),(80.8 ± 11.7) mmHg vs.(93.4 ± 12.5) mmHg,(207.0 ± 71.8),(220.8± 113.2) nmol/L vs.(367.1 ± 157.3)nmol/L,(78.8 ± 12.8) mmHg vs.(92.6 ± 15.3) mmHg,(135.2 ± 60.7) nmol/L vs.(311.9 ± 165.6) nmol/L],there were significant differences (P ＜ 0.05).The scores of S-AI at postoperative in G group and L group were significantly lower than that at preoperative:(31.5 ± 6.6) scores vs.(44.3 ± 15.0) scores,(35.2 ± 11.5) scores vs.(49.3 ± 14.2) scores,there were significant differences (P ＜ 0.05).Conclusion Monitored anesthesia care can alleviate stress reaction in operation with local anesthesia,while its effect is similar with general nesthesia.

Objective To evaluate the clinical value of 99Tcm-MIBI scintigraphy for diagnosis of residual thyroid tissue and metastasis in patients with DTC after their first 131I therapy.Methods From February 2010 to March 2014,192 DTC patients (38 males,154 females,average age (43.2±8.6) years) who received total or near-total thyroidectomy and were pathologically diagnosed as DTC (171 papillary and 21 follicular carcinomas) underwent 99Tcm-MIBI scan (average dosage:740-925 MBq) 6 months after their first 131 I therapy.131 I scans was performed 4 d after oral administration of 131I of therapeutic dose (average dosage:5 550-8 140 MBq).Pre-and post-therapeutic images and the serum Tg level (detected before the imagings) were compared and analyzed.Any abnormal uptake of agent found inside or outside the thyroid was regarded as positive result.Patient-based and lesion-based data analysis were performed by x2 test and two-sample t test.Results A total of 191 patients were finally included,of which 65 positive cases were found.The sensitivity of 99Tcm-MIBI imaging was significantly lower than that of 131I imaging(56.9％ (37/ 65) vs 92.3％ (60/65);x2 =14.7,P＜0.01).Among 43 thyroid remnants and 22 metastatic lesions,99Tcm-MIBI imaging detected 39.5％ (17/43) of thyroid remnants and 90.9％ (20/22) of metastases,and those of 131I imaging were 100％ (43/43) and 77.3％ (17/22) respectively.The sensitivity of 131 I imaging in detecting thyroid remnants was significantly higher than that of 99Tcm-MIBI imaging(x2=24.0,P＜0.01).The sensitivities in detecting metastasis were not significantly different (x2=0.57,P＞0.05).The serum Tg level of positive groups (99Tcm-MIBI positive + 131I positive or 131I negative) were significantly higher than that of 99Tcm-MIBI negative + 131I negative group (t =-20.7 and-6.0,both P＜0.01),and that of 99Tcm-MIBI positive + 131I negative group was higher than that of 131I positive + 99Tcm-MIBI negative group(t=-2.7,P＜0.05).Conclusion 99Tcm-MIBI imaging could detect metastasis of DTC patient after first radioiodine therapy,but the value in detecting thyroid remnants is limited.