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.

Based on a review of classical literature combined with modern anatomical and biomechanical research， this paper proposes the "four intersections" of channel sinew diseases from the perspective of structural interfaces， which involves sinew-bone， sinew-sinew， sinew-joint， and sinew-vessel intersections， and analyzes the corresponding pathological characteristics. It is believed that the dynamic evolution of channel sinew diseases can be summarized as "starting with mechanical imbalancew， with interface transmission as the pivot， compensation continuation as the variation， and neurological adaptation as the consolidation". Furthermore， the pathological changes at the "four intersections" structural interfaces correspond respectively to clinical manifestations of enthesial pain， referred pain， joint dysfunction and sensory abnormalities. Understanding channel sinew diseases based on the "four intersections" structural interface is conducive to deepening the understanding of the pathogenesis， thereby providing a reference for clinical identification and precise treatment.

Background Per- and polyfluoroalkyl substances (PFASs) are a class of persistent organic pollutants that pose potential health risks to humans. Infants and young children have higher requirements for food safety due to the underdeveloped detoxification and immune systems. Therefore, developing a comprehensive method for determination of PFASs and their novel alternatives in infant complementary food is of great significance. Objective To develop an analytical method using liquid chromatography high-resolution mass spectrometry technology for determination of 55 PFASs in plant- and animal-derived infant complementary fruit purees. Methods Oasis WAX (200 mg, 6 CC) solid-phase extraction columns were used for sample enrichment and purification. The pH of the acetonitrile extract was adjusted using 0%, 1%, 1.5%, and 2% formic acid aqueous solutions to evaluate its impact on the recovery rate of target compounds. Additionally, the impact of a 2 mL methanol wash during the purification process on the recovery of target compounds was assessed to determine the optimal pretreatment conditions. Three types of chromatographic columns—Agilent Poroshell 120 EC-C₁₈, Thermo InfinityLab Poroshell 120 Aq-C₁₈, Acquity Waters BEH-C₁₈, and changes in mobile phase, were compared for their effects on retention time, peak shape, and response of target compounds. The method was validated in terms of selectivity, linear range, detection limit, and precision. The established method was applied to 49 commercial samples of infant complementary fruit purees. Results Adjusting the sample pH using 1.5% formic acid water and incorporating a 2 mL methanol wash during purification achieved satisfactory recovery rates. The target compounds were chromatographically separated using an Agilent Poroshell 120 EC-C₁₈ column with a gradient elution system. The mobile phase consisted of methanol-water (methanol/water: 2/98, v/v) containing 5 mmol·L⁻¹ ammonium formate as mobile phase A, and methanol as mobile phase B. Good separation was achieved within 15 min, resulting in optimal chromatographic peak shapes. The 55 target compounds exhibited good linearity across the standard curve range, with correlation coefficients (R²) greater than 0.99. The method detection limits ranged from 0.02 to 0.05 µg·L⁻¹. In the plant- and animal-based fruit puree samples, the spiked recovery rates ranged from 60% to 112% and 57% to 119%, respectively, with relative standard deviations (RSD) ≤ 30%. A total of 9 traditional PFASs and 5 novel PFASs were positive in 49 samples of infant complementary fruit purees. Conclusion This method enables comprehensive detection of 55 traditional and emerging PFASs, offering wide coverage, high accuracy, and excellent sensitivity. It provides technical support for characterizing contamination by traditional and emerging PFASs in food matrices.

Eight compounds were isolated and purified from the ethyl acetate part of 70% acetone extract of Rehmannia glutinosa by various chromatographic techniques such as silica gel, MCI gel CHP-20, ODS, Toyopearl HW-40C, combined with TLC and semi-preparative HPLC. Their structures were elucidated by modern spectroscopy techniques (NMR, MS, UV, IR), and identified as neomartynoside A (1), osmanthuside B₆ (2), martynoside (3), isomartynoside (4), (E)-p-hydroxycinnamic acid (5), caffeic acid (6), ferulic acid (7), and methyl caffeate (8). Compound 1 is a new phenylethanol glycoside, which was identified as neomartynoside A. Compound 2 was isolated from Rehmannia glutinosa for the first time. In addition, compounds 2, 6 and 7 significantly increased relative glucose consumption, showing potential hypoglycemic activity.

The concept of "qi deficiency with stagnation" refers to a pathological state characterized by the depletion of primordial qi， impaired qi transformation， and the development of internal stagnation. Under the cyclic chemotherapy regimen in oncology， chemotherapy-induced myelosuppression follows a progressive pathological course from qi deficiency to increasing stagnation. This sequential evolution from mild to severe myelosuppression closely aligns with the dynamic syndrome differentiation and treatment framework of "qi deficiency with stagnation". "Qi deficiency" reflects the gradual depletion of qi， blood， and essence， while "stagnation" refers to the accumulation of phlegm， turbid dampness， and blood stasis. These two components interact reciprocally， forming a vicious cycle where deficiency leads to stagnation， and stagnation further damages the healthy qi. In the early stage of mild myelosuppression， chemotoxicity begins to accumulate in the bone marrow， leading to qi consumption， blood deficiency， yin injury， and the gradual formation of turbid phlegm and damp stagnation. In the advanced stage of severe myelosuppression， the accumulation of toxicity causes qi sinking， exhaustion of essence， and marrow depletion， along with blood stasis obstructing the collaterals. Treatment strategies should be based on syndrome differentiation， with an emphasis on assessing the severity of the condition， balancing deficiency and excess， and achieving both symptomatic relief and root cause resolution.

It has been demonstrated that long-term space flights have a significantly greater impact on the cardiovascular, skeletal, and nervous systems of astronauts. The structural and functional alterations in the skeletal and muscular systems resulting from exposure to weightlessness can lead to the development of low back pain, significantly impairing the ability of astronauts to perform tasks and respond to emergencies. Both space flight and simulated microgravity have been shown to result in low back pain among astronauts, with the following factors identified as primary contributors to this phenomenon. The occurrence of intervertebral disc (IVD) edema results in the stimulation of type IV mechanoreceptors, which subsequently activate nociceptive afferents. The protrusion of an IVD causes compression of the spinal nerve roots. Furthermore, the elongation of the vertebral column and/or the diminished lumbar curvature of the spine exert traction on the dorsal root nerves. Paravertebral muscle degeneration leads to the inhibition of decreased nociceptive activity of the wide-dynamic range neurons of the spinal dorsal horn. Moreover, endogenous pain descending facilitation triggered by conditioning stimulation can be enhanced via the thalamic mediodorsal nuclei, while endogenous pain descending inhibition triggered by conditioning stimulation can be weakened via the thalamic ventromedial nuclei. Psychological factors may contribute to the development of low back pain. The mechanisms governing the generation, maintenance, and alleviation of low back pain in weightlessness differ from those observed in normal gravitational environments. This presents a significant challenge for space medicine research. Therefore, the elucidation of the occurrence and development mechanism of low back pain in weightlessness is important for the prevention and treatment during space flight. To reduce the incidence of low back pain during long-term missions on the space station, astronauts may choose to wear specialized space clothing that can provide axial physiological loads, designed to stimulate both musculature and skeletal structures, mitigating potential increases in vertebral column length, diminished lumbar curvature, and intervertebral disc edema and/or muscular atrophy. Additionally, assuming a “fetal tuck position” described as the knees to chest position may increase lumbar IVD hydrostatic pressure, subsequently reducing disc volume, rectifying diminished lumbar curvature, and alleviating dorsal root nerve tensions. Moreover, this position may reduce type IV mechanoreceptor facilitation and nerve impulse propagation from the sinuvertebral nerves of the annulus fibrosus. Elongated posterior soft tissues (apophyseal joint capsules and ligaments) with spinal flexion may potentially stimulate type I and II mechanoreceptors. It is also recommended to exercise the paraspinal muscles to prevent and alleviate the decrease in their cross-sectional area and maintain their structure and function. Photobiomodulation has been proved to be an effective means of activating the pain descending inhibition pathway of the central nervous system. In addition, astronauts should be encouraged to participate in mission-related activities and strive to avoid psychological problems caused by the long-term confinement in a small space station. The article presents a concise review of potential causes and targeted treatment strategies for low back pain induced by space flight or simulated microgravity in recent years. Its objective is to further elucidate the mechanisms underlying the occurrence and development of low back pain in weightless environments while providing scientific evidence to inform the development of guidelines for preventing, treating, and rehabilitating low back pain during long-term space flights.

Objective:To analyze the prognostic factors of patients with liver cirrhosis and portal vein thrombosis (PVT), and to construct a prognostic prediction model based on machine learning methods.Methods:The clinical data of 388 patients with liver cirrhosis and PVT admitted to the Fifth Medical Center of PLA General Hospital from January 2022 to April 2024 were retrospectively collected and analyzed, including 243 males and 145 females, aged (56.9±10.9) years. A total of 388 patients were randomly divided into the training set ( n=310) and the testing set ( n=78) in a 4∶1 ratio. The Boruta algorithm was used to screen the key features in the training set, and then four machine learning algorithms, including random forest, support vector machine, generalized linear model and Bayesian, were used to establish a survival prediction model. Model performance was evaluated by the receiver operating characteristic (ROC) curves of the test set and the training set. The patients were followed up for 1 year for survival. Sort the importance of features based on the SHAP value. Results:There were 250 patients (80.6%) who survived and 60 (19.4%) who died. The model for end-stage liver disease score, total bilirubin, serum creatinine, prothrombin time, international normalized ratio, D-dimer, white blood cell count, severe ascites ratio, and Child-Pugh grade C ratio of liver function in the death group were higher than those in the survival group, and the red blood cell count and hematocrit were lower than those in the survival group, and the differences were statistically significant (all P<0.05). The areas under the ROC curve for predicting survival by random forest, support vector machine, generalized linear model and Bayesian model were 0.92, 0.78, 0.81 and 0.71 in the training set, and the area under the ROC curve in the testing set were 0.81, 0.72, 0.67 and 0.68, respectively. Random forest had the best prediction performance, with an accuracy of 81.7%, a sensitivity of 84.6%, and a specificity of 76.9% in the testing set. In the analysis of the importance of characteristic parameters of the random forest model, total bilirubin, red blood cells, hematocrit, serum creatinine, ascites classification, etc. had a relatively high contribution to the model. Conclusion:In the survival prediction model of patients with liver cirrhosis and PVT based on machine learning algorithm, the random forest model had high prediction performance, and total bilirubin may be the most important factor affecting the survival prognosis of patients.

Objective:To compare the lung shunt fraction (LSF) of 90Y imaging after 90Y-selective internal radiation therapy (SIRT) and preoperative 99Tc m-macroaggregated albumin (MAA) imaging in patients with liver malignant tumors, and compare the volume and visual score of intrahepatic distribution of both nucleins on SPECT/CT images. Methods:A total of 91 patients with liver malignant tumors (78 males, 13 females; age (56.7±13.7)years; 99 cases) who underwent 90Y-SIRT in the Second Affiliated Hospital of Guangzhou Medical University from November 2022 to June 2024 were retrospectively collected. All patients underwent preoperative 99Tc m-MAA simulation and postoperative 90Y distribution verification by whole-body planar scintigraphy and hepatic SPECT/CT imaging. ROIs of the liver and lungs under the anterior-posterior position were delineated on the planar scintigraphy and LSF of 99Tc m-MAA and 90Y were calculated. The volume of interest (VOI) was drawn on the SPECT/CT images to calculate the nuclide distribution volume of both 99Tc m-MAA and 90Y within the liver. Wilcoxon signed rank test was used to compare the difference between two groups. In addition, the liver was divided into five lobes, namely left lateral lobe, left medial lobe, caudate lobe, right anterior lobe and right posterior lobe. Visual assessment of 90Y and 99Tc m-MAA radioactive distribution was performed ( 90Y and 99Tc m-MAA uptakes were graded on a scale of 0-3, where 0 indicated no nuclide accumulation and 3 indicated heavy accumulation). Kappa consistency test was used to analyze the scores of the corresponding lobes between two groups. Results:LSF for 99Tc m-MAA was 11.60%(4.27%, 15.03%), and LSF for 90Y was 11.80%(9.70%, 13.30%), without significant difference ( Z=-1.50, P=0.134). The distribution volume of 99Tc m-MAA within the liver was 542.63(204.00, 818.00)ml, which was significantly different from that of 90Y (688.69(287.00, 954.00)ml; Z=-7.37, P<0.001). Kappa values of the score of each lobe between 99Tc m-MAA imaging and 90Y imaging were 0.469-0.740 (all P<0.001). Conclusions:99Tc m-MAA simulation is reliable for assessing LSF for 90Y-SIRT. The distribution volume of 99Tc m-MAA is generally smaller than that of 90Y, but the consistency of the visual score of radioactive distribution is high. Overall, 99Tc m-MAA may well simulate the distribution pattern of 90Y-SIRT.

Objective:To compare the efficacy of internal brace-augmeted reconstruction combined with tape tail-folding anterolateral ligament reconstruction (ALL) and isolated internal brace-augmented reconstruction for high-grade pivot-shift anterior cruciate ligament (ACL) injuries.Methods:A retrospective cohort study was conducted to analyze the clinical data of 60 patients with high-grade pivot-shift ACL injuries who were admitted to 910th Hospital of Joint Logistics Support Force of PLA between March 2021 and March 2023, including 48 males and 12 females, aged 18-40 years [(28.4±5.6)years]. All ACL injuries were at grade III. The pivot-shift test results were classified as grade 2 in 42 patients and grade 3 in 18. According to the surgical technique, 30 patients underwent artificial internal brace-augmented ACL reconstruction combined with tape tail-folding ALL reconstruction (joint ACL reconstruction group), while the other 30 received isolated internal brace-augmented ACL reconstruction (simple ACL reconstruction group). The two groups were compared in terms of operative duration, intraoperative blood loss, improvement rate of pivot-shift at 3 months postoperatively, rate of sports function recovery at the last follow-up, Tegner and Lysholm scores preoperatively, at 3 months postoperatively, and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 6-24 months [(14.8±5.8)months]. The operative duration and intraoperative blood loss were (44.6±8.2)minutes and (45.3±4.6)ml in the simple ACL reconstruction group, significantly shorter or less than (58.0±7.4)minutes and (61.8±9.1)ml in the joint ACL reconstruction group ( P<0.01). At 3 months after surgery, the improvement of pivot-shift test was 93%(28/30) in the joint ACL reconstruction group, higher than 73%(22/30) in the simple ACL reconstruction group ( P<0.05). At the last follow-up, the recovery rate of motor function was 100%(30/30) in the joint ACL reconstruction group, significantly higher than 80%(24/30) in the simple ACL reconstruction group ( P<0.05). There were no statistically significant differences in Tegner or Lysholm scores between the two groups before surgery ( P>0.05). At 3 months after surgery and at the last follow-up, the Tegner scores were (3.8±0.5)points and (5.7±1.1)points in the joint ACL reconstruction group, significantly higher than (2.5±0.6)points and (3.9±0.9)points in the simple ACL reconstruction group ( P<0.01). At 3 months after surgery and at the last follow-up, the Lysholm scores were (67.2±5.7)points and (89.4±6.4)points in the joint ACL reconstruction group, significantly higher than (56.4±5.0)points and (72.6±5.7)points in the simple ACL reconstruction group ( P<0.01). Both groups demonstrated gradual improvement in Tegner and Lysholm scores at all postoperative time points, compared to preoperative values ( P<0.05). After operation, one patient in the joint ACL reconstruction group had superficial tibial infection, with a complication rate of 3% (1/30), whereas there was one patient with superficial tibial infection, and one with ligament injury in the simple ACL reconstruction group, with a total complication rate of 7% (2/30)( P<0.05). Conclusion:For high-grade pivot-shift ACL injuries, internal brace-augmented reconstruction combined with tape tail-folding ALL reconstruction can significantly improve knee rotational stability, promote motor function recovery, and enhance knee joint outcomes, compared to isolated internal brace-augmented reconstruction.

Objective:To investigate the application of 18F-FDG PET/MR and its derived parameters in the diagnosis and staging of bladder cancer. Methods:Forty patients (32 males, 8 females; age (66.8±11.2) years) with suspected bladder cancer between December 2019 and March 2022 were retrospectively included and underwent 18F-FDG PET/MR in Nanjing First Hospital. Parameters including SUV max, SUV mean, maximum tumor diameter and mean of apparent diffusion coefficient (ADC mean) were obtained, and bladder cancer muscle invasiveness and lymph node involvement were determined. The efficacy of 18F-FDG PET/MR and its derived parameters for tumor diagnosis and staging was analyzed using transurethral resection of bladder tumor (TUR-BT) or radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND) histopathology as the " gold standard". Independent-sample t test, Mann-Whitney U test or χ2 test was used to analyze the data, and Delong test was used to compare different AUCs. Results:Of 40 patients, 8 were non-muscle invasive bladder cancer (NMIBC), 32 were muscle invasive bladder cancer (MIBC), and 5 were pathologically confirmed to have lymph node metastasis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 18F-FDG PET/MR for identifying MIBC were 96.9%(31/32), 7/8, 96.9%(31/32), 7/8, 95.0%(38/40), respectively, and those for lymph node metastasis were 4/5, 90.0%(18/20), 4/6, 18/19, 88.0%(22/25), respectively. For pathological tumor (pT) staging, significant differences were observed between pT2-3 and pT1 groups in maximum tumor diameter ( t=-2.37, P=0.024), SUV mean( Z=-2.11, P=0.035), and ADC mean( t=2.91, P=0.006). The AUCs of maximum tumor diameter, SUV mean and ADC mean in distinguishing MIBC were 0.781, 0.746, and 0.825, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of MRI alone in identifying MIBC were 87.5%(28/32), 1/8, 80.0%(28/35), 1/5 and 72.5%(29/40), respectively, with the AUC of 0.500. The AUC of 18F-FDG PET/MR in identifying MIBC was 0.796, which was better than MRI alone ( Z=5.54, P<0.001), and the accuracy of PET/MR was also higher than MRI alone ( χ2=7.44, P=0.006). Conclusion:Compared with MRI alone, 18F-FDG PET/MR significantly improves the diagnostic efficacy of bladder cancer and the accuracy of pT staging.