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.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Glucocorticoid therapy constitutes an essential and pivotal element in the management of lupus nephritis. Nevertheless, prolonged administration of glucocorticoids may result in systemic toxicities that adversely affect patients' quality of life and elevate mortality rates. Currently, there is a lack of definitive guidelines regarding the timing and methodologies for glucocorticoid tapering. This article aims to summarise the current evidence on glucocorticoid tapering strategies for lupus nephritis from various guidelines and studies to provide enhanced references for clinical practice.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Glucocorticoid therapy constitutes an essential and pivotal element in the management of lupus nephritis. Nevertheless, prolonged administration of glucocorticoids may result in systemic toxicities that adversely affect patients' quality of life and elevate mortality rates. Currently, there is a lack of definitive guidelines regarding the timing and methodologies for glucocorticoid tapering. This article aims to summarise the current evidence on glucocorticoid tapering strategies for lupus nephritis from various guidelines and studies to provide enhanced references for clinical practice.

BACKGROUND:The Pilon fracture has a complex fracture line and a comminuted fracture fragment.It is often associated with bone loss and soft tissue damage and is one of the most difficult fractures to treat clinically. OBJECTIVE:To analyze the correlation between tibial and fibular fractures in Pilon fractures. METHODS:A retrospective analysis was conducted on 188 patients with Pilon fracture in the Department of Trauma Orthopedics,The Second People's Hospital of Lianyungang City from January 2014 to January 2022.Imaging data of these patients were collected.Fibular fracture level,fibular fracture type,number of fibular fracture blocks,tibial position status,main fracture blocks of the tibia,size of medial fracture blocks of the tibia,tibial fracture angle,Topliss classification(sagittal plane)and Topliss classification(coronal plane)were summarized into a database.SPSS 25.0 was used to analyze the data of tibia and fibula in Pilon fractures by Spearman correlation analysis.On the basis of the correlation,multiple disordered Logistic regression was used to further analyze the correlation. RESULTS AND CONCLUSION:(1)Spearman correlation analysis showed that tibial fracture angle was positively correlated with fibular fracture type,fibular fracture level and fibular fracture number.Tibial position status was positively correlated with tibial fracture angle and Topliss classification(coronal plane),but negatively correlated with major tibial fracture blocks and Topliss classification(sagittal plane).The level of fibular fracture was positively correlated with the type of fibular fracture and the number of fibular fractures.The main fracture blocks of the tibia were positively correlated with Topliss classification(coronal plane)and negatively correlated with Topliss classification(sagittal plane).(2)Multiple Logistic regression analysis showed that:the level of fibular fracture was correlated with the type of fibular fracture(P<0.05);the number of fibular fractures was correlated with the main fracture block of tibia(P<0.05).(3)It is indicated that the more inclined the ankle joint was to the valgus,the more likely it was to lead to fibular fracture,and the higher the fibular fracture level,the more serious the fibular fracture degree,the more complex the fibular fracture type,the larger the tibial fracture angle,the more the tibia presented Topliss classification(coronal plane)fracture.(4)When the ankle joint was more inclined to be in varus or varus + dorsiflexion,the fibula often did not fracture or simple fracture occurred,and the lower the fracture level,the smaller the tibial fracture angle,the more Topliss classification of the tibia(sagittal plane),the more main fracture blocks of the tibia,the larger the medial fracture block.When the ankle joint is in the dorsiflexion,it often results in a simple fibular fracture with a posterolateral tibial fracture.

Objective To explore the feasibility and safety of prolonging the use time of non-corng needles in totally implantable venous access ports for patients with breast cancer.Methods A total of 100 breast cancer patients implanted in the chest wall totally implantable venous access ports of Zhejiang Cancer Hospital in June to December 2022 were randomly divided equally into 7-day group and 8-day group by means of random number table according to the time of removing the non-destructive needle.Catheter function evaluation,catheter-related complications,comfort evaluation and cost calculation were used for investigation and analysis.Results In both groups,blood was returned from the infusion port catheter and the catheter flushed smoothly.There were 1 case of local skin allergy in 7-day group and 2 cases in 8-day group.In the comfort evaluation,comfort accounted for 86%in 7d group and 90%in 8d group,and the difference was not statistically significant(P>0.05).The maintenance cost of the infusion port per capita in the 7d group was higher than that in the 8d group,and the difference was statistically significant(P<0.05).Conclusion Under certain circumstances,after evaluation by nurses,the use time of non-corng needles in totally implantable venous access ports of breast cancer patients can be appropriately prolonged,which can improve work efficiency and reduce costs.

Objective To discuss the outcome of repair of limbs bone defect by using mineralized collagen graft.Methods The clinical data of 35 cases who diagnosed the existence of bone defect from January 2013 to December 2013 in our department were retrospectively analyzed.After operation,Lane Sandhu X-ray score standard was evaluated.Results All patients were followed up for 12 months.Postoperative 1 month,Lane Sandhu X-ray score was 3 points in 20 cases and 15 cases with 2 pointss;postoperative 6 months,Lane Sandhu X-ray score was 9 points in 21 cases,10 cases with 8 points and 4 cases with 7 points.Postoperative 12 months,Lane Sandhu X-ray score was 12 points in 28 cases,7 cases with 11 points.The scores of postoperative 6 months were better than the scores of postoperative 1 month [(2.60±0.49)points vs.(8.49±0.12)points,t=107.860,P=0.000].There was significant difference between the scores of postoperative 12 months and scores of postoperative 6 months [(8.49±0.12)points vs.(11.8±0.06)points,t=41.630,P=0.000].Conclusion MC is used as an effective bone substitute material,and its clinical effect is good.

Objective To evaluate the clinical efficacy of intra-articular injection of ozone in collagen-induced arthritis (CIA) rats and to assess its effects on serum receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) levels. Methods Forty weight age malched Wistar rats were randomly divided into normal control group (normal group), the CIA model group (CIA group), ozone (O 3 group), and methotrexate (MTX group). In addition to the normal control group, Freund's complete adjuvant and bovine type Ⅱ collagen were injected to establish the rat model of CIA. After the model was sucessfully developed, double ankle injection concentration ozone group of 40 μg/ml of O3 each 1 ml, 1 times a week, a total of injection for 3 weeks for the experimenal group. MTX group of 0.9 mg/kg was injected 1 times a week for 3 weeks for the MTX group. Degree of foot swelling was measured, and radiographic assessment of arthritis index (AI) score was performed. One week after treatment, angular vein blood was collected for the rats after the intervention, flow multi-factor detection technology was used to test each rat. T test or Wilcoxon rank test was used to compare the difference between groups. Results ① After 3 week administration with O3, dcgree of foot swelling, and AI of the O3 group was reduced significanly than the CIA group during the same period (foot swelling degree: O3 group: (4.21±0.14) ml, CIA group (9.12±0.17) ml, T=64.08, P=0.00; AI O3 group: [(2.97± 0.18) ml, CIA group: 5.76 ±0.13, T=37.24, P=0.00], and X-ray showed joint damage was alleviated. ② The serum level of RANKL in the CIA group was significantly higher than of the normal group [CIA model group 1890.70(797.03, 10571.94)], normal group [74.46(29.21, 95.37), T=43, P=0.005] during the same period; The serum level of RANKL in the O3 group was significantly lower than the CIA group [O3 group 28.09 (14.11, 207.30), CIA group 1890.70 (797.03, 10571.94), T=39, P<0.05]; RANKL level of the Ozone group when compared with MTX group, was not statistically significantly difference (T=52, P>0.05).③Serum RANKL/OPG of the CIA group was significantly higher than that of the normal group during this period, the difference was statistically significant [CIA group 250.68(42.33, 2959.78), normal group 4.32(3.16,5.30), T=36, P<0.01);The serum level of RANKL/OPG in the O3 group was significantly lower than the CIA group [O3 treatment group 5.10 (3.38, 6.64), CIA group 250.68 (42,33, 2959.78), T=36, P<0.01]; There was no statistically significant difference of the serum RANKL/OPG between the O3 group and the MTX group (T=62.5, P>0.05). Conclusion Intra-articular injection of concentration of 40 μg/ml of O3 can reduce RA rat joint swelling degree, which may relate to the mechanism that O3 can lower levels of serum RANKL and RANKL/OPG ratio, reduce osteoclast formation and activation.

Objective To observe the effects of intra-articular ozone injection on the secretion of tumor necrosis factor (TNF)-α,Interleukin (IL)-6,IL-17A,and vascular endothelial growth factor (VEGF) in the serum of rats with collagen-induced arthritis (CIA) and explore the therapeutic mechanism of ozone in RA treatment.Methods Thrity-two Wistar rats were randomized into 4 groups,including the ozone groups that receivedintra-articularinjection of 40 μg/ml ozone (O3 group),a blank control group (normal group),a methotrexate (MTX) group (MTX group) anda collagen-induced arthritismodel (CIA group).All the rats,except for those in the blank control group,were subjected to hypodermic injection of bovine collagen Ⅱ and complete Freund's adjuvant to induce CIA.Ozone treatment was administered once weekly for 3 weeks starting at 14 days after the model were established.MTX group were treated with methotrexate 0.9 mg/kg,once a week,a total of three weeks.The swelling degree of the foot were observed,and the serum contents of TNF-oα,IL-6,IL-17A and VEGF were detected.One-way analysis of variance or Kruskal-Wallis test was used to evaluate the experimental data.Results At the end of treatment,the degree of foot swelling was reduced significantly in rats with O3 group compared with that in the CIA group [(4.21±0.14) ml vs (9.12±0.17) ml,t=8.43,P=0.023].The serum concentration of TNF-α,IL-6 and VEGF showed significant difference between the CIA group and the O3 group[91.55(86.55,98.53) pg/ml vs 14.45 (12.55,16.15) pg/ml,x2=6.216,P=0.002;145.08(37.44± 362.82) pg/ml vs 5.84(5.47,15.93) pg/ml,x2=13.136,P=0.004;51.56(46.09,74.10) pg/ml vs.36.22(32.18,41.69) pg/ml,x2=3.732,P=0.002].There was no statistically significant difference between the O3 group and MTX group [14.45(12.55,16.15) pg/ml vs [12.45(11.80,15.60) pg/ml,x2=0.243,P＞0.05;5.84(5.47,15.93) pg/ml vs 7.86(5.25,15.23) pg/ml,x2=0.058,P＞0.05;36.22(32.18±41.69) pg/ml vs 40.17(35.47,50.73) pg/ml,x2=0.516,P＞0.05].The serum concentration of IL-17A showed no significant difference between the normal group,the CIAgroup,the MTX group and the O3 group (F=1.827,P=0.165).Conclusion Intra-articular injecfion of 40 μg/ml ozone can attenuate synovitis in rats with CIA,the mechanism may relate to the inhibition of TNF-oα,IL-6 and VEGF in the serum.