Based on the theory of evidence-based medicine （EBM）， this paper systematically constructed a multi-dimensional evaluation framework for traditional Chinese medicine （TCM） appropriate technologies， encompassing three core dimensions including evidence， practitioner， and patient. For the current practical challenges in the promotion of TCM technologies such as lack of high-quality evidence， inconsistent operational standards， and varying patient acceptance， the paper proposed the integration of published literature evidence and real-world research data to construct a scientific and applicable evaluation pathway. Regarding the evidence dimension， it emphasizes syste-matic assessment of effectiveness， safety， and economic efficiency， introducing methods like the target trial emulation framework to enhance evidence quality； for the practitioner dimension， it suggests developing multi-aspects competency evaluation tools based on educational background， training assessment， and clinical outcomes； for the patient dimension， it recommends designing patient acceptance assessment tools by considering factors such as technical characte-ristics， expected efficacy， patient-practitioner interaction， and the availability of alternative treatments. The purpose of the above measures is to provide methodological support for the standardized popularization and precision application of TCM appropriate technologies.

[Objective]To analyze the manipulation and acupoint selection rules of Tuina treatment for adolescent idiopathic scoliosis(AIS).[Methods]Clinical research literature on Tuina treatment for AIS was searched in databases such as China National Knowledge Infrastructure(CNKI),VIP Database,WanFang Data,China Biology Medicine disc(CBMdisc)and PubMed from database establishment date to November 31,2024.Frequency statistics,association rules and cluster analysis were performed on the data by using R Studio 4.3.0 software,and the analysis results were visualized.[Results]A total of 122 clinical research articles on Tuina treatment for AIS were included,among which 116 were Chinese articles and 6 were English articles.These studies were extracted 122 tuina prescriptions,which involved 75 types of Tuina techniques,with a total application frequency of 376 times.The technique with the highest application frequency was the kneading method.A total of 19 acupoint prescriptions were extracted,involving 48 acupoints with a frequency of 119,among which Shenshu was the most frequently used acupoint.The acupoints mainly belonged to the Bladder Meridian of Foot-Taiyang,the Governing Vessel,the Kidney Meridian of Foot-Shaoyin,the Liver Meridian of Foot-Jueyin and some Extra-meridian Points.Among the combinations of manipulations and acupoints,kneading and Shenshu were used most frequently in combination with other manipulations and acupoints.Association rule network analysis showed that Dachangshu,Shenshu,Weizhong and Chengfu were strongly correlated among acupoints;kneading,pressing and Tuina were strongly correlated among manipulations.In the cluster analysis results,high-frequency acupoints formed 5 effective clusters and high-frequency manipulations formed 3 effective clusters.[Conclusion]Tuina treatment of AIS mainly uses loosening and pulling manipulations as a supplement,focusing on adjusting the balance of Yin and Yang of the spine;the selection of acupoints is mainly in local part combined with those along the meridians.

Lumbar manipulation plays an important role in the non-surgical treatment of lumbar degenerative diseases.Lumbar manipulation is a compound technique that contains many mechanical elements and motion characteristics at the moment of operation.Quantifying and objectifying parameters of the manipulation,summarizing technical characteristics of the operation,and discussing biomechanical mechanism of the manipulation in-depth,can contribute to teaching assessment and clinical diagnosis and treatment standards of the manipulation,making the manipulation safer and efficient,and further promoting inheritance and development of the traditional Chinese medicine manipulation.This article reviews and synthesizes domestic and foreign biomechanical research papers on lumbar manipulation for the treatment of lumbar degenerative diseases in recent years.The biomechanical effects on the lumbar spine and its accessory structures under manual transient loading,the measurement of technical parameters,and the characteristics of manual operation are summarized.

[Objective]To analyze the manipulation and acupoint selection rules of Tuina treatment for adolescent idiopathic scoliosis(AIS).[Methods]Clinical research literature on Tuina treatment for AIS was searched in databases such as China National Knowledge Infrastructure(CNKI),VIP Database,WanFang Data,China Biology Medicine disc(CBMdisc)and PubMed from database establishment date to November 31,2024.Frequency statistics,association rules and cluster analysis were performed on the data by using R Studio 4.3.0 software,and the analysis results were visualized.[Results]A total of 122 clinical research articles on Tuina treatment for AIS were included,among which 116 were Chinese articles and 6 were English articles.These studies were extracted 122 tuina prescriptions,which involved 75 types of Tuina techniques,with a total application frequency of 376 times.The technique with the highest application frequency was the kneading method.A total of 19 acupoint prescriptions were extracted,involving 48 acupoints with a frequency of 119,among which Shenshu was the most frequently used acupoint.The acupoints mainly belonged to the Bladder Meridian of Foot-Taiyang,the Governing Vessel,the Kidney Meridian of Foot-Shaoyin,the Liver Meridian of Foot-Jueyin and some Extra-meridian Points.Among the combinations of manipulations and acupoints,kneading and Shenshu were used most frequently in combination with other manipulations and acupoints.Association rule network analysis showed that Dachangshu,Shenshu,Weizhong and Chengfu were strongly correlated among acupoints;kneading,pressing and Tuina were strongly correlated among manipulations.In the cluster analysis results,high-frequency acupoints formed 5 effective clusters and high-frequency manipulations formed 3 effective clusters.[Conclusion]Tuina treatment of AIS mainly uses loosening and pulling manipulations as a supplement,focusing on adjusting the balance of Yin and Yang of the spine;the selection of acupoints is mainly in local part combined with those along the meridians.

Lumbar manipulation plays an important role in the non-surgical treatment of lumbar degenerative diseases.Lumbar manipulation is a compound technique that contains many mechanical elements and motion characteristics at the moment of operation.Quantifying and objectifying parameters of the manipulation,summarizing technical characteristics of the operation,and discussing biomechanical mechanism of the manipulation in-depth,can contribute to teaching assessment and clinical diagnosis and treatment standards of the manipulation,making the manipulation safer and efficient,and further promoting inheritance and development of the traditional Chinese medicine manipulation.This article reviews and synthesizes domestic and foreign biomechanical research papers on lumbar manipulation for the treatment of lumbar degenerative diseases in recent years.The biomechanical effects on the lumbar spine and its accessory structures under manual transient loading,the measurement of technical parameters,and the characteristics of manual operation are summarized.

[Objective]Based on the propensity score matching method to explore the therapeutic effect of lever positioning manipulation in the treatment of L4/5 different types of lumbar disc herniation.[Methods]A prospective cohort design was used to select 122 patients with L4/5 lumbar disc herniation and divide them into unilateral group,bilateral group and central group.Samples with balanced covariates were obtained after matching,including 36 patients in unilateral group,35 patients in bilateral group and 35 patients in central group.All patients in the three groups were treated with leverage positioning technique,and all patients in the three groups were treated 3 times a week,once every other day,for a total of 2 weeks.Pain Visual Analogue Scale(VAS)score and Japanese Orthopaedic Association(JOA)score were observed before and after treatment to evaluate the differences in the postoperative effects of the three groups.[Results]The covariates of age,sex,course of disease,VAS score and JOA score were all balanced after matching(P>0.05).The results of following-up after 2 weeks and 6 months of treatment showed that the VAS score and JOA score were statistically significant(P<0.05),the distant and near term curative effect of lever positioning manipulation in the treatment of unilateral lumbar disc herniation was better than bilateral and central disc herniation(P<0.05).[Conclusion]The clinical efficacy of unilateral lumbar disc herniation is superior to bilateral and central disc herniation in the treatment of the same segment of lumbar disc herniation with leverage positioning manipulation.

Objective To investigate the risk factors affecting the malignancy of amorphous calcifications in the breast and to establish a predictive nomogram.Methods Patients with amorphous calcifications detected by mammography were retrospectively collected,clinical data were obtained from electronic medical record(EMR),and the mammographic features of the patients were assessed by diagnostic physicians.The risk factors affecting the malignancy of amorphous calcifications were analyzed to develop a predictive model and to assess the performance of the model.Results A total of 153 amorphous calcifications in 144 patients were included in the study,and the overall malignancy rate of calcifications was 20.92％.Patient's age ≥45 years,linear distribution of calcifications,unilateral single or unilateral multiple calcifications,and a larger maximum ratio of calcification extent all predicted a higher probability of malignancy,establishing a nomogram based on these 4 risk factors,with a 3.65％predicted probability of malig-nancy as the cut-off,33.99％(52/153)of patients were allowed to be spared biopsy.Conclusion Patient's age and the distribution,number,and maximum ratio of calcifications may be the risk predictors of malignancy for amorphous calcifications,with nomogram con-struction for distinguishing benignity from malignancy of amorphous calcifications via combining with mammographic features and clinical data.

Objective To construct a risk prediction model for liver cancer in patients with chronic hepatitis C based on seven different machine learning algorithms and select the optimal model. Methods A total of 236 patients with chronic hepatitis C were selected as the research subjects. Patients were divided into a case group and a control group according to whether liver cancer occurs. Prediction models were constructed based on seven machine learning algorithms including classification and regression tree, random forest, gradient boosting decision tree, extreme gradient boosting (XGBoost), logistic regression, K-near neighbor, and support vector machine. The Shapley additive explanations (SHAP) algorithm was used to interpret the best prediction model. Results Among the seven models, the XGBoost model had the best comprehensive prediction performance (accuracy of 0.933, sensitivity of 0.775, specificity of 0.960, area under the ROC curve of 0.956, F1 score of 0.764). The SHAP algorithm suggested that AFP, age, AST, diabetes, BMI, PLT, ALT, liver cysts, FIB-4, and gender contributed to the model decision and are the risk factors for liver cancer in patients with chronic hepatitis C. Conclusion This study develops an interpretable machine learning model based on the XGBoost algorithm, which has a good reference value for individualized monitoring of liver cancer in patients with chronic hepatitis C.

A 58-year-old female patient without disease history of diabetes mellitus was enrolled in the phase Ⅲ clinical trial of alpelisib combined with fulvestrant due to ineffective treatment of stage Ⅳ breast cancer. The treatment regimen was alpelisib tablets 300 mg orally once daily and fulvestrant injection 500 mg once a month intramuscularly. One month later, the patient experienced symptoms such as poor appetite, nausea, vomiting, drowsiness, and blurred consciousness. Laboratory tests showed arterial blood pH 7.1, random blood glucose >34.7 mmol/L, serum creatinine 210 μmmol/L, blood potassium 3.00 mmol/L, blood sodium 129 mmol/L, and urine ketone body (++). Diabetic ketoacidosis was diagnosed, and treatments such as intravenous insulin supplementation, rehydration, and correction of acidosis and electrolyte disorders were given. After 5 days, the patient′s symptoms were improved, but the blood glucose was poor controlled. Diabetic ketoacidosis was considered to be related to alpelisib. The dose of alpelisib was reduced by half, oral hypoglycemic drugs were added, and the insulin regimen was adjusted. Later, the blood glucose was relatively well controlled, and urinary ketone bodies turned negative.

A 58-year-old female patient without disease history of diabetes mellitus was enrolled in the phase Ⅲ clinical trial of alpelisib combined with fulvestrant due to ineffective treatment of stage Ⅳ breast cancer. The treatment regimen was alpelisib tablets 300 mg orally once daily and fulvestrant injection 500 mg once a month intramuscularly. One month later, the patient experienced symptoms such as poor appetite, nausea, vomiting, drowsiness, and blurred consciousness. Laboratory tests showed arterial blood pH 7.1, random blood glucose >34.7 mmol/L, serum creatinine 210 μmmol/L, blood potassium 3.00 mmol/L, blood sodium 129 mmol/L, and urine ketone body (++). Diabetic ketoacidosis was diagnosed, and treatments such as intravenous insulin supplementation, rehydration, and correction of acidosis and electrolyte disorders were given. After 5 days, the patient′s symptoms were improved, but the blood glucose was poor controlled. Diabetic ketoacidosis was considered to be related to alpelisib. The dose of alpelisib was reduced by half, oral hypoglycemic drugs were added, and the insulin regimen was adjusted. Later, the blood glucose was relatively well controlled, and urinary ketone bodies turned negative.