Objective To explore the application value of three mainstream large language models in the diagnosis, differential diagnosis, and treatment decision support of the primary diseases related to pediatric liver transplantation. Methods Seventy-nine cases of pediatric liver transplantation-related diseases diagnosed through pathological or clinical follow-up data were collected from Renji Hospital, Shanghai Jiao Tong University School of Medicine or published high-quality case reports. These cases covered 25 types of primary diseases such as cholestatic liver disease, metabolic diseases, and tumors. Standardized prompts were used to input the case information into the DeepSeek-R1, ChatGPT-4o and Grok-3 models, and the accuracy of their preliminary diagnosis and differential diagnosis based on basic clinical data was evaluated. The final diagnosis accuracy and the response time after supplementary examination were also assessed, as well as the completeness and rationality of their analysis of disease treatment principles. Results In the initial diagnosis and differential diagnosis stage, the comprehensive accuracy of DeepSeek-R1 was the highest [72.1%, 95% confidence interval (CI) 61.4% - 80.8%], and there was a statistically significant difference in the comprehensive accuracy of the three models for initial diagnosis (P = 0.008). After adding further examination information, the final diagnosis accuracy of the three models increased, with DeepSeek-R1 at 88.6% (95% CI 79.7% - 93.9%), ChatGPT-4o at 87.3% (95% CI 78.2% - 93.0%), and Grok-3 at 78.5% (95% CI 68.2% - 86.1%). There was no statistically significant difference among the three models (P = 0.05). The scores given by experts for the treatment principles showed good consistency (Kappa = 0.769). In addition, the response time of ChatGPT-4o is shorter than that of the other two models [(24 ± 7) s]. Conclusions Large language models demonstrate good efficacy in the diagnosis and treatment decision-making process of various pediatric liver diseases, have a good application prospect for auxiliary diagnosis and decision support, and are expected to help improve the accuracy and efficiency of clinical diagnosis and treatment of pediatric liver transplantation-related primary diseases.

In recent years， repetitive transcranial magnetic stimulation （rTMS） has garnered significant attention as a therapeutic approach for sleep disorders in the elderly. However， the prevailing rTMS protocols are predominantly developed based on normative neurophysiological data derived from young adults and fail to incorporate individualized parameters tailored to the brain characteristics of the elderly. To address this gap， the consensus development group synthesized the latest evidence from 2010 to 2025 and established a standardized rTMS protocol specifically for elderly patients with sleep disorders. Adhering to the Appraisal of Guidelines for Research and Evaluation II （AGREE II） framework， systematically screened randomized controlled trials （RCTs） and systematic reviews regarding rTMS in the treatment of sleep disorders across various conditions. Meanwhile， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system was employed to rigorously grade the quality of evidence and the strength of recommendations. This consensus guideline delineates precise rTMS protocols for the management of sleep disorders in the elderly， highlights the adjustment of stimulation intensity according to scalp-cortex distance recommends either MRI‑guided neuronavigation or the Beam F3/F4 heuristic approach for accurate target localization， thereby providing precise rTMS intervention protocol for sleep disorders in the elderly， aiming to enhance clinical efficacy while ensuring treatment safety. ［Funded by National Key Research and Development Program （number， 2023YFC3603200）； General Program of Shenzhen Science and Technology Innovation Commission （number， JCYJ20240813112859008， JCYJ20240813112900002）； Youth Program of Shenzhen Kangning Hospital （number， KN2023A004）； www.guidelines-registry.cn number， PREPARE-2026CN530］

Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.

ObjectiveTo investigate the feasibility and efficacy of modified video-endoscopic inguinal lymphadenectomy （M-VEIL）， guided by the layer surgery concept， in reducing postoperative complications in patients with penile cancer. MethodsA retrospective analysis was conducted on 27 patients with penile cancer who underwent bilateral laparoscopic inguinal lymphadenectomy at the Affiliated Hospital of Qingdao University between March 2018 and March 2022. All patients had undergone prior penile surgery. M-VEIL followed a standardized four-step procedure guided by fascial planes to achieve compartment-oriented resection， with deep lymphatic trunks ligated by silk sutures and endoscopic compression suture of the skin to the muscle layer using 4-0 absorbable threads. ResultsPreoperative physical examinations and imaging findings revealed bilateral inguinal lymphadenopathy， and no distant metastases were detected in any patient. Among the 27 patients， 12 underwent traditional video-endoscopic inguinal lymphadenectomy （T-VEIL； mean age 61.08±12.75） years and 15 underwent M-VEIL （mean age 54.47±14.64） years. All 27 operations were successfully completed without conversion to open surgery. No significant differences were observed between the two groups in operative time， intraoperative blood loss， postoperative hospital stay， number of lymph nodes retrieved， or lymph node positivity rate （all P >0.05）. Drain removal time was significantly shorter in the M-VEIL group （15.93±6.89 days vs. 23.33±10.42 days； P＜0.05）. Lymphatic leakage （2 vs. 8 patients） and surgical site infection （1 vs. 6 patients） occurred less frequently in the M-VEIL group （both P ＜0.05）. No significant differences were found in lymphocele， flap necrosis， lymphedema， or lower limb edema between the two groups （all P >0.05）. During postoperative follow-up for 1-3 years， 2 patients developed pelvic lymph node metastases， while the remaining 25 showed no evidence of local or pelvic recurrence. ConclusionCompared with T-VEIL， M-VEIL appears to reduce postoperative complications and shorten drain removal time in patients undergoing inguinal lymphadenectomy for penile cancer， while providing favorable clinical outcomes. Preliminary evidence suggests that M-VEIL is a safe and feasible modified procedure.

Objective:To investigate the effects and mechanism of Qiangjin Zhuanggu Capsules in bone remodeling in ovariectomized osteoporotic mice.Methods:Totally 75 8-week-old C57BL/6 female mice were divided into a sham-operation group of 15 mice and a modeling group of 60 mice. The model was created using bilateral ovariectomy (OVX) to replicate a postmenopausal osteoporosis mouse model. The successfully modeled mice were divided into model group, estradiol group, and Qiangjin Zhuanggu Capsules low-, medium-, and high-dosage groups using a random number table method, with 10 mice in each group. The estradiol group was given a 0.013 mg/ml solution of estradiol valerate tablets by gavage; Qiangjin Zhuanggu Capsules low-, medium-, and high-dosage groups were orally administered with Qiangjin Zhuanggu Capsule solution at dosages of 46.0, 92.0, and 184.0 mg/ml. The sham-operation group and model group were orally administered with equal volumes of physiological saline once a day for 8 consecutive weeks. After the intervention, the femoral trabecular bone structure, bone mineral density (BMD), bone volume/total volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), bone surface area/bone volume (BS/BV), and trabecular separation (Tb.Sp) were assessed using Micro-CT. Serum levels of bone metabolism markers such as calcium (Ca), phosphorus (P), bone alkaline phosphatase (BALP), osteocalcin (OCN), and cathepsin K (CTSK) were measured by ELISA. Hematoxylin and eosin (HE) and Masson staining were used to observe the morphological changes in femoral trabecular bone structure and collagen fibers. Western blot analysis was employed to detect the protein expression of Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), and bone morphogenetic protein-2 (BMP-2), .Results:Compared with the model group, the levels of BMD, BV/TV, Tb. N, and Tb.Th ( P<0.01 or P<0.05) in estradiol group and Qiangjin Zhuanggu Capsule medium- and high-dosage groups increased ( P<0.01, P<0.05), and BS/BV and Tb.Sp decreased ( P<0.01, P<0.05)serum levels of Ca, P, BALP, and OCN were elevated ( P<0.01, P<0.05), while CTSK was reduced ( P<0.01); the expression of Runx2, ALP and BMP-2 proteins significantly increased ( P<0.01, P<0.05). Conclusion:Qiangjin Zhuanggu Capsules exhibit preventive and therapeutic effects on postmenopausal osteoporosis, potentially through the regulation of Runx2, ALP and BMP-2.

Objective To observe the incidence of vascular calcification in patients with chronic renal failure(CRF)undergoing maintenance hemodialysis and analyze the related influencing factors.Methods A total of 110 CRF patients undergoing maintenance hemodialysis at Xingtai Central Hos-pital in Hebei Province were selected.Vascular calcification was determined through hip,abdominal,and bilateral hand X-ray examinations,and patients were divided into calcification group(n=59,with mild,moderate,and severe calcification)and non-calcification group(n=51,without calcifica-tion)based on the calcification results.General information and laboratory indicators[white blood cell(WBC)count,hemoglobin(Hb),total cholesterol(TC),triglycerides(TG),high-density lip-oprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),albumin(LB),serum potassium(K),serum calcium(Ca),serum phosphorus(P),serum creatinine(SCr),urea nitro-gen(BUN),uric acid(UA),intact parathyroid hormone(iPTH),high-sensitivity C-reactive pro-tein(hs-CRP),interleukin-13(IL-13),fibroblast growth factor 23(FGF23),sclerostin(SOST)]were compared between the two groups,and Logistic regression analysis was performed to screen in-fluencing factors of vascular calcification.Results There were no statistically significant differences in gender,body mass index,smoking history,and primary renal diseases between the calcification and non-calcification groups(P＞0.05).The mean age and dialysis duration were higher in the calcification group compared to the non-calcification group(P＜0.05).There were no statistically significant differences in WBC,Hb,TC,TG,HDL-C,LDL-C,K,Ca,and BUN levels between the two groups(P＞0.05).Compared with the non-calcification group,the calcification group had lower ALB and UA levels and higher P,SCr,iPTH,hs-CRP,IL-13,FGF23,and SOST levels(P＜0.05).Multivariate Logistic regression analysis showed that age,dialysis duration,and levels of P,iPTH,IL-13,FGF23,and SOST were influencing factors for vascular calcification in patients(P＜0.05).The receiver operating characteristic curve indicated that IL-13,FGF23,and SOST had cer-tain diagnostic value for vascular calcification in patients[area under the curve(AUC)＞0.7],and the diagnostic efficacy of combined IL-13,FGF23,and SOST was higher than that of each indi-cator alone(AUC=0.911,P＜0.05).Conclusion Vascular calcification is common in CRF pa-tients undergoing maintenance hemodialysis,and age,dialysis duration,P,IL-13,FGF23,and SOST are influencing factors for vascular calcification.

Objective To investigate the association between fecal incontinence and the risk of postoperative recurrence in patients with complete rectal prolapse(CRP).Methods A retrospective cohort study design was employed,CRP patients who underwent surgical treatment in the Guang'an-men Hospital of China Academy of Chinese Medical Sciences from January 2013 to June 2024 were selected as the study subjects.Two sequential survival analysis models were used to explore the rela-tionship between fecal incontinence and postoperative recurrence of rectal prolapse;restricted cubic spline regression was utilized to examine the linear relationship between the two indexes;survival curves were generated to illustrate the postoperative recurrence-free survival probabilities among patients with varying degrees of incontinence.Results A total of 180 CRP patients were included in this study,among whom 44 patients had severe fecal incontinence.The results of the multivariate sur-vival analysis model revealed a significant correlation between fecal incontinence and the risk of post-operative recurrence after controlling for covariates(P＜0.05).Considering a Wexner fecal inconti-nence score ≤ 5 as reference group,the recurrence risk in the group with a score≥16 was 4.26 times than that of the reference group[unadjusted model:HR=4.3(1.62 to 11.41);model 1:HR=3.37(1.27 to 8.94);model 2:HR=4.26(1.48 to 12.24);P＜0.05],indicating a significantly elevated recurrence risk in patients with high scores.A linear positive correlation was observed be-tween fecal incontinence and recurrence risk(Pnon-linearity＞0.05).The survival curves demonstrated significant differences in recurrence-free survival rates among different fecal incontinence groups.The survival probability in the group with a score ≥ 16 declined sharply(with only 3 cases remaining recurrence-free at 9 years),indicating the highest recurrence risk in this group.Conclusion Fecal incontinence is an important predictor of postoperative recurrence in rectal prolapse,with severe fe-cal incontinence serving as an independent high-risk factor.The severity of fecal incontinence should be incorporated into the preoperative risk assessment system in clinical practice to provide evidence-based support for optimizing surgical plans,stratified postoperative management,and preventing postoperative recurrence.

Objective To explore the bioactive components in Jiawei Xiaoyao Pills(JWXYP)and their mechanisms for alleviating depression-like behaviors.Methods The active compounds,key targets,and pathways of JWXYP were identified using TCMSP and TCMIP databases.Thirty-six SD rats were randomized equally into 6 groups including a control group and 5 chronic unpredictable mild stress(CUMS)-induced depression groups.After modeling,the 5 model groups were treated with daily gavage of normal saline,1.8 mg/kg fluoxetine hydrochloride(positive control drug),or JWXYP at 1.44,2.88,and 4.32 g/kg.The depression-like behaviors of the rats were evaluated using behavioral tests,and pathological changes in the liver and hippocampus were examined with HE staining.The biochemical indicators in the serum and brain tissues were detected using ELISA.Serum metabolomics analysis was performed to identify the differential metabolites using OPLS-DA,and gut microbiota changes were analyzed using 16S rDNA sequencing.Results Network pharmacology revealed that menthone and paeonol in JWXYP were capable of penetrating the blood-brain barrier to regulate inflammatory pathways and protect the nervous system.In the rat models subjected to CUMS,treatment with JWXYP significantly improved body weight loss,sucrose preference and open field activities,reduced liver inflammation,alleviated structural changes in the hippocampal neurons,decreased serum levels of TNF-α,IL-1β,IL-6 and LBP,and increased 5-HT and VIP concentrations in the serum and brain tissue,and these effects were the most pronounced in the high-dose group.Metabolomics analysis showed changes in such metabolites as indole-3-acetamide and acetyl-L-carnitine in JWXYP-treated rats,involving the pathways for bile acid biosynthesis and amino acid metabolism.16S rDNA analysis demonstrated increased gut microbiota diversity and increased abundance of Lactobacillus species in JWXYP-treated rats.Conclusion JWXYP alleviates depression-like symptoms in rats by regulating the neurotransmitters,inhibiting inflammation and oxidation,and modulating gut microbiota.

OBJECTIVE To understand the current status of antimicrobial agent usage intensity(AUD)of antibiot-ics,carbapenems(CB)and isolation rates of carbapenem-resistant gram-negative bacteria(CRGNB)and explore the effect of CB on hospital-associated CRGNB infections.METHODS A retrospective analysis was conducted on antimicrobial agent usage and clinical data of the patients who were hospitalized in Nantong University Affiliated Hospital from 2023 to 2024.The antimicrobial usage patterns,CB-AUD and isolation rates of CRGNB were sta-tistically analyzed.Additionally,the clinical data from 1933 confirmed hospital-acquired infection cases from 2023 to 2024 were retrospectively analyzed,and the patients were classified into two groups based on CRGNB resist-ance:the CRGNB-infected group with 376 cases and the non-CRGNB-infected group with 1557 cases.The risk factors for CRGNB infections were identified.RESULTS In the two years,the overall utilization rate of antimicro-bial drug and AUD fluctuated every six months(P＜0.05).The overall define daily dose system(DDDs)and AUD of the three CBs(meropenem,imipenem/cilastatin and biapenem)increased every six months(P＜0.05).The o-verall drug resistance rate of gram-negative bacilli to CB decreased every six months(P＜0.05).The logistic re-gression analysis showed that the duration of use of CB and combined use of antibiotics were the risk factors for the CRGNB infections(with the OR values,1.445,2.479,1.958,respectively,all P＜0.05).CONCLUSIONS The overall use of CB is on the rise.The use of CB,especially the duration of CB,increases the probability of CRGNB infection.Therefore,it is necessary for the hospital to strengthen the monitoring of CB-AUD and supervi-sion of CB.

Objective:To explore the specific mechanism of Baijiesan on microangiogenesis of wound after perianal abscess in rats by regulating RAS signal pathway.Methods:A total of 72 SD rats were divided into control group,model group,Baijiesan group and Baijiesan+farnesylthiosalicylic acid(FTS)group,with 18 rats in each group.Cut off the whole layer of skin on the back of rats.The model group,Baijiesan group and Baijiesan+FTS group were treated with fecal supernatant,while the control group was treated with normal saline.After the successful establishment of the model,Baijiesan+FTS group were treated with Baijiesan and received in-traperitoneal injection of FTS,while Baijiesan group were treated with Baijiesan only.The back wound images of rats were taken after successful modeling(day 0),4 days,8 days and 12 days after treatment,and the wound healing rate was calculated.After 4 days,8 days and 12 days of treatment,6 rats in each group were randomly selected and killed,the new wound healing tissue was removed,and the blood of abdominal aorta of rats after treatment for 12 days was collected.Histopathological morphology of wound tissue was observed by HE and Masson staining.Immunohistochemistry was used to detect the number of microvessels.ELISA was used to detect serum inflammatory markers.RAS signal pathway and angiogenesis-related molecules were detected by qRT-PCR and Western blot.Results:Compared with control group,the wound healing rate of model group,Baijiesan group and Baijiesan+FTS group decreased at each time point(P<0.05),while the number of microvessels,the levels of TNF-α,IL-1β,IL-6,RAS and Raf-1,VEGF,VEGFR2 mRNA and protein,ERK1,ERK2 mRNA,p-MEK1/2,p-ERK1/2 protein expressions were increased(P<0.05).Compared with model group and Baijiesan+FTS group,the wound healing rate,the number of microvessels,RAS,Raf-1,VEGF,VEGFR2 mRNA and protein,ERK1,ERK2 mRNA,p-MEK1/2,p-ERK1/2 protein expressions were further increased in Baijiesan group(P<0.05),while the levels of TNF-α,IL-1β and IL-6 were decreased(P<0.05).Conclusion:Baijiesan can reduce the level of wound inflamma-tion after operation of perianal abscess,and may enhance the ability of wound angiogenesis and wound healing by promoting RAS signal pathway.