OBJECTIVE To construct a preoperative medication reconciliation model assisted by a localized large language model （LLM） for gastric cancer and evaluate its clinical efficacy. METHODS A total of 249 gastric cancer patients with a history of continuous medication before admission in the Gastric Surgery Department of Jiangsu Cancer Hospital were retrospectively enrolled. Patients were divided into training set （154 cases） and validation set （95 cases） based on the order of time. Based on guidelines， drug package inserts， and other evidence， a standardized medication reconcili ation process and a structured knowledge base were constructed. DeepSeek-V3 LLM was deployed privately in the hospital， combined with retrieval-augmented generation technology， to achieve automated integration of medication information， risk screening， and generation of personalized recommendations. The quality of LLM-generated recommendations was evaluated using automatic metrics （BERT Score and ROUGE-1， 2， L） and manual scoring [seven-dimensional index （7DI） ] . Spearman correlation analysis was performed to explore the correlation between automatic scores and manual scores. Cronbach’s α coefficient was used to test the internal consistency of manual scoring results. The time consumed by manual and LLM-assisted medication reconciliation was compared across tasks of different difficulty levels （simple， moderate， and high）. RESULTS A structured knowledge base covering 8 major drug categories was finally established， covering common and high-risk preoperative medication scenarios and providing structured retrieval support for the LLM. For automatic evaluation， the precision， recall， and F1-score of BERT Score were 0.783±0.033， 0.811±0.038， and 0.796±0.028， respectively. The F1-scores of ROUGE-1， ROUGE-2 and ROUGE-L were 0.566±0.067， 0.338±0.076 and 0.468±0.082， respectively. The 7DI scores from three manual raters ranged from 32.06 to 33.45. The F1-score of automatic scoring was significantly positively correlated with the 7DI score of manual scoring （maximum coefficient of determination＝0.611， P ＜0.001）， and the internal consistency of manual scoring was good （Cronbach’s α ＝ 0.876）. In terms of efficiency， LLM-assisted medication reconciliation reduced time consumption by more than 90% compared with manual reconciliation in the simple， moderate， and high-difficulty groups （ P ＜0.001）. CONCLUSIONS The medication reconciliation model constructed based on a localized LLM and structured knowledge base shows high accuracy， consistency， and clinical applicability in complex preoperative medication scenarios for gastric cancer. It can improve the efficiency of medication reconciliation and reduce potential medication risks.

The 26th World Conference on Lung Cancer (WCLC) was held in Barcelona during September 6-9, 2025. As the world's largest and most influential academic meeting in the field of lung cancer, this year's congress unveiled long-term follow-up data from several pivotal studies and significant advances in novel therapeutic strategies. In the realm of targeted therapy, a next-generation combination strategy has been established as the new standard of care for the first-line treatment of patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC), demonstrating a significant improvement in overall survival. In immunotherapy, novel combination regimens have not only addressed the therapeutic challenge of acquired resistance to EGFR targeted therapies, but also shown clear long-term survival benefits in both the perioperative and locally advanced settings. These findings pave the way for shifting the treatment paradigm to earlier stages for patients with NSCLC. Antibody-drug conjugates have made remarkable strides in this field. They have shown outstanding efficacy in patients with specific resistance mutations and those with brain metastases, and have also demonstrated immense potential in treating patients with HER2-aberrant lung cancer and broader NSCLC populations. This offers new therapeutic options for patients with refractory lung cancer.However, significant challenges remain, including the heterogeneity of resistance mechanisms, the selection of optimal treatment regimens, and management strategies for special populations. Future research should focus on identifying novel precision biomarkers and optimizing therapeutic strategies to ultimately improve clinical outcomes for all patients with lung cancer.

Objective:To explore the influencing factors of the therapeutic effect of fiberoptic bronchoscopic alveolar lavage (BAL) in children with severe pneumonia (SP), and the relationship between pulmonary ultrasound parameters and the clearance rates of procalcitonin (PCT) and C-reactive protein (CRP) after treatment.Methods:A total of 284 children with SP admitted to the Yan ′an People′s Hospital from February 2019 to October 2023 were selected as the research subjects; According to the prognosis after 30 days of treatment, they were divided into the good prognosis group ( n=213) and the poor prognosis group ( n=71). The changes of PCT clearance rate, CRP clearance rate and Lung Ultrasound Score (LUS) before and after treatment were compared between the two groups. The correlation between indexes was analyzed using the multiple linear regression (MLR) model. The odds ratio ( OR) of risk factors was calculated using the multivariate logistic regression model. The dose-response relationship was evaluated using the restricted cubic spline (RCS) model. The receiver operating characteristic (ROC) curve was used to analyze the predicting value of each index for poor prognosis after 30 days of treatment. Results:Compared with the good prognosis group, the CRP clearance rate and PCT clearance rate of children in the poor prognosis group were lower 7-14 days after treatment (all P<0.05), and the LUS was higher (all P<0.05). The MLR analysis results showed that LUS was negatively correlated with both CRP clearance rate and PCT clearance rate (all P<0.05), and there was still a significant correlation after adjusting for confounding factors (all P<0.05). The results of logistic regression analysis showed that after excluding confounding factors (Model 4), LUS, PCT clearance rate, and CRP clearance rate were independent risk factors for poor prognosis in children with SP after 30 days of treatment (all P<0.05). The results of RCS analysis showed that there was a nonlinear relationship between the continuous changes of LUS, PCT clearance rate and CRP clearance rate and the risk of poor prognosis in children with SP after 30 days of treatment (nonlinear tests all P<0.001). The combined accuracy of LUS, PCT clearance rate and CRP clearance rate in predicting the poor prognosis of children with SP after 30 days of treatment was relatively high ( P<0.05, AUC>0.75). Conclusions:The clearance rates of LUS and CRP, as well as PCT, are all associated with poor prognosis in children with SP, and the decreased clearance rates of CRP and PCT are independent factors for predicting the increase of LUS. The combined clearance rates of LUS and CRP, as well as PCT, can accurately predict the risk of poor prognosis in children.

Objective:To construct a communication skills assessment scale for newly employed nurses, verify the reliability and validity of the scale in a simulated setting, and develop and construct an effective and structured assessment tool for the communication skills of newly employed nurses.Methods:The Chinese version of the Liverpool Communication Skills Assessment Scale was modified and two rounds of expert consultation were conducted to construct the communication skills assessment scale for newly employed nurses. A total of 194 newly employed nurses at a tertiary hospital between 2024 and 2025 were selected using convenience sampling. Data were collected using a teacher-based evaluation method during simulated communication scenarios. The performance of the nurses was scored, and the reliability and validity of the scale were analyzed.Results:The final version of the scale consisted of 4 dimensions and 11 items, and can be used in both workplace-based and simulation-based evaluations. The expert authority coefficients of both rounds were greater than 0.70. The Kendall's W coordination coefficients for the two rounds of consultation were 0.278 and 0.309 for workplace-based evaluations and 0.256 and 0.295 for simulation-based evaluations. The coefficients of variation for the 11 items in both application scenarios were <0.250. The total Cronbach's alpha coefficient of the scale was 0.805 and the total split-half reliability coefficient was 0.814. In the two application scenarios, the item-level content validity index ranged from 0.769 to 1.000 (all >0.750). The scale-level content validity index was 0.916 and 0.909 (>0.900), respectively, in the workplace-based and simulation-based evaluations. The exploratory factor analysis extracted a total of four common factors, with a cumulative variance contribution of 69.09%, and all item loadings on their corresponding factors exceeded 0.500. Conclusions:The communication skills assessment scale for newly employed nurses has moderate and validated content and number of items. The scale demonstrates high reliability and validity in simulation-based evaluations, and can be used as an effective tool for assessing the communication skills of newly employed nurses.

Objective To analyze the risk factors for moderate-to-severe coronary artery stenosis in the population of Tacheng,Xinjiang Uygur Autonomous Region,and to construct and verify a nomogram prediction model for the degree of coronary artery ste-nosis.Methods We retrospectively selected 629 patients who were hospitalized in the Cardiovascular Department of Tacheng Peo-ple's Hospital from January 2021 to June 2023.Using R language software,the sociodemographic data,disease-related data,and va-rious laboratory indicators of the 629 patients were included in the initial screening of risk factors for use in the LASSO regression analysis using a random number table method.The 629 patients were divided into a training group(n=440)and a validation group(n=189)in a 7:3 ratio.Data from the training group were used for model construction,with the degree of coronary artery stenosis as the dependent variable,and the variables selected by LASSO regression as independent variables in the logistic regression model.The validation group was used for model validation.Based on the results of the logistic regression analysis,a visual nomogram for predicting the degree of co-ronary artery stenosis was constructed using R language software.The discriminability,calibration,and clinical utility of the model were evaluated using the area under the receiver operating characteristic curve(AUC),a calibration curve,and decision curve analysis(DCA).Results Age,non-Han ethnicity,hypertension,hyperlipidemia,and a history of cerebrovascular disease were risk factors for mode-rate-to-severe coronary artery stenosis and were included in the risk prediction model.The AUC of the training group and the validation group were 0.905(95％CI:0.790-0.863)and 0.864(95％CI:0.744-0.861),respectively.The predicted values of the calibration curve were consistent with the actual values(Brier scores of the training and validation group:0.03 and 0.14,respectively).The predictive per-formance of the model was good,and the DC A results indicated that the model had net clinical benefits.Conclusion The risk prediction model for coronary artery stenosis in the population of the Tacheng area constructed in this study has good predictive performance and can provide a simple,feasible,economical,and easy-to-promote evaluation tool for medical personnel to screen patients with moderate-to-se-vere coronary artery stenosis.

Gastric cancer, a highly malignant tumor, has seen a persistent rise in global incidence in recent years. Claudin 18.2, a protein with highly specific expression in gastric cancer, has emerged as a prominent research target in therapeutic development. The overexpression of Claudin 18.2 in gastric cancer cells and its abnormal surface exposure provide novel opportunities for targeted and immunotherapeutic interventions. Therapeutic approaches targeting Claudin 18.2 have shown promising initial results in clinical trials, primarily including monoclonal antibodies and chimeric antigen receptor T-cell therapies. The authors systematically summarize the biological characteristics, mechanism of action, clinical research progress, and future treatment prospects and challenges of Claudin 18.2.

Objectives:To investigate the predictive value of Murray's law-based quantitative flow ratio(μQFR)in side branches for long-term clinical prognosis in patients with non-left main bifurcation lesions who underwent simple main branch stenting,and to provide a potential functional assessment standard for intervention decision-making on coronary bifurcation lesions.Methods:A retrospective analysis was conducted in 408 patients with non-left main bifurcation lesions who underwent simple main branch stenting at Lianyungang First People's Hospital and Nanjing First Hospital between July 2018 and January 2021.The study utilized third-generation QFR software to analyze pre-and post-procedure anatomical and functional parameters of the target lesion's main branch and key branches.The primary endpoint was target vessel failure(TVF)events during the 3-year follow-up.Patients were stratified into TVF and non-TVF groups.Baseline characteristics,procedural data,and pre-/post-procedural parameters of target vessels were compared between groups.Multivariable Cox regression was performed to identify predictors of TVF.Diagnostic efficacy of predictors was evaluated using area under the receiver operating characteristic(ROC)curve(AUC)with DeLong's method for comparison.Patients were dichotomized based on the optimal cutoffof post-procedural side branch μQFR,with TVF incidence rates compared via Cox regression and Kaplan-Meier analysis.Results:During 3-year follow-up,54 patients(13.2%)experienced TVF(TVF group),data were compared with 354 patients(86.76%)without TVF(non-TVF group).The TVF group showed higher post-procedural side branch diameter stenosis([32.93±17.80]%vs.[22.62±11.96]%,P<0.001)and lower μQFR(0.80±0.10 vs.0.89±0.07,P<0.001).Multivariate Cox regression identified higher post-procedural side branch μQFR as an independent protective factor against 3-year TVF(per 0.01 increase:HR=0.903,95%CI:0.850-0.959,P<0.001).ROC curves indicated that post-procedural side branch μQFR had moderate diagnostic efficacy for predicting 3-year TVF(AUC=0.769,95%CI:0.678-0.861,P<0.001),with a significantly higher AUC value than post-operative side branch area stenosis and minimal lumen diameter(both P<0.001),the optimal cutoffvalue was 0.84.Multivariate Cox regression and Kaplan-Meier survival analysis revealed markedly higher 3-year TVF rates in patients with μQFR≤0.84 compared to patients with μQFR>0.84(HR=4.007,95%CI:2.342-6.855,P<0.001;28.3%vs.7.9%,log-rank P<0.001).Conclusions:For patients with bifurcation lesions not involving the left main,the immediate post-procedural side branch μQFR could better predict 3-year TVF than anatomical indices.Maintaining post-stenting side branch μQFR>0.84 may optimize clinical outcomes when using a single-stent strategy.

Objective:To investigate the clinical features of patients with congenital atresia of the oval window (CAOW).Methods:A retrospective analysis was conducted on 7 cases (8 ears) of surgically confirmed CAOW treated at our department from July 2018 to July 2024. Among the cases, 1 patient had bilateral CAOW, and 4 patients had unilateral CAOW combined with other types of ossicular chain malformations in the contralateral ear. We collected and analyzed the clinical data, audiological features, and temporal bone HRCT results of all patients.Results:The 7 patients were diagnosed at ages ranging from 8 to 19 years, with a mean age of (13.2±6.9) years. None of the patients exhibited significant auricular deformities. All presented with conductive hearing loss or mixed hearing loss predominantly of the conductive type, with an intact tympanic membrane. The diagnosis of CAOW was confirmed via endoscopic tympanotomy, revealing a concave oval window area on the medial wall of the tympanic cavity, sealed by a bony plate. All 8 ears exhibited additional ossicular chain deformities. Stapes absence was present in all 8 ears. Partial absence of the incus long process was observed in 3 ears, while, abnormal bony connections between the incus long process and the promontory were seen in 4 ears, 1 ear had a short malleolar handle, 1 ear had a smaller than normal malleus volume. In addition, facial nerve deformities were found in 6 ears, with 4 ears showing bifurcation of the facial nerve and 2 ears showing facial nerve obscuration of the oval window. Pure-tone audiometry revealed that 62.5% (5/8 ears) of patients had air conduction (AC) thresholds≥60 dB preoperatively, with a mean pure-tone average (PTA) of (69.0±11.8) dB HL and a mean air-bone gap (ABG) of (52.0±7.0) dB. The mean AC threshold and ABG were higher in the low-frequency (125-1 000 Hz) range compared to the high-frequency (2 000-8 000 Hz) range (both P<0.05). Preoperative HRCT showed abnormalities in all patients, with 7 ears being diagnosable as CAOW. Although the remaining 1 ear could not be diagnosed as CAOW, stapes and incus long process absence were detected. Conclusion:CAOW is rare in clinical, as the patients with non-progressive conductive hearing loss (AC≥60 dB, ABG≥50 dB) since childhood, intact tympanic membrane without malformations of auricle and external auditory canal, and thick bony plate covered the oval window of the HRCT imaging, CAOW should be highly suspected, which could be confirmed by the exploratory tympanotomy.

Objective To investigate the protective effects and mechanism of Shuilian Fengkui Formula(SFF)of Yao medicine on sequelae pelvic inflammatory disease(SPID)in rats.Methods The SPID rat model was established by mechanical injury coupled with bacterial infection,and then the rats were randomly divided into:the SPID group,the positive drug(Fukeqianjin tablets)group,SFF groups at low,medium and high doses,and the sham-operation group,with 8 rats in each group;SPID group,SFF groups,TLR4 agonist CRX-527(CRX-527)group,SFF plus CRX-527 group,with 8 rats in each group.Corresponding drug intervention was given for 21 consecutive days.The indexes of uterus,spleen,thymus and other organs were calculated.The histopathological changes in rat uterus were observed by HE staining.The levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),immunoglobulin G(IgG),immunoglobulin M(IgM)in serum were detected by ELISA;The protein expression levels of Toll receptor 4(TLR4),myeloid differentiation factor(MyD88),nuclear factor kappa B p65(NF-κB p65),and phosphorylated nuclear factor kappa B p65(p-NF-κB p65)in rat uterine tissues were detected by Western blot.Results Compared with the sham operation group,the uterine index of SPID group significantly increased(P<0.01),the spleen index and thymus index significantly decreased(P<0.01),the pathological damage of uterine tissue was serious,the contents of IL-1β,IL-6,TNF-α in serum significantly increased(P<0.01),the contents of IgG and IgM significantly decreased(P<0.01),the TLR4,MyD88 protein and the ratio of p-NF-κB p65/NF-κB p65 protein in uterine tissue significantly increased(P<0.01).Compared with the SPID group,the uterine index of the positive drug group and the SFF groups significantly decreased(P<0.05),the spleen index and thymus index significantly increased(P<0.05),the pathological damage of uterine tissue significantly improved,the contents of IL-1β,IL-6 and TNF-α in serum were significantly lowered(P<0.05),the contents of IgG and IgM significantly increased(P<0.05),and the TLR4,MyD88 protein and the ratio of p-NF-κB p65/NF-κB p65 protein in uterine tissue significantly downregulated(P<0.01).However,CRX-527 significantly reversed the effects of SFF on SPID in rats.Conclusion SFF could improve SPID in rats by impeding the inflammatory response,and its mechanism might be attributed to inhibition of TLR4/MyD88/NF-κB signaling pathway.

Objective:To investigate the clinical features of patients with congenital atresia of the oval window (CAOW).Methods:A retrospective analysis was conducted on 7 cases (8 ears) of surgically confirmed CAOW treated at our department from July 2018 to July 2024. Among the cases, 1 patient had bilateral CAOW, and 4 patients had unilateral CAOW combined with other types of ossicular chain malformations in the contralateral ear. We collected and analyzed the clinical data, audiological features, and temporal bone HRCT results of all patients.Results:The 7 patients were diagnosed at ages ranging from 8 to 19 years, with a mean age of (13.2±6.9) years. None of the patients exhibited significant auricular deformities. All presented with conductive hearing loss or mixed hearing loss predominantly of the conductive type, with an intact tympanic membrane. The diagnosis of CAOW was confirmed via endoscopic tympanotomy, revealing a concave oval window area on the medial wall of the tympanic cavity, sealed by a bony plate. All 8 ears exhibited additional ossicular chain deformities. Stapes absence was present in all 8 ears. Partial absence of the incus long process was observed in 3 ears, while, abnormal bony connections between the incus long process and the promontory were seen in 4 ears, 1 ear had a short malleolar handle, 1 ear had a smaller than normal malleus volume. In addition, facial nerve deformities were found in 6 ears, with 4 ears showing bifurcation of the facial nerve and 2 ears showing facial nerve obscuration of the oval window. Pure-tone audiometry revealed that 62.5% (5/8 ears) of patients had air conduction (AC) thresholds≥60 dB preoperatively, with a mean pure-tone average (PTA) of (69.0±11.8) dB HL and a mean air-bone gap (ABG) of (52.0±7.0) dB. The mean AC threshold and ABG were higher in the low-frequency (125-1 000 Hz) range compared to the high-frequency (2 000-8 000 Hz) range (both P<0.05). Preoperative HRCT showed abnormalities in all patients, with 7 ears being diagnosable as CAOW. Although the remaining 1 ear could not be diagnosed as CAOW, stapes and incus long process absence were detected. Conclusion:CAOW is rare in clinical, as the patients with non-progressive conductive hearing loss (AC≥60 dB, ABG≥50 dB) since childhood, intact tympanic membrane without malformations of auricle and external auditory canal, and thick bony plate covered the oval window of the HRCT imaging, CAOW should be highly suspected, which could be confirmed by the exploratory tympanotomy.