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.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective To investigate the clinic efficacy of proximal humeral internal locking system(PHILOS) in the treatment of Neer Ⅱ and Ⅲ proximal humeral fractures.Methods From January 2013 to December 2015,a total of 47 patients with Neer Ⅱ and Ⅲ proximal humeral fractures was treated with PHILOS fixation in our hospital.The operative time,blood loss in operation,hospital stay,complications,Constant scores and radiography films were retrospectively analyzed.Results All 47 patients were followed up for an average of (19.2 ±9.6) month.The average operative time,the level of average intraoperative blood loss,the mean hospitalization time and the complication rate were(95.6 ±43.1) min,(108 ± 41.6) mL,(11.3 ±3.2) d and 14.7 ％ respectively.The Constant score was improved from(21.74 ± 8.24) preoperatively to(82.83 ± 7.21) at the last follow-up,and the difference was statistically significant(t=-36.57,P＜0.01).Conclusion Fixation with PHILOS is a safe and effective treatment for patients with Neer Ⅱ and Ⅲ proximal humeral fractures.

Objective To analyze the periopemtive blood loss of elderly patients with intertrochanter fracture that fixed with proximal femoral nail-antirotation (PFNA),and to explore the risk factor influencing the perioperative blood loss following PFNA fixation.Methods The clinical data of 62 elderly patients with intemochanter fracture treated with PFNA were analyzed retrospectively to determine the perioperative obvious blood loss and hidden blood loss.The impact of gender,age and fracture type on blood loss was also analyzed.Results The obvious blood loss of 62 patients was (120.6 ±42.0) ml,which accounted for 15.5％ in total blood loss [(775.8 ± 129.6) ml].The hidden blood loss was (655.2 ± 109.1) ml,which accounted for 84.5％ in total blood loss.The hidden blood loss was much more than obvious blood loss (P＜ 0.01).The total blood loss,obvious blood loss,hidden blood loss was (773.3 ± 131.5),(122.5 ± 44.1),(650.8± 114.2) mlinmahgroup (20cases),(777.0± 124.7),(119.7±40.2),(657.3 ± 107.7) ml in female group (42 cases),and there was no significant difference between two groups (P ＞ 0.05).The total blood loss,obvious blood loss was (813.1 ± 107.5),(117.7 ±49.7) ml in advanced age group (35 cases),(727.4 ± 114.3),(124.4 ± 36.6) ml in non-advanced age group (27 cases),and there was no significant difference between two groups (P ＞0.05).The hidden blood loss was (695.4 ±74.1) ml in advanced age group,(603.0 ± 65.3) ml in non-advanced age group,and there was significant difference between two groups (P＜0.05).The total blood loss,obvious blood loss,hidden blood loss was (578.1 ±82.3),(68.5 ±23.1),(509.6 ±63.1) ml in stable group (14 cases),(833.5 ±84.1),(135.8 ±35.0),(697.7 ±79.3) ml in unstable group (48 cases),and there was significant difference between two groups (P ＜ 0.05).Conclusions Hidden blood loss is the major part of perioperative blood loss of elderly patients with intertrochanter fractures that fixed with PFNA.Advanced age and unstable fracture type are risk factors of hidden blood loss.

BACKGROUND: Macrophage colony-stimulating factor (M-CSF)/receptor activator of nudeer kappa B ligand (RANKL), two types of cytokines co-induce myeloid stem cells to form osteoclasts, is a kind of new method to harvest ostaoclasts with high purity and quantity, but there is lack of uniform cultivation standard. OBJECTIVE: To construct an effective M-CSF/RANKL induced mice myeloid stem cells inducing osteoclast differentiation cultivation system. METHODS: Myeloid stem cells ware obtained from ICR mice and then cultured for 24 hours in a-minimum essential medium containing M-CSF, at cell density of 10~7/L, 10~8/L, 10~9/L. Then 10 μg/L M-CSF and 20, 50, 100 μg/L RANKL were added into culture medium. Tartaric-resistant acid phosphatase stained was performed to observe the transition process from stem cell to osteoclast, as well as cell morphology and stain situation after culture, and positive stained osteoclasts were counted. We compared the influence of different induction conditions to the quantity of osteoclast. RESULTS AND CONCLUSION: A small quantity of osteoclasts contained many red positive beads in the intracytoplasm were observed at 3 days. There were positive beads with hypochromatic dikeryon in cells. A large amount of positively stained osteoclests were seen after 6-day cultudng, which maintained dikaryon. After 9-day culturing, positively stained colossal multinudear cells occurred, became larger and maintained three nuclei. At certain cell density, 100 μg/L RANKL could induce to form more osteoclasts compared with other 2 concentrations (P < 0.05); at certain RANKL concentration, the osteoclasts formation at cells density of 10~8/L was dramatically greater than other 2 cell densities (P < 0.05); the number of osteoclasts was the most when the concentration of RANKL was 100 μg/L and cell density of 10~8/L (P < 0.05). When osteoclasts are induced by M-CSF/RANKL from mudne myeloid stem cells, the best concentration of RANKL is 100 μg/L and cells density is 10~8/L.

Objective To explore the influencing factors during long-distance transportation and medical rescue of trauma patients in Wenchuan earthquake. Methods After Wenchuan earthquake, based on prehospital care scheme, we organized medical coordinators and psychologically trained medical staff in emergency medicine, cardiovascular medicine and logistics to transport trauma patients and pro-vide early psychological intervention during whole course of transportation. Results A total of 162 trauma patients were safely transported from Sichuan province to Chongqing relying on prehospital care scheme, equipment supplies, integrated rescue mode and psychological intervention during the transporta-tion. Conclusions Medical rescue mode and psychological intervention indicate that it is necessary to conduct psychological intervention for better transportation of patients for further medical treatments. In the meantime, we should establish medical rescue system for coping with psychological stress, improve rescue preparation scheme and professional medical care team for long-distance transportation and guaran-tee sufficient medical supplies in station hospitals.

Adolescent ; Adult ; Aged ; Bacterial Infections ; drug therapy ; Bone Diseases ; drug therapy ; Child ; Female ; Humans ; Iodophors ; administration & dosage ; Joint Diseases ; drug therapy ; Male ; Middle Aged ; Suppuration ; drug therapy ; Therapeutic Irrigation

AIM: To investigate the levels of IL-18, IL-16, IL-8, eotaxin and the chymase activity in the sputum of asthmatics. METHODS: IL-18, IL-16, IL-8 and eotaxin levels were detected with sandwich ELISA procedures and chymase activity was determined spectrophotometrically (410 nm) by the rate of hydrolysis of N-succinyl-L-Ala-L-Ala-L-Pro-L-Phe-p-nitroanilide (SAAPP). RESULTS: The specific chymase activities in the severe and moderate asthmatics were higher than that in controls. Native protease inhibitors ?_1-antitrypsin (?_1-AT) and soybean trypsin inhibitor (SBTI) inhibited 71.9% and 72.1% enzymatic chymase activity, respectively. The levels of IL-18, IL-16, IL-8 and eotaxin were significantly elevated in the sputum of patients with acute asthma. There were correlations between the levels of IL-8 and IL-16 (r=0.55, P