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.

Objective To evaluate the reliability of Vitek 2 AST-N335 card for determining the susceptibility of Acinetobacter bauman-nii(AB)to cefoperazone/sulbactam.Methods A total of 318 non-repeated clinical isolates of AB collected in 2023 were tested for antimicrobial susceptibility to cefoperazone/sulbactam using broth microdilution(BMD),the AST-N335 card,and the Kirby-Bauer(K-B)disk diffusion method.Using BMD as the reference method,the reliability of AST-N335 card was assessed,and the accuracy of K-B disk diffusion method as the confirmatory test was validated.Results Compared with BMD,the susceptibility testing of 318 AB strains to cefoperazone/sulbactam using the AST-N335 card showed categorical agreement(CA)of 87.8％(279/318),very major er-ror(VME)of 6.0％(19/318),major error(ME)of 0％(0/318),and minor error(mE)of 1.9％(6/318),which fall outside of the acceptable error range.In contrast,the K-B method achieved CA of 99.4％(316/318),VME of 0％,ME of 0.3％(1/318),and mE of 0.3％(1/318),all within acceptable limits.Of these,the errors with AST-N335 card occurred within the minimum inhibitory concentration(MIC)range of 8-32 μg/mL.Using BMD as the reference method,further analysis was performed on the 171 AB strains with AST-N335 card MIC values of 8-32 μg/mL for cefoperazone/sulbactam.It was revealed that at MIC of 32 μg/mL,the CA was 0％;at MIC of 16 μg/mL,CA was 5.3％(1/19)and VME rate was 84.2％(16/19),both of which substantially exceeded accepta-ble error ranges.At MIC of 8 μg/mL,the CA was 94.9％(131/138)and VME was 2.2％(3/138),both approaching the acceptable ranges.Conclusion The results obtained with Vitek 2 AST-N335 card in determining for cefoperazone/sulbactam are unreliable when the MIC values fall within the range of 8-32 μg/mL,which leads to an underestimation of the resistance rate to cefoperazone/sulbac-tam.This issue requires urgent attention in both laboratories and clinical practice.The K-B disk diffusion method could serve as a sup-plementary verification approach in routine laboratories.

Objective To analyze the multimodal ultrasound imaging characteristics in patients with different molecular subtypes of breast cancer.Methods The medical records of 85 patients with breast cancer were retrospectively collected and classified into 12 cases of Luminal A,35 cases of Lu-minal B,21 cases of HER2,and 17 cases of triple-negative breast cancer based on immunohisto-chemical results.All patients underwent conventional ultrasound,color Doppler ultrasound,ultra-sound elastography,and contrast-enhanced ultrasound.The relationship between multimodal ultra-sound characteristics and breast cancer molecular subtypes and their diagnostic value were analyzed.Results Conventional ultrasound and color Doppler ultrasound results showed statistically significant differences in the margin characteristics of breast cancer lesions among the four molecular subtypes(P＜0.05).Ultrasound elastography results revealed that the maximum elastic modulus(Emax)lev-els of HER2 and triple-negative subtypes were higher than those of Luminal A and Luminal B,respec-tively.The ratios of elastic modulus to normal tissue(Eratio)for Luminal B,HER2,and triple-nega-tive subtypes were higher than that of Luminal A,and the Eratio level of Luminal Bwas lower than that of HER2(P＜0.05).Contrast-enhanced ultrasound results showed statistically significant differences in enhancement levels,perfusion defects,and peak intensity(IMAX),time to peak(TTP),and augmentation time(AT)among the four molecular subtypes of breast cancer lesions(P＜0.05).Multivariate Logistic regression analysis showed that margin characteristics,Emax,Emin,Emean,Eratio,IMAX,TTP,and AT were independent influencing factors for breast cancer molecular subtypes(P＜0.05).Receiver operating characteristic curve analysis showed that the area under the curve and sensitivity of multimodal ultrasound imaging characteristics(combined indicators)for diagnosing breast cancer molecular subtypes were significantly greater than those of individual indicators(P＜0.05).Conclusion There are differences in two-dimensional ultrasound,color Doppler ultra-sound,ultrasound elastography,and contrast-enhanced ultrasound results among different molecular-subtypes of breast cancer.Multimodal ultrasound imaging characteristics have high diagnostic value for breast cancer molecular subtypes.

Objective To explore the effect of sitagliptin and metformin combined with zoledronic acid in the treatment of type 2 diabetes mellitus(T2DM)complicated with osteoporosis(OP)on the levels of glucose and lipid metabolism and bone metabolism in patients.Methods Patients with T2DM combined with OP admitted to Nantong Second People's Hospital from January 2021 to January 2024 were selected as the research subjects and randomly divided into the combined group(sitagliptin and metformin combined with zoledronic acid)and the control group(zoledronic acid only).After 6 months of treatment,the clinical efficacy,glucose and lipid metabolism indicators[fasting blood glucose(FBG),2-hour postprandial blood glucose(2hPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],bone metabolism indicators[osteoprotegerin(OPG),bone-specific alkaline phosphatase(BALP),osteocalcin(OC)]levels,changes in bone density,and incidence of adverse reactions were compared between the two groups before and after treatment.Results A total of 120 patients were included,with 60 patients in each group.After treatment,the total effective rate of the combination group was 93.33％,significantly higher than the control group's 73.33％(P＜0.05).The levels of FBG,2hPG,HbA1c,TC,TG,and LDL-C in two groups were significantly lower than those before treatment,while the levels of HDL-C,OPG,BALP,OC,and bone density in the femoral neck and lumbar spine were significantly higher than before treatment(P＜0.05);and all indicators of the combined group were better than those of the control group(P＜0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Sitagliptin and metformin combined with zoledronic acid in the treatment of patients with T2DM complicated with OP is more effective in regulating their glycolipid metabolism and bone metabolism levels,increasing bone density,improving therapeutic effects,and it has better safety than zoledronic acid alone.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective:This study aim to explore the distribution patterns of inhalant allergen specific immunoglobulin E(sIgE) positive rates in children with respiratory diseases and its correlation with clinical characteristics, so as to provide reference basis for the prevention and diagnosis of respiratory diseases in children.Methods:A cross-sectional retrospective study was conducted using clinical data from 3 574 children with respiratory tract infections and allergic diseases attending Hunan Children′s Hospital from August 2022 to August 2024.The χ 2 test or Fisher′s test was used for statistical analysis to compare the distribution characteristics of inhaled allergen positive rates among children across different ages, genders, seasons, and diseases. The correlation between allergens and clinical features was analyzed. Results:Of the 3 574 children, 51.4%(1 838) were positive for at least 1 inhalant allergen sIgE, with house dust mite, dust mite, and house dust being the most common allergens with top 3 positive rates. The children had a single sensitization rate of 17.9%(329/1 838) and a multiple sensitization rate of 82.1%(1 509/1 838), with a predominance of two (31.6%, 580/1 838) and three (30.6%, 562/1 838) positive allergens. The total positive rate of allergen sIgE for children in the adolescent group was 70.1%(103/147), higher than that in children in the infant group 24.9%(122/489), the preschool group 49.0%(818/1 669), and the school-age group 62.6%(795/1 269)(all P<0.001). The positive rate of allergen sIgE increased gradually with age (χ 2 trend value=93.70, P<0.001). The overall positive rate of allergen sIgE was higher in male children 52.6%(1 157/2 199) than in female children 49.0%(673/1 375)(χ 2=5.95, P<0.05). The allergic rhinitis subgroup had the highest sIgE positive rate of 60.3%(152/252), followed by the 54.9%(123/224) from the allergic rhinitis with asthma subgroup, and the 52.6%(1 142/2 173) from the asthma subgroup. These differences were statistically significant (χ 2=9.87, P<0.05). The allergen sIgE positive rate of the children was the highest in summer, with 57.8%(786/1 360), and the lowest in winter, with 42.1%(215/511). The difference between the different seasons was statistically significant (χ 2=58.20, P<0.001). Spearman correlation analysis found that the number of positive species of allergens was positively correlated with the sIgE levels ( r=0.51, P<0.001), and there was a positive correlation between sIgE levels of house dust mites and dust mites ( r=0.88, P<0.01). Conclusions:The main allergens of respiratory diseases in children are house dust mite and dust mite. The positive rate of allergen sIgE increases with age, is higher in males than females, has the highest rate of sensitization in summer, and is easy to be multiple sensitized. Early sIgE screening is recommended to guide the prevention and diagnosis of the disease for children.

Objective:To investigate the mutation of PIK3CA, AKT1 and PTEN genes in hormone receptor (HR)-positive and HER2-negative invasive breast cancer.Methods:A total of 44 formalin-fixed paraffin-embedded samples from HR-positive/HER2-negative female patients with breast cancer obtained between January 2020 and July 2024 in Peking Union Medical College Hospital were selected. The mutations of PIK3CA, AKT1 and PTEN genes were analyzed by next-generation sequencing (NGS), and the related clinicopathological characteristics were summarized.Results:In the cohort, 31 out of 44 cases (70.5%) exhibited alterations in the PIK3CA, AKT1 and PTEN genes. Of these, 83.9% (26/31) tumors harbored genetic abnormalities involving one gene, including 21 (47.7%, 21/44) PIK3CA, 2 (4.5%, 2/44) PTEN and 3 (6.8%, 3/44) AKT1 gene mutations. Mutations of both PIK3CA and PTEN genes were found in 16.1% (5/31) of specimens. Among the 26 cases with PIK3CA gene mutations, 13 variants were identified, including E542K, E545K, Q546K, H1047R, H1047L, G1049R, M1043I, C420R, P447_L455del, N345K, N345I, K711N and H1047L/V346G. In addition, 7 mutants of PTEN gene were determined (T319 *, T321Qfs *23, Q245 *, Q171H, L108P, Y68Ifs *6 and V343fs). For AKT1 gene mutation, only E17K was observed.Mutations of PIK3CA/AKT1/PTEN genes are more likely to occur over 40 year-old patients.In this cohort, the PIK3CA V346G mutation (co-existent PIK3CA H1047L) and the PTEN V343fs mutation were not found in previous publications. Conclusion:In addition to the predominance of common loci, PIK3CA and PTEN gene mutations also have rare loci mutations in the breast cancer, warranting further analysis with an expanded sample size.

Objective To explore the effect of sitagliptin and metformin combined with zoledronic acid in the treatment of type 2 diabetes mellitus(T2DM)complicated with osteoporosis(OP)on the levels of glucose and lipid metabolism and bone metabolism in patients.Methods Patients with T2DM combined with OP admitted to Nantong Second People's Hospital from January 2021 to January 2024 were selected as the research subjects and randomly divided into the combined group(sitagliptin and metformin combined with zoledronic acid)and the control group(zoledronic acid only).After 6 months of treatment,the clinical efficacy,glucose and lipid metabolism indicators[fasting blood glucose(FBG),2-hour postprandial blood glucose(2hPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],bone metabolism indicators[osteoprotegerin(OPG),bone-specific alkaline phosphatase(BALP),osteocalcin(OC)]levels,changes in bone density,and incidence of adverse reactions were compared between the two groups before and after treatment.Results A total of 120 patients were included,with 60 patients in each group.After treatment,the total effective rate of the combination group was 93.33％,significantly higher than the control group's 73.33％(P＜0.05).The levels of FBG,2hPG,HbA1c,TC,TG,and LDL-C in two groups were significantly lower than those before treatment,while the levels of HDL-C,OPG,BALP,OC,and bone density in the femoral neck and lumbar spine were significantly higher than before treatment(P＜0.05);and all indicators of the combined group were better than those of the control group(P＜0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Sitagliptin and metformin combined with zoledronic acid in the treatment of patients with T2DM complicated with OP is more effective in regulating their glycolipid metabolism and bone metabolism levels,increasing bone density,improving therapeutic effects,and it has better safety than zoledronic acid alone.

[This corrects the article DOI: 10.1016/j.jpha.2023.08.006.].