Objective: To develop QingNangTCM, a specialized large language model (LLM) tailored for expert-level traditional Chinese medicine (TCM) question-answering and clinical reasoning, addressing the scarcity of domain-specific corpora and specialized alignment. Methods: We constructed QnTCM_Dataset, a corpus of 100 000 entries, by integrating data from ShenNong_TCM_Dataset and SymMap v2.0, and synthesizing additional samples via retrieval-augmented generation (RAG) and persona-driven generation. The dataset comprehensively covers diagnostic inquiries, prescriptions, and herbal knowledge. Utilizing P-Tuning v2, we fine-tuned the GLM-4-9B-Chat backbone to develop QingNangTCM. A multi-dimensional evaluation framework, assessing accuracy, coverage, consistency, safety, professionalism, and fluency, was established using metrics such as bilingual evaluation understudy (BLEU), recall-oriented understudy for gisting evaluation (ROUGE), metric for evaluation of translation with explicit ordering (METEOR), and LLM-as-a-Judge with expert review. Qualitative analysis was conducted across four simulated clinical scenarios: symptom analysis, disease treatment, herb inquiry, and failure cases. Baseline models included GLM-4-9B-Chat, DeepSeek-V2, HuatuoGPT-II (7B), and GLM-4-9B-Chat (freeze-tuning). Results: QingNangTCM achieved the highest scores in BLEU-1/2/3/4 (0.425/0.298/0.137/0.064), ROUGE-1/2 (0.368/0.157), and METEOR (0.218), demonstrating a balanced and superior normalized performance profile of 0.900 across the dimensions of accuracy, coverage, and consistency. Although its ROUGE-L score (0.299) was lower than that of HuatuoGPT-II (7B) (0.351), it significantly outperformed domain-specific models in expert-validated win rates for professionalism (86%) and safety (73%). Qualitative analysis confirmed that the model strictly adheres to the “symptom-syndrome-pathogenesis-treatment” reasoning chain, though occasional misclassifications and hallucinations persisted when dealing with rare medicinal materials and uncommon syndromes. Conclusion Combining domain-specific corpus construction with parameter-efficient prompt tuning enhances the reasoning behavior and domain adaptation of LLMs for TCM-related tasks. This work provides a technical framework for the digital organization and intelligent utilization of TCM knowledge, with potential value for supporting diagnostic reasoning and medical education.

ObjectiveTo evaluate the efficacy and safety of Janus kinase （JAK） inhibitors combined with Chinese herbal medicine （CHM） in treating rheumatoid arthritis （RA）. MethodsClinical data from 169 RA patients were retrospectively collected. Among them， 71 cases received JAK inhibitors as the control group， while 98 cases received JAK inhibitors plus CHM as the observation group， both treated for 24 weeks. The rheumatoid factor （RF）， cyclic citic peptide antibody （anti-CCP）， erythrocyte sedimentation rate （ESR）， C-reactive protein （CRP）， and white blood cell count （WBC） were recorded before and after treatment. Databases including CNKI， Wanfang， VIP， PubMed and Web of Science were searched from inception till August 31st， 2025 for randomized controlled trials （RCTs） on the combined use of JAK inhibitors and CHM for RA. The methodological quality of the included studies was evaluated using the risk of bias assessment tool. Meta-analyses were performed for RF， anti-CCP， ESR， CRP， 28-joint disease activity score （DAS28）， overall clinical effective rate， and incidence of adverse events. Sensitivity analysis were also performed. ResultsThe retrospective study demonstrated that after treatment， ESR， CRP， and anti-CCP levels decreased in the observation group， while ESR and CRP levels decreased in the control group （P＜0.05）. Moreover， ESR and RF levels in the observation group were lower than those in the control group （P＜0.05）. A total of 9 RCTs involving 770 patients were included in the meta-analysis. The results indicated that the JAK inhibitors plus CHM group was superior to the JAK inhibitors group in reducing RF （MD=-8.97， 95%CI -15.01 to -2.94， P=0.004）， CRP （MD=-3.34， 95%CI -3.82 to -2.86， P＜0.001）， ESR （MD=-5.33， 95%CI -7.98 to -2.69， P＜0.001）， and DAS28 score （MD=-0.54， 95%CI -0.74 to -0.34， P＜0.001）， as well as in improving the overall clinical effective rate （OR=4.53， 95%CI 2.55 to 8.03， P＜0.001）. No statistically significant differences were observed between groups in anti-CCP levels （SMD=-2.08， 95%CI -4.41 to 0.24， P=0.080） or incidence of adverse events （OR=0.93， 95%CI 0.55 to 1.57， P=0.790）. ConclusionThe combination of JAK inhibitors and CHM demonstrates remarkable efficacy in treating RA， contributing to improved disease activity and reduced inflammatory markers with a favorable safety profile.

The ethical review exemption system was introduced to meet the needs of modernized ethical governance， implement hierarchical management for ethical review projects involving human subjects， and explore an ethical management model that reduces procedural supervision for specific types of research involving no greater than minimal risk. Through a comparative study， this paper seeks to elaborate on the differences between China and the United States （US） in the ethical review exemption system from multiple aspects， such as ethical regulations， risk definition， preconditions， applicable scenarios， and operational procedures. The aim is to provide references for ethical review committees to better implement the ethical review exemption system， enhance policy research， and ensure the fairness and objectivity of ethical review. Through the comparative study of the ethics review exemption system in China and the US， the following recommendations are proposed for institutions implementing the ethical review exemption system for reference. First， the system should clearly define the meaning of ethical review exemption to prevent researchers or even committee members from misunderstanding it as falling outside the scope of ethical review， thereby exposing research participants’ rights and interests to unnecessary risks. Second， the system should specifically explain the preconditions， including the requirements for research types and research risks. Among them， risks should be considered from multiple dimensions such as physiology， psychology， society， and economy. Clear explanations should be provided for involving commercial interests and sensitive personal information. Finally， the system should establish basic principles and judgment criteria for applicable scenarios， including specifying exactly what the public data refers to and legal requirements that need to be met， providing a concept of anonymization to distinguish it from deidentified information data， and clarifying the relevant regulations and ethical principles to be followed， as well as the clear requirements for informed consent.

OBJECTIVE To further standardize the technical operations and management processes throughout therapeutic drug monitoring （TDM）， clarify the clinical value of TDM implementation， improve the scientific validity and reliability of monitoring results， and provide a solid reference basis for the formulation and optimization of clinical individualized precision dosing regimens. METHODS The Guidelines for the Management of Therapeutic Drug Monitoring were formulated in accordance with the latest definition of guidelines by the Institute of Medicine of the National Academies and the standard guideline development methodology of the World Health Organization， and in compliance with the requirements of the appraisal of guidelines for research and evaluation. A modified Delphi method was adopted to establish the research question system； evidence-based medicine research methods were applied to systematically search multiple databases to screen the latest and most comprehensive evidence. Evidence was graded and evaluated based on the evidence grading system of the Chinese Evidence-Based Medicine Center， and the grading criteria for recommendation strength from the Oxford Centre for Evidence-Based Medicine were used to determine the recommendation strength. The recommendation opinions were formed through multidisciplinary expert consensus. RESULTS The Guidelines for the Management of Therapeutic Drug Monitoring cover four core modules， including TDM application indications， technical procedures， result interpretation and clinical application， and quality control， involving 18 primary research questions， 34 secondary research questions， and yield 82 recommendations. CONCLUSIONS The guidelines systematically standardize the key technical links and management requirements of the whole TDM process， provide scientific and operable standardized tools， help improve the standardization level of TDM work， promote the translation of monitoring results into clinical decision-making， and provide strong support for precision personalized medicine and ensuring the safety and rationality of medication use.

Objective: To analyze the epidemiological characteristics of infectious diseases among children and adolescents in Lanshan District, Linyi City, 2014-2023,so as to provide a scientific basis for prevention and control strategies in schools. Methods: The surveillance data were obtained from the China Information System for Disease Control and Prevention (CISDCP). Data on reported infectious disease cases and related demographic information among school children and kindergarteners in the study area from 2014 to 2023 were collected. Rate comparison was performed by using the χ 2 test. Trend analysis was conducted by using Joinpoint Regression Progrom, and the annual percent change (APC) and average annual percent change (AAPC) were calculated. Results: A total of 10 222 cases of infectious diseases among children and adolescents were reported from 2014 to 2023, with an average annual incidence rate of 273.32 per 100 000. The overall incidence trend remained stable from 2014 to 2023 (AAPC=12.33%, 95%CI=-2.63%-29.59%, P >0.05). Whereas a significant upward trend was observed from 2014 to 2019 (AAPC=37.08%, 95% CI =12.92%-66.41%, P <0.05), followed by a stable trend from 2019 to 2023 (AAPC=-0.31%, 95%CI=-39.70%-64.83%, P>0.05). Seasonal distribution exhibited dual peaks in summer and winter. The incidence rate in urban areas(707.29/100 000) was significantly higher than that in rural areas(257.50/100 000), and the incidence rate among kindergarteners (325.49/100 000) was higher than that among school children (257.07/100 000) (χ2=1 518.60, 116.36, both P<0.01). The reported infectious diseases among children and adolescents were predominantly respiratory and intestinal infectious diseases, with incidence rates of 156.13/100 000 and 108.51/100 000, respectively. Hand, foot, and mouth disease (HFMD) was the predominant infectious disease among kindergarteners, accounting for 47.51%. Influenza was the leading condition in the primary school group, accounting for 38.64%, and other infectious diarrheal diseases were most common in junior and senior high school group, accounting for 53.34%. The top six diseases by incidence rate were other infectious diarrheal diseases(65.22/100 000), influenza(63.24/100 000), varicella(46.34/100 000), HFMD(41.07/100 000), mumps(23.42/100 000), and scarlet fever(10.56/100 000). Among them, the incidence of other infectious diarrheal diseases rose significantly (AAPC=35.31%, 95% CI =14.32%-60.14%, P <0.01). The trend transitioned from a rapid escalation during 2014-2019 (APC=69.98%, 95% CI =17.58%-145.74%, P =0.01) to a stable phase during 2019-2023 (APC=1.74%, 95% CI =-15.61%- 22.66%, P >0.05). Conclusions In Lanshan, urban educational institutions should prioritize the prevention and control of infectious diseases, with particular emphasis on other infectious diarrheal diseases, influenza and varicella. Targeted interventions should be implemented in accordance with seasonal patterns and the specific characteristics of the school age populations.

After continuous development and improvement, lung transplantation has become the preferred means to treat a variety of benign end-stage lung diseases. However, the field of lung transplantation still faces many challenges, including shortage of donor resources, preservation and maintenance of donor lungs, and postoperative complications. Lung tissue samples removed after lung transplantation are excellent clinical resources for the study of benign end-stage lung disease and perioperative complications of lung transplantation. However, at present, the collection, storage and utilization of tissue samples after lung transplantation are limited to a single study, and unified technical specifications have not been formed. Based on the construction plan of the biobank for lung transplantation in the First Affiliated Hospital of Xi'an Jiaotong University, this study reviewed the practical experience in the collection, storage and utilization of lung transplant tissue samples in the aspects of ethical review, staffing, collection process, storage method, quality control and efficient utilization, in order to provide references for lung transplant related research.

Objective:To investigate the effect of dandelion polysaccharide(DP)on inflammatory response and the protein expression of S100 calcium binding protein A8/A9(S100A8/A9)in lung tissue and small intestinal tissue of rats with multiple organ dysfunction syndrome(MODS).Methods:The two-hit method of hemorrhagic shock and intraperitoneally injected lipopolysaccharide was used to establish a rat model of MODS,and the rats were divided into sham-operation group,model group,low-dose DP group,and high-dose DP group.The organ coefficient and wet/dry weight ratio of the lung and the small intestine were observed for each group of rats;HE staining was used to observe the pathomorphological changes of lung tissue and small intestinal tissue;immunohistochemical staining was used to measure the expression of interleukin-1β(IL-1β),interleukin-6(IL-6),and interleukin-10(IL-10)in lung tissue and small intestinal tissue;Western blot was used to measure the protein expression level of S100A8/A9 in lung tissue and small intestinal tissue.Results:Compared with the sham-operation group,the model group had significant increases in the organ coefficient of the lung(5.849±0.824),the wet/dry weight ratio of the lung(6.556±0.631),the wet/dry weight ratio of the small intestine(6.356±0.535),and the wet weight/length ratio of the small intestine(73.950±5.569).HE staining showed that that the model group had massive in-flammatory cell infiltration in alveolar space and pulmonary interstitium,thickened alveolar wall,and disintegration and fragmentation of the villi of the small intestine,with inflammatory cell infiltration and proliferation of segmental aggregated lymphoid follicles.In the model group,S100A8/A9 was mainly expressed in neutrophils and macrophages,and there were increases in the expression of S100A8/A9,IL-1β,and IL-6 and a reduction in the expression of IL-10 in the lung tissue and small intestinal tissue of rats.After treatment with high-dose DP,there were reductions in the organ coefficient of the lung(4.297±0.462),the wet/dry weight ratio of the lung(5.313±0.495),the wet/dry weight ratio of the small intestine(5.398±0.388),and the wet weight/length ratio of the small intestine(59.417±2.891).The high-dose group also had alleviation of pathological injury in the small intestine,with reductions in the expres-sion of S100A8/A9,IL-1β,and IL-6 and an increase in the expression of IL-10 in lung tissue and small intestinal tissue.Conclusion:DP may alleviate inflammatory response in lung and small intestinal injuries of rats with MODS by inhibiting the expression of S100A8/A9.

Objective To analyze the distribution characteristics of infectious respiratory particles(IRPs)in hospi-tal waiting rooms,and explore the impact of indoor air environmental on the distribution characteristics of bacterial IRPs.Methods In the summer and winter of 2024,nine waiting rooms in non-infectious departments of three ter-tiary hospitals in a district of Beijing were selected for on-site investigation on basic conditions.Concentration and distribution of particle diameter of cultivable bacteria from 36 air specimens collected by the impacting method were analyzed.Cyclone method was employed to collect 36 IRPs specimens.Major respiratory pathogens were analyzed by fluorescence polymerase chain reaction(PCR).Results The median of the total bacterial count in IRPs in the waiting rooms in summer was 1 035 CFU/m3,which was higher than that in winter(295 CFU/m3),with statisti-cally significant difference(P＜0.05).The orders of medians of the total bacterial count from IRPs of different types in the waiting rooms in both summer and winter were as follows:emergency department waiting room＜re-spiratory department waiting room＜pediatric waiting room＜general outpatient waiting room.There was no sta-tistically significant difference in the total bacterial count among different waiting rooms(P＞0.05).Particle diame-ter of bacterial IRPs in the waiting rooms in summer and winter mainly distributed in the range of＜4.7 μm,ac-counting for 73.77％and 69.44％,respectively.The total number of bacteria in IRPs in the waiting rooms was positively correlated with indoor air temperature,relative humidity,PM10,and PM2.5(all P＜0.01),while nega-tively correlated with indoor wind speed(all P＜0.01).The types of respiratory infectious and non-infectious pathogens detected from IRPs in different types of waiting rooms were different between summer and winter.The pathogens detected in summer were mainly concentrated in respiratory non-infectious pathogens(Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus).In winter,respiratory infectious pathogens(virus and Mycoplas-ma pneumoniae)were detected.The types of detected pathogens in different types of waiting rooms were different.Non-infectious respiratory pathogens detected from IRPs in winter were mainly Escherichia coli,Klebsiella pneumoniae,and Staphylococcus aureus.Conclusion Particle diameter of bacterial IRPs in the waiting room is mainly＜4.7 μm.These particles can enter the lower respiratory tract of human body,and pose potential risk to health.The detection of main infectious and non-infectious respiratory pathogens from IRPs in waiting rooms suggests risk of exposure to infection for patients and healthcare workers.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.