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.

Salmonellosis represents a global epidemic, and the emergence of extensively drug-resistant (XDR) Salmonella and its sustained transmission worldwide constitutes a significant public health concern. Flagellum-mediated motility serves as a crucial virulence trait of Salmonella that guides the pathogen toward the epithelial surface, enhancing gut colonization. Artemisia argyit essential oil, a traditional herb extract, demonstrates efficacy in treating inflammation-related symptoms and diseases; however, its effects on flagellum assembly and expression mechanisms in anti-Salmonella activity remain inadequately explored. This study aimed to elucidate the mechanism by which Artemisia argyit essential oil addresses Salmonella infections. Network pharmacological analysis revealed that Traditional Chinese Medicine (TCM) Artemisia argyit exhibited anti-Salmonella infection potential and inhibited flagellum-dependent motility. The application of Artemisia argyit essential oil induced notable motility defects through the downregulation of flagellar and fimbriae expression. Moreover, it significantly reduced Salmonella-infected cell damage by interfering with flagellum-mediated Salmonella colonization. In vivo studies demonstrated that Artemisia argyit essential oil administration effectively alleviated Salmonella infection symptoms by reducing bacterial loads, inhibiting interleukin-1 beta (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α) production, and diminishing pathological injury. Gas chromatography-mass spectrometry (GC-MS) analysis identified forty-three compounds in Artemisia argyit essential oil, with their corresponding targets and active ingredients predicted. Investigation of an in vivo model of Salmonella infection using the active ingredient demonstrated that alpha-cedrene ameliorated Salmonella infection. These findings suggest the potential application of Artemisia argyit essential oil in controlling Salmonella, the predominant food-borne pathogen.
Artemisia/chemistry* ; Oils, Volatile/chemistry* ; Animals ; Flagella/drug effects* ; Salmonella Infections/microbiology* ; Humans ; Mice ; Anti-Bacterial Agents/pharmacology* ; Salmonella/pathogenicity*

Our previous research demonstrated that the Wenxia Changfu Formula (WCF), as a neoadjuvant therapy, inhibits M2 macrophage infiltration in the tumor microenvironment and prevents lung cancer metastasis. Given tumor-associated macrophages (TAMs) in epithelial-mesenchymal transition (EMT), this study investigated whether WCF impedes lung cancer metastasis by attenuating TAM-induced EMT in non-small cell lung cancer (NSCLC) cells. Utilizing a co-culture model treated with or without WCF, we observed that WCF downregulated cluster of differentiation 163 (CD163) expression in macrophages, reduced CCL18 levels in the conditioned medium, and inhibited the growth, invasion, and EMT of NSCLC cells induced by macrophage co-culture. Manipulation of CCL18 levels and Src overexpression in NSCLC cells revealed that WCF's effects are mediated through CCL18 and Src signaling. In vivo, WCF inhibited recombinant CCL18 (rCCL18)-induced tumor metastasis in nude mice by blocking Src signaling. These findings indicate that WCF inhibits NSCLC metastasis by impeding TAM-induced EMT via antagonistic modulation of CCL18, providing evidence for its potential development and clinical application in NSCLC patients.
Epithelial-Mesenchymal Transition/drug effects* ; Carcinoma, Non-Small-Cell Lung/metabolism* ; Humans ; Animals ; Lung Neoplasms/metabolism* ; Chemokines, CC/antagonists & inhibitors* ; Mice ; Mice, Nude ; Drugs, Chinese Herbal/administration & dosage* ; Cell Line, Tumor ; Neoplasm Metastasis ; Tumor-Associated Macrophages/drug effects* ; Mice, Inbred BALB C ; Signal Transduction/drug effects*

Objective:To evaluate the clinical efficacy of autologous costal cartilage combined with nasal Pitanguy ligament reconstruction for correcting downward rotation of the nasal tip following rhinoplasty.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent this combined technique at the Department of Plastic Surgery, Chongqing Contemporary Plastic Surgery Hospital, between January 2019 and January 2021. Autologous costal cartilage was carved into a bifurcated nasal columella support graft (3 cm in length × 8 mm in width × 2 mm in thickness, with a 1 cm bifurcation at the distal end). This graft was fixed across the caudal septum to establish a costal cartilage support framework. A piece of costal perichondrium (approximately 3 cm × 1 cm) was harvested. Using 5-0 PDS sutures, the cephalic end of the perichondrium was meticulously fixed to the residual stump of the Pitanguy ligament on the nasal dorsum, while the caudal end was anchored to the nasal tip scaffold, thereby reconstructing the ligamentous tension system. Postoperative complications were monitored. Preoperatively and at 12 months postoperatively, patients’ photographs were processed using Adobe Photoshop CS 6 to measure the nasolabial angle, nasofrontal angle, and columellar-lobular angle. Patient satisfaction was assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (total score range: 0-24; higher scores indicate greater satisfaction). The paired t-test was employed for statistical comparison of these measurements and scores, with a P-value < 0.05 considered statistically significant. Results:A total of 76 patients were included (16 males, 60 females), with a mean age of 26.5 ± 4.3 years (range: 18-42 years). The mean follow-up duration was 13.2 months (range: 12-15 months). All patients recovered well, with no complications, such as nasal tip graft visibility, graft displacement, or breathing difficulties were observed. Natural contouring between the nasal tip and dorsum was achieved, and the fullness of the infratip lobule was significantly improved. Statistically significant differences ( P < 0.01 for all) were found between preoperative and 12-month postoperative measurements: nasofrontal angle (143.54° ± 5.08° vs. 134.12° ± 8.63°), nasolabial angle (82.28° ± 7.02° vs. 95.36° ± 3.76°), columellar-lobular angle (50.72° ± 6.67° vs. 43.05° ± 4.52°), and ROE scores [(9.05 ± 2.03) points vs. (22.07 ± 2.45)points]. Conclusion:The combined technique utilizing autologous costal cartilage and Pitanguy ligament reconstruction effectively corrects downward rotation of the nasal tip. Through the synergistic action of costal cartilage structural support and anatomical restoration of the Pitanguy ligament, it achieves a natural nasal tip contour, functional stability and high patient satisfaction.

Objective:To summarize and evaluate the temporal trends of the burden of congenital heart disease (CHD) in China and globally from 1990 to 2021, and to predict the burden of the disease up to 2035.Methods:The Joinpoint regression method was used to study the time trend of congenital heart disease, and the Bayesian age-period-cohort method (BAPC) was used to predict the change in disease burden due to congenital heart disease in China and globally between 2022 and 2035. Results:From 1990 to 2021, the disability-adjusted life years and mortality burdens of congenital heart disease have decreased in China and globally. Although the disease burden is higher in men than in women, the difference is gradually decreasing. BAPC estimates that the burden of congenital heart disease is expected to continue to decline in China and globally in 2022-2035, but congenital heart disease remains a major health problem. China has made remarkable progress in reducing the burden of congenital heart disease, which reflects the positive impact of rapid advances in medical technology and improved public health policies.Conclusion:Although congenital heart disease will remain a significant disease burden over the past three decades and into 2035, it is critical to focus on disease-specific differences to develop more targeted interventions to further reduce the disease burden of congenital heart disease and improve the quality of life and living standards of patients.

Screening carbonyl reductases with the ability to catalyze the reduction of complex carbonyl compounds is of great significance for the biosynthesis of R-tolvaptan(R-TVP). In this study, the target carbonyl reductase in the crude enzyme extract of rabbit liver was separated, purified, and identified by ammonium sulfate precipitation, gel-filtration chromatography, ion exchange chromatography, affinity chromatography, and protein mass spectrometry. With the rabbit liver genome as the template, the gene encoding the carbonyl reductase rlsr5 was amplified by PCR and the recombinant strain was successfully constructed. After RLSR5 was purified by affinity chromatography, its enzymatic properties were characterized. The results indicated that the gene sequence of rlsr5 was 972 bp, encoding a protein with a molecular weight of 40 kDa. RLSR5 was a dimeric protein, and each monomer was composed of a (α/β)₈-barrel structure. RLSR5 could asymmetrically reduce 7-chloro-1-[2-methyl-4-[(2- methylbenzoyl)amino]benzoyl]-5-oxo-2,3,4,5-tetrahydro-1H-1-benzazepine (prochiral ketone, PK) to synthesize R-TVP. The specific activity of the enzyme was 36.64 U/mg, and the optical purity of the product was 99%. This enzyme showcased the optimal performance at pH 6.0 and 30 °C. It was independent of metal ions, with the activity enhanced by Mn²⁺. This study lays a foundation for the biosynthesis of tolvaptan of optical grade.
Animals ; Rabbits ; Alcohol Oxidoreductases/biosynthesis* ; Recombinant Proteins/metabolism* ; Escherichia coli/metabolism* ; Liver/enzymology*

Objective:To develop and evaluate a medical visual question answering (VQA) model for neonatal lung ultrasound (LUS) images to enhance intelligent auxiliary diagnosis of neonatal pulmonary diseases.Methods:Using data from neonates admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University (January 2023 to December 2024), an image-question-answer dataset comprising 251 LUS images was constructed [43 pneumonia (17.1%), 42 neonatal respiratory distress syndrome (16.7%), 83 transient tachypnea (33.1%), and 83 normal (33.1%) images] with a four-tier medical question-answer framework. Building upon the Qwen2.5-VL-7B base model and integrating LoRA fine-tuning with chain-of-thought prompting, we developed the NLUS-VQA model to enhance visual-language semantic alignment and enable stepwise clinical reasoning, achieving efficient small-sample adaptation. Model performance was comprehensively assessed through natural language generation metrics (BLEU-4, ROUGE-1/2/L), qualitative evaluation of characteristic recognition, and clinical consistency analysis.Results:(1) Quantitative evaluation demonstrated that NLUS-VQA achieved scores of 22.38 (BLEU-4), 48.26 (ROUGE-1), 22.40 (ROUGE-2), and 37.20 (ROUGE-L), representing significant improvements over baseline models. (2) Qualitatively, the model exhibited strong performance in identifying lung consolidation, coalescent B-lines, and snowflake signs, with its chain-of-thought strategy enhancing clinical interpretability and answer accuracy. (3) Clinically, NLUS-VQA achieved a Cohen's Kappa coefficient of 0.78 and diagnostic accuracy of 80.8% (21/26), indicating substantial agreement with clinical experts.Conclusion:The NLUS-VQA model demonstrates robust interpretability in recognizing key sonographic patterns (e.g. lung consolidation, confluent B-lines, and snowflake signs), providing a scalable framework for small-sample medical image analysis, though diagnostic performance on complex conditions remains limited by dataset scale and minority class representation.

Objective:To evaluate the clinical efficacy of autologous costal cartilage combined with nasal Pitanguy ligament reconstruction for correcting downward rotation of the nasal tip following rhinoplasty.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent this combined technique at the Department of Plastic Surgery, Chongqing Contemporary Plastic Surgery Hospital, between January 2019 and January 2021. Autologous costal cartilage was carved into a bifurcated nasal columella support graft (3 cm in length × 8 mm in width × 2 mm in thickness, with a 1 cm bifurcation at the distal end). This graft was fixed across the caudal septum to establish a costal cartilage support framework. A piece of costal perichondrium (approximately 3 cm × 1 cm) was harvested. Using 5-0 PDS sutures, the cephalic end of the perichondrium was meticulously fixed to the residual stump of the Pitanguy ligament on the nasal dorsum, while the caudal end was anchored to the nasal tip scaffold, thereby reconstructing the ligamentous tension system. Postoperative complications were monitored. Preoperatively and at 12 months postoperatively, patients’ photographs were processed using Adobe Photoshop CS 6 to measure the nasolabial angle, nasofrontal angle, and columellar-lobular angle. Patient satisfaction was assessed using the rhinoplasty outcome evaluation (ROE) questionnaire (total score range: 0-24; higher scores indicate greater satisfaction). The paired t-test was employed for statistical comparison of these measurements and scores, with a P-value < 0.05 considered statistically significant. Results:A total of 76 patients were included (16 males, 60 females), with a mean age of 26.5 ± 4.3 years (range: 18-42 years). The mean follow-up duration was 13.2 months (range: 12-15 months). All patients recovered well, with no complications, such as nasal tip graft visibility, graft displacement, or breathing difficulties were observed. Natural contouring between the nasal tip and dorsum was achieved, and the fullness of the infratip lobule was significantly improved. Statistically significant differences ( P < 0.01 for all) were found between preoperative and 12-month postoperative measurements: nasofrontal angle (143.54° ± 5.08° vs. 134.12° ± 8.63°), nasolabial angle (82.28° ± 7.02° vs. 95.36° ± 3.76°), columellar-lobular angle (50.72° ± 6.67° vs. 43.05° ± 4.52°), and ROE scores [(9.05 ± 2.03) points vs. (22.07 ± 2.45)points]. Conclusion:The combined technique utilizing autologous costal cartilage and Pitanguy ligament reconstruction effectively corrects downward rotation of the nasal tip. Through the synergistic action of costal cartilage structural support and anatomical restoration of the Pitanguy ligament, it achieves a natural nasal tip contour, functional stability and high patient satisfaction.

Objective:To summarize and evaluate the temporal trends of the burden of congenital heart disease (CHD) in China and globally from 1990 to 2021, and to predict the burden of the disease up to 2035.Methods:The Joinpoint regression method was used to study the time trend of congenital heart disease, and the Bayesian age-period-cohort method (BAPC) was used to predict the change in disease burden due to congenital heart disease in China and globally between 2022 and 2035. Results:From 1990 to 2021, the disability-adjusted life years and mortality burdens of congenital heart disease have decreased in China and globally. Although the disease burden is higher in men than in women, the difference is gradually decreasing. BAPC estimates that the burden of congenital heart disease is expected to continue to decline in China and globally in 2022-2035, but congenital heart disease remains a major health problem. China has made remarkable progress in reducing the burden of congenital heart disease, which reflects the positive impact of rapid advances in medical technology and improved public health policies.Conclusion:Although congenital heart disease will remain a significant disease burden over the past three decades and into 2035, it is critical to focus on disease-specific differences to develop more targeted interventions to further reduce the disease burden of congenital heart disease and improve the quality of life and living standards of patients.

Objective:To develop and evaluate a medical visual question answering (VQA) model for neonatal lung ultrasound (LUS) images to enhance intelligent auxiliary diagnosis of neonatal pulmonary diseases.Methods:Using data from neonates admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University (January 2023 to December 2024), an image-question-answer dataset comprising 251 LUS images was constructed [43 pneumonia (17.1%), 42 neonatal respiratory distress syndrome (16.7%), 83 transient tachypnea (33.1%), and 83 normal (33.1%) images] with a four-tier medical question-answer framework. Building upon the Qwen2.5-VL-7B base model and integrating LoRA fine-tuning with chain-of-thought prompting, we developed the NLUS-VQA model to enhance visual-language semantic alignment and enable stepwise clinical reasoning, achieving efficient small-sample adaptation. Model performance was comprehensively assessed through natural language generation metrics (BLEU-4, ROUGE-1/2/L), qualitative evaluation of characteristic recognition, and clinical consistency analysis.Results:(1) Quantitative evaluation demonstrated that NLUS-VQA achieved scores of 22.38 (BLEU-4), 48.26 (ROUGE-1), 22.40 (ROUGE-2), and 37.20 (ROUGE-L), representing significant improvements over baseline models. (2) Qualitatively, the model exhibited strong performance in identifying lung consolidation, coalescent B-lines, and snowflake signs, with its chain-of-thought strategy enhancing clinical interpretability and answer accuracy. (3) Clinically, NLUS-VQA achieved a Cohen's Kappa coefficient of 0.78 and diagnostic accuracy of 80.8% (21/26), indicating substantial agreement with clinical experts.Conclusion:The NLUS-VQA model demonstrates robust interpretability in recognizing key sonographic patterns (e.g. lung consolidation, confluent B-lines, and snowflake signs), providing a scalable framework for small-sample medical image analysis, though diagnostic performance on complex conditions remains limited by dataset scale and minority class representation.