ObjectiveTo observe the clinical effectiveness and safety of Qingfei Shenshi Decoction （清肺渗湿汤） combined with western medicine for patients with bronchial asthma of heat wheezing syndrome， and to explore its potential mechanism of action. MethodsEighty-six participants with bronchial asthma of heat wheezing syndrome were randomly divided into treatment group and control group， each group with 43 participants. The control group received conventional western medicine， and the treatment group was additionally administered Qingfei Shenshi Decoction orally on the basis of the control group， 1 dose per day. Both groups were treated for 14 days. The primary outcome measure was clinical effectiveness； secondary outcome measures included traditional Chinese medicine （TCM） syndrome score， asthma control test （ACT） score， pulmonary function indices such as forced expiratory volume in 1 second （FEV₁）， forced vital capacity （FVC）， peak expiratory flow （PEF）， serum inflammatory factor levels including interleukin-4 （IL-4）， tumour necrosis factor-α （TNF-α）， and high-sensitivity C-reactive protein （hs-CRP）， and immune function indices including CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺. All outcome measures were evaluated before and after treatment. Vital signs were monitored， and electrocardiography， blood routine， urine routine， liver function， and renal function tests were performed before and after treatment. Adverse events and reactions during the study were recorded. ResultsA total of 80 patients completed the trial with 40 in each group. The total clinical effective rate of the treatment group was 97.5% （39/40）， which was significantly higher than that of the control group （85.0%， 34/40， P＜0.05）. After treatment， both groups showed decreased TCM syndrome scores， IL-4， TNF-α， hs-CRP， and CD8⁺ levels， as well as increased ACT scores， CD3⁺， CD4⁺， CD4⁺/CD8⁺， FEV₁， FVC， and PEF levels （P＜0.05 or P＜0.01）. Moreover， the improvements in these indices were more significant in the treatment group than in the control group （P＜0.05 or P＜0.01）. No significant abnormalities in safety indicators were observed in either group， and no adverse events or reactions occurred. ConclusionQingfei Shenshi Decoction combined with conventional western medicine for patients with bronchial asthma of heat wheezing syndrome can effectively improve the clinical symptoms， pulmonary function， and clinical effectiveness， with good safety. Its mechanism may be related to reducing inflammatory factor levels and regulating T lymphocyte subsets to improve immune function.

Objective: To develop a clinical decision and prescription generation system (CDPGS) specifically for diarrhea in traditional Chinese medicine (TCM), utilizing a specialized large language model (LLM), Qwen-TCM-Dia, to standardize diagnostic processes and prescription generation. Methods: Two primary datasets were constructed: an evaluation benchmark and a fine-tuning dataset consisting of fundamental diarrhea knowledge, medical records, and chain-of-thought (CoT) reasoning datasets. After an initial evaluation of 16 open-source LLMs across inference time, accuracy, and output quality, Qwen2.5 was selected as the base model due to its superior overall performance. We then employed a two-stage low-rank adaptation (LoRA) fine-tuning strategy, integrating continued pre-training on domain-specific knowledge with instruction fine-tuning using CoT-enriched medical records. This approach was designed to embed the clinical logic (symptoms → pathogenesis → therapeutic principles → prescriptions) into the model’s reasoning capabilities. The resulting fine-tuned model, specialized for TCM diarrhea, was designated as Qwen-TCM-Dia. Model performance was evaluated for disease diagnosis and syndrome type differentiation using accuracy, precision, recall, and F1-score. Furthermore, the quality of the generated prescriptions was compared with that of established open-source TCM LLMs. Results: Qwen-TCM-Dia achieved peak performance compared to both the base Qwen2.5 model and five other open-source TCM LLMs. It achieved 97.05% accuracy and 91.48% F1-score in disease diagnosis, and 74.54% accuracy and 74.21% F1-score in syndrome type differentiation. Compared with existing open-source TCM LLMs (BianCang, HuangDi, LingDan, TCMLLM-PR, and ZhongJing), Qwen-TCM-Dia exhibited higher fidelity in reconstructing the “symptoms → pathogenesis → therapeutic principles → prescriptions” logic chain. It provided complete prescriptions, whereas other models often omitted dosages or generated mismatched prescriptions. Conclusion By integrating continued pre-training, CoT reasoning, and a two-stage fine-tuning strategy, this study establishes a CDPGS for diarrhea in TCM. The results demonstrate the synergistic effect of strengthening domain representation through pre-training and activating logical reasoning via CoT. This research not only provides critical technical support for the standardized diagnosis and treatment of diarrhea but also offers a scalable paradigm for the digital inheritance of expert TCM experience and the intelligent transformation of TCM.

OBJECTIVE To establish a method for simultaneous determination of plasma concentration of lamotrigine（LTG）， levetiracetam（LEV） and perampanel（PER） in children with epilepsy and apply this method in clinical practice. METHODS Plasma proteins were precipitated with acetonitrile. Using PER-D 5 as internal standard， ultra-high performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS） method was adopted. The determination was performed on ACQUITY UPLC HSS T3 C 18 column with mobile phase consisted of 0.1% formic acid with 5 mmol/L ammonium acetate-acetonitrile （gradient elution） at the flow rate of 0.3 mL/min. The column temperature was 40 ℃， and sample size was 5 μL. The analysis time was 5 min. The electrospray ionization source and multiple reaction monitoring mode were used for positive ion scanning. The ion pairs used for quantitative analysis of LTG， LEV， PER and internal standard were m / z 255.9→144.9， m / z 171.1→126.1， m / z 350.1→219.0 and m / z 354.9→220.2， respectively. The steady-state trough concentrations of the aforementioned drugs in the plasma of 14 pediatric epilepsy patients receiving combination therapy were determined using the same UPLC-MS/MS method as above. RESULTS The linear ranges of LTG， LEV and PER were 0.15-24 μg/mL （ R 2 ＞0.993）， 0.312 5-50 μg/mL （ R 2 ＞0.997） and 6.25-1 000 ng/mL （ R 2 ＞0.997）， respectively. The lower limits of quantification were 0.15 μg/mL， 0.312 5 μg/mL and 6.25 ng/mL， respectively. RSDs of intraday and interday precision tests of the three drugs were no more than 9.83%， and the accuracies （relative errors） were between －9.33% and 13.72%（ n ＝6 or n ＝18）； the average extraction recovery rates were 86.4%-97.9%， and the average matrix effects were 86.9%-110.0% （ n ＝6）. The absolute values of the relative errors in the stability tests were all below 15%. The steady-state trough concentrations of LTG， LEV and PER were （5.64±4.03）μg/mL， （10.67±8.78）μg/mL and（450.20±251.27）ng/mL， respectively； the rates of achieving target trough concentrations were 71.4%， 37.5% and 84.6%， respectively. CONCLUSIONS The established UPLC-MS/MS method is specific， rapid and suitable for the plasma concentration monitoring in epileptic children receiving combination therapy.

Natural products (NPs) have long held a significant position in various fields such as medicine, food, agriculture, and materials. The chemical space covered by NPs is extensive but often underexplored. Therefore, high-throughput and efficient methodologies for the annotation and discovery of NPs are desired to address the complexity and diversity of NP-based systems. Mass spectrometry (MS) has emerged as a powerful platform for the annotation and discovery of NPs. MS databases provide vital support for the structural characterization of NPs by integrating extensive mass spectral data and sample information. Additionally, the released annotation methodologies, based on a variety of informatics tools, continuously improve the ability to annotate the structure and properties of compounds. This review examines the current mainstream databases and annotation methodologies, focusing on their advantages and limitations. Prospects for future technological advancements are then discussed in terms of novel applications and research objectives. Through a systematic overview, this review aims to provide valuable insights and a reference for MS-based NPs annotation, thereby promoting the discovery of novel natural entities.
Biological Products/chemistry* ; Mass Spectrometry/methods* ; Databases, Factual ; Drug Discovery/methods* ; Humans

Objective To explore the potential clinical value of the ratio of glycated albumin to albumin(GA/ALB)in the occurrence of heart failure(HF)among patients with coronary atherosclerotic heart disease(CHD).Methods A total of 337 CHD patients admitted to the Department of Cardiology in Shanxi Provincial People's Hospital from July 2023 to June 2024 were selected in this study.CHD patients were divided into HF group and non-HF group based on whether they progressed to HF.The clinical data and laboratory parame-ters of the two groups were compared.Restricted cubic spline curve was used to analyze the relationship be-tween GA/ALB levels and the risk of HF in CHD patients.Receiver operating characteristic curve was applied to evaluate the diagnostic efficacy of GA/ALB,GA,platelet to lymphocyte ratio(PLR),and monocyte to lym-phocyte ratio(MLR)in CHD patients with the occurrence of HF.Logistic regression was used to explore the relationship between serum GA/ALB levels and the risk of CHD patients occurrence of HF,and to analyze the degree of influence and stability of subgroup variables on results.Results There were statistically significant differences in GA/ALB,GA,PLR,MLR,and other indicators between the HF group and the non-HF group in CHD patients(P＜0.05).A non-linear relationship was observed between GA/ALB levels and the risk of HF in CHD patients.When the value of GA/ALB multiplied by 10 was less than 5.751,the risk of HF in CHD pa-tients increased with the increase of GA/ALB levels(P＜0.001).GA/ALB was an effective predictor for HF occurrence in CHD patients.Multivariable Logistic regression model showed that GA/ALB was an independ-ent risk factor for CHD patients with occurrence of HF.Subgroup analysis also confirmed the stability of GA/ALB in predicting the occurrence of HF in CHD patients.Conclusion GA/ALB is an independent risk factor for the occurrence of HF in CHD patients,and monitoring GA/ALB levels provides predictive value for the oc-currence of HF in these patients.

This paper summarized Professor ZHOU Zhaoshan's clinical experience in treating bronchial asthma （abbreviated as asthma） by stages with dampness-draining method. It is believed that pathogenic dampness is the key pathological factor in the onset of asthma. Dampness accumulates into water， which gathers into rheum； the condensed rheum forms phlegm， which lingers in the lungs. When external pathogens trigger the latent phlegm， phlegm and qi become mutually obstructed， leading to airway obstruction， disrupted qi movement， and upward reversal of lung qi， thereby resulting in asthma attacks. The treatment emphasizes a stage-based approach. During acute attacks， the main syndromes include cold-damp obstructing the lungs， damp-heat accumulating in the lungs， and shaoyang （少阳） constraint with heat. For the syndrome of cold-damp obstructing the lungs， a self-formulated Wenfei Shenshi Decoction （温肺渗湿汤） is used to warm the lungs and disperse cold， drain dampness and relieve panting； for the syndrome of damp-heat accumulating in the lungs， a self-formulated Qingfei Shenshi Decoction （清肺渗湿汤） is employed to clear the lungs and expel heat， drain dampness and relieve asthma； and for the syndrome of shaoyang constraint with heat， a self-formulated Chaihu Shenshi Decoction （柴胡渗湿汤） is administered to harmonize the shaoyang， clear heat and drain dampness. During the remission stage， treatment is based on the underlying kidney-deficiency constitution， and a self-formulated Bushen Shenshi Decoction （补肾渗湿汤） is formulated to tonify the kidneys and drain dampness， improve qi reception and relieve panting.

ObjectiveTo investigate the protective effect and mechanism of action of flavonoid combination of Alpiniae Officinarum Rhizoma （A. officinarum） against Helicobacter pylori （H. pylori） gastritis in mice. MethodsAfter acclimatization for one week， 56 SPF-grade healthy C57BL/6J mice were gavaged with mixed antibiotics for three consecutive days. They were randomly divided into a normal group， model group， positive drug group （triple therapy group）， and low- and high-dose groups （100， 200 mg·kg^-1） of flavonoid combination of A. officinarum. The H. pylori gastritis mice model was established by gavage with H. pylori bacterial suspension in each group except for the normal group. After successful modeling， mice were administrated with corresponding drugs once a day for two weeks. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in gastric tissue. Rapid urease test paper was used to detect the positive rate of H. pylori. Silver staining was used to observe the H. pylori adherence on the surface of gastric tissue. Immunohistochemistry was used to detect the protein expression of interleukin-8 （IL）-8 and myeloid differentiation factor （MyD88） in gastric tissue. The serum levels of IL-6， tumor necrosis factor-α （TNF-α）， IL-8， and IL-1β were detected by enzyme-linked immunosorbent assay （ELISA）. The expressions of phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） protein were detected by Western blot. ResultsCompared with those in the normal group， mice in the model group had lower gastric weight coefficients， higher pH of gastric juice， 100% H. pylori infection rate， and significantly changed gastric histopathology. The expressions of IL-8 and MyD88 proteins in the gastric tissue of mice in the model group were significantly elevated， and the serum levels of inflammatory factors IL-6， TNF-α， IL-8， and IL-1β were significantly up-regulated in mice. Compared with that in the model group， the gastric weight coefficient of mice in each treatment group of the flavonoid combinations of A. officinarum was elevated （P<0.01）， and the pH of gastric juice was reduced （P<0.01）. The infection rate of H. pylori was reduced. The expressions of IL-8 and MyD88 proteins in the gastric tissue of mice in the treatment groups were significantly reduced （P<0.01）， and the serum levels of inflammatory factors IL-6， TNF-α， IL-8， and IL-1β were significantly reduced in a dose-dependent manner （P<0.01）. The flavonoid combinations of A. officinarum down-regulated the expression of PI3K and Akt proteins in H. pylori gastritis-infected cells （P<0.01）. ConclusionThe protective effect of flavonoid combinations of A. officinarum against H. pylori gastritis is associated with the inhibition of H. pylori infection rate and regulation of PI3K/Akt signaling pathway， resulting in inhibiting the release of inflammatory factors.

Objective:To investigate the radiation field distribution characteristics in a 9 MeV electron FLASH (e-FLASH) linear accelerator treatment room.Methods:The Geant4 Monte Carlo program was employed for physical simulating of the radiation field distribution inside and outside the treatment room under a single-beam delivery condition with a total dose of 50 Gy at the reference point and a dose rate of 250 Gy/s. High-sensitivity radiation detectors (AT1123) were used to validate the measurements at key points.Results:The dose rate at the reference point was approximately 9×10 11 μSv/h. Due to the scattering and shielding effects, the deviation of the attenuation rate from the inverse-square law was observed and the isodose lines exhibited spatial drift. Measured dose rates at key points showed good agreement with the simulation result, with a maximum deviation within 30%. Conclusions:The complex radiation field distribution can be effectively simulated using Geant4 in an e-FLASH treatment room. This indicated the Geant4 is not only applicable for the shielding calculations in e-FLASH radiotherapy facilities, but also for the design optimization through, reduction of trial-and-error iterations and engineering costs.

Objective To investigate the mechanism by which cancer-associated fibroblast(CAF)in the tumor microenvironment regulate key pathways in prostate cancer stem cells(PCSCs).Methods An in vitro co-culture system of CAF and PCSC was established to observe the effects of CAF on PCSC proliferation and sphere formation.Prostate cancer stem cells were treated with CAF conditioned medium pre-treated with Wnt inhibitor DKK-1 and SDF-1 neutralizing anti-body(MAB310).Western blot was used to detect the expression of β-catenin,CXCR4,CD133 and CD44 in PCSCs.And PCR was used to detect the expression of β-catenin,CXCR4,TCF,and LEF mRNA.TOPflash/FOPflash dual-luciferase reporter assays were conducted to detect the effects of SDF-1 on Wnt/β-catenin signaling activity in PCSCs.Results ELISA results showed that the secretion of Wnt3a and SDF-1 in CAF supernatant was significantly higher than that in WPMY-1 cells(P＜0.05).The A value of PCSCs co-cultured with CAF at a 1∶6 ratio was significantly higher than that of the PCSC-only group(P＜0.0 1),and CAF promoted sphere formation in PCSCs(P＜0.05).Western blot results showed that CAF-CM significantly increased the relative expression of β-catenin,CXCR4,CD133 and CD44 in PCSCs(P＜0.01).Compared to CAF-CM,CAFanti-Wnt-CM significantly reduced the expression of β-catenin,CD133 and CD44(P＜0.01).CAFanti-SDF-1-CM also significantly inhibited the expression of CXCR4,β-catenin,CD133 and CD44(P＜0.01).PCR results showed that CAFanti-SDF-1-CM inhibited the expression of β-catenin,CXCR4 and downstream Wnt signaling effectors TCF and LEF(P＜0.01).Dual-luciferase reporter assay results showed that luciferase activity in the CAFanti-SDF-1-CM group was significantly lower than that in the CAF-CM group(P＜0.05).Conclusion CAF reg-ulates the stemness of PCSCs through the Wnt/β-catenin and SDF-1/CXCR4 pathways.CXCR4 may enhance the mainte-nance of stemness by activating β-catenin.

Objective:To explore the clinical efficacy of suture-bridge techniques assisted by our self-designed novel auxiliary sleeve in arthroscopic repair of large rotator cuff tear.Methods:A retrospective analysis was conducted of the clinical data of 35 patients with large rotator cuff tear who had been treated by the arthroscopic suture-bridge technique assisted by our novel auxiliary sleeve at Department of Orthopaedics, The People’s Hospital of Shanxi Province from July 2022 to January 2024. The 35 patients were set as an observation group [14 males and 21 females with an age of (58.3±10.3) years]. According to a 1:1 ratio, another 35 patients with large rotator cuff tear who had been treated by simple arthroscopic suture-bridge technique from January 2021 to June 2022 were selected as a control group [15 males and 20 females with an age of (55.3±10.5) years]. The perioperative efficacy between the 2 groups was evaluated by comparing operation time, total length of incision, and disparity in hemoglobin level between preoperation and postoperative day 1. The American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and visual analogue scale (VAS) pain score at 3 months after operation were compared between the 2 groups to evaluate the functional recovery and shoulder pain relief, and comparisons of the 3 scores were also made between preoperation and 3 months after operation in each group.Results:There were no statistically significant differences in the general preoperative data between the 2 groups, indicating comparability ( P > 0.05). The 70 patients were followed up for 5.7 (5.0, 7.0) months after operation. No such complications as recurrent rotator cuff tear, poor wound healing, infection, or anchor withdrawal occurred in either group after operation. The operation time in the observation group was 133.3 (120.0, 140.0) min, significantly shorter than 171.7 (140.0, 200.0) min in the control group ( P < 0.05). In the control group, the ASES and UCLA scores increased significantly from 29.1 (27.5, 31.4) points and 11.8 (10.0, 13.0) points before operation to 56.0 (51.9, 59.5) points and 24.6 (22.0, 27.0) points at 3-month follow-up, respectively, and the VAS pain score decreased significantly from preoperative 8.1 (7.0, 10.0) points to 2.0 (2.0, 2.0) points at 3-month follow-up ( P < 0.05). In the observation group, the ASES and UCLA scores increased significantly from 29.9 (29.1, 31.2) points and 12.6 (11.0, 14.0) points before operation to 58.8 (53.1, 62.2) points and 26.7 (25.0, 29.0) points at 3-month follow-up, respectively, and the VAS pain score decreased significantly from preoperative 8.0 (7.0, 9.0) points to 1.9 (2.0, 2.0) points at 3-month follow-up ( P < 0.05). At 3 months after operation, the UCLA score for the observation group was significantly better than that for the control group ( P < 0.05). There were no significant differences between the 2 groups in total length of incision, hemoglobin level disparity, ASES score or VAS pain score at 3 months after operation ( P > 0.05). Conclusion:In arthroscopic repair of large rotator cuff tear with suture-bridge techniques, application of our novel auxiliary sleeve can shorten operation time, simplify surgical procedures, and achieve good shoulder joint function and efficacy without increasing the length of surgical incision.