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.

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 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.

Armeniacae Semen Amarum， the dried mature seeds of plants such as Prunus armeniaca var. ansu （Rosaceae）， have a long history for medicinal use. Modern research indicates that the core active compounds of Armeniacae Semen Amarum， such as amygdalin， fatty acids， and volatile oils， exhibit multiple pharmacological effects including antitussive， bronchodilatory， anti-inflammatory， antioxidant， antitumor， antifibrotic， and immunomodulatory effects. Consequently， their potential applications in treating respiratory diseases， tumors， tissue injury， and metabolic disorders have garnered significant attention. However， a systematic integrated analysis of the relationship between the traditional efficacy， modern pharmacology， key material basis， and multi-pathway mechanisms of Armeniacae Semen Amarum remains lacking. Using bibliometric methods combined with CiteSpace visualization technology， this study systematically summarizes the research hotspots on Armeniacae Semen Amarum and its representative component amygdalin， including the key roles in inflammation regulation， apoptosis induction， cell cycle arrest， oxidative stress balance， and fibrosis modulation. This article reviews the research progress in Armeniacae Semen Amarum across from four major dimensions—traditional applications， visualization analysis， material basis， and modern pharmacological studies， providing a reference for the further basic and clinical studies of Armeniacae Semen Amarum in respiratory diseases， oncology， and immune-related disorders.

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.

Objective:To construct a failure mode and effects analysis(FMEA)evaluation model for medical devices to manage devices,so as to enhance management efficiency for medical devices.Methods:The FMEA was adopted to construct FMEA evaluation model for medical devices,so as to conduct comprehensive lifecycle management for medical devices.The process of management for equipment was optimized,and the operational risk of medical devices was reduced through failure mode(FM)analysis and the construction of management system for equipment.A total of 47 medical devices in clinical use of The First People's Hospital of Neijiang from January to December 2023 were included.In them,23 devices received conventional management mode during January and June 2023,and 24 devices received FMEA evaluation model(model management mode)during July and December 2023.For each group,2,000 patients'medical records were selected.The control effectiveness of infectious indicators,effect of cleaning and disinfection,and quality scores of infectious control for medical devices were compared between different management modes.A self-designed questionnaire was adopted to investigate the recognition scores of engineers who used and managed devices,operators,physicians,and department administrators for two kinds of management modes.Results:In 2,000 patients'medical records,who adopted model management mode,the infection rate of patients,and infection rate of aseptic surgical incision were respectively 0.15%and 0.05%,both were significantly lower than those in the conventional management mode(x2=5.420,8.358,P<0.05).The cleaning rate,and disinfection qualification rate of 24 medical devices,which adopted model management mode,were respectively 83.33%and 87.50%,all of which were significantly higher than these of conventional management mode(x2=8.080,6.741,P<0.05).The scores of standardized operation,rational use,disinfection and cleaning,and emergency intervention for medical devices in adopting model management mode were significantly higher than those in adopting conventional management mode(t=14.435,16.014,13.049,12.537,P<0.05).The recognition scores of engineers who used and managed devices,operators,physicians,and department administrators for adopting model management mode were significantly higher than those for adopting conventional management mode,and the differences were significant(t=12.219,12.147,17.437,13.420,P<0.05).Conclusion:The FMEA evaluation model for medical devices can real-time monitor the entire management process for medical devices,and reduce clinical infections,and ensure normal operation of devices,and improve clinically operational quality of them,and increase satisfaction of staffs in clinical departments.

Rotator cuff injury is a shoulder disease most commonly seen with the elderly, and as China enters an aging society, the number of patients with rotator cuff injury is rapidly increasing. For patients with poor results of conservative treatment and serious conditions, arthroscopic rotator cuff repair has become the first choice due to less trauma and better efficacy. However, the rehabilitation exercise time required for postoperative functional recovery is long, and at the same time, the existence of a series of complications seriously affects patients' postoperative recovery and quality of life. The purpose of this article is to summarize the complications and preventive measures after arthroscopic rotator cuff injury repair, and to provide help for the diagnosis and treatment of postoperative complications and postoperative rehabilitation.

Viruses,as important biological agents influencing human health and social development,have played a key role in the spread of epidemics and the evolution of diseases since ancient times.Upon infecting hosts,viruses often trigger a series of com-plex responses,including innate and adaptive immunity,inflammatory responses and pathological damage.Despite advances in mod-ern antiviral drugs development,chemical drugs typically rely on a single molecular target within the viral life cycle,making them highly susceptible to the emergence of drug resistance and the induction of systemic toxic side effects.In contrast,traditional Chi-nese medicines(TCMs),posing the distinctive advantage of multi-component,multi-target,and multi-pathway,have exerted a pivotal role in viral prevention and viral treatment.In recent years,fresh herbs have gained increasing attention for their ability to preserve intact bioactive components.Fresh herb-derived nanovesicles possess excellent biocompatibility,targeting and cross-species regula-tory capabilities.These fresh herb-derived nanovesicles can effectively encapsulate and deliver a variety of antiviral components,demonstrating significant potential in antiviral immunomodulation,inflammation control and viral-induced pathologies.This review systematically sorts out the mechanisms of viral infection,and summarizes the advantages of fresh herbs,and the application pros-pects of fresh herb-derived nanovesicles in antiviral therapy.Furthermore,it focuses on summarizing the research progress of fresh herb-derived nanovesicles in the field of antiviral therapy,with the aim of providing insights and references for the development of fresh herb-derived nanovesicles-based antiviral strategies,as well as offering novel approaches and perspectives for the clinical treat-ment of viral diseases.

Bone defect repair is an urgent problem in the field of orthopedics,and numerous researchers are working to develop more effective treatment plans.The accurate evaluation of bone repair after surgery is a crucial step.In line with the development of computed tomography(CT)imaging,dual-energy CT imaging has shown significant advantages in analyzing bone composition and reducing metal artifacts.This article reviews the application of dual-energy CT imaging for the evaluation of bone repair in animals.

Objective:To investigate the effect of miR-1-3p on mitophagy in human esophageal squamous cell carcinoma (ESCC) cells and the related mechanisms.Methods:The differentially expressed miRNAs in ESCC were screened using the GEO database. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to measure miR-1-3p expression in normal esophageal epithelial cells (HET-1A) and ESCC cell lines (TE1, KYSE30, KYSE150, KYSE410, Eca109). Bioinformatics tools were utilized to predict target genes of miR-1-3p, subcellular localization was confirmed by fluorescence in situ hybridization. The targeting relationship between miR-1-3p and SLC7A11 was validated using dual-luciferase reporter assay. Cell proliferation and apoptosis were detected by CCK8 assay and flow cytometry, respectively. Furthermore, experimental validation demonstrated that overexpression of SLC7A11 rescued the presence of the miR-1-3p/SLC7A11 axis. Confocal microscopy was used to detect changes in mitochondrial autophagic lysosomes, while transmission electron microscopy was employed to observe mitophagy and morphological alterations. Western blot was conducted to evaluate the expression of autophagy-related proteins LC3 and P62. Flow cytometry was used to measure mitochondrial membrane potential and reactive oxygen species (ROS). Immunohistochemistry was applied to assess SLC7A11 expression in 133 ESCC patient tissues and 115 normal esophageal epithelial tissues. The correlation between SLC7A11 expression level and clinicopathological features was analyzed. Survival analysis was performed using the Kaplan-Meier method, and Cox proportional hazard regression models were used for multivariate analysis.Results:The expression of miR-1-3p in ESCC cells was significantly lower than that in HET-1A cells ( P＜0.05). SLC7A11 was a target gene of miR-1-3p. Transfection of miR-1-3p mimic inhibited the proliferation of ESCC cells. CCK-8 assay results showed that the proliferative capacity of KYSE30 and KYSE410 cells in the miR-1-3p mimic group (absorbance values: 2.88±0.24 and 2.88±0.18, respectively) was significantly lower than that in the miRNA mimic negative control (NC) group (3.94±0.27, P＜0.001; 4.20±0.21, P＜0.001). Meanwhile, the proliferative capacity of KYSE30 and KYSE410 cells in the miR-1-3p mimic+SLC7A11-overexpression (OE) group (absorbance values: 3.57±0.15 and 3.60±0.13, respectively) was significantly higher than that in the miR-1-3p mimic +empty vector (EV) group (2.54±0.10, P＜0.001, 2.36±0.16, P＜0.001). Additionally, transfection of miR-1-3p mimic promoted apoptosis. Flow cytometry results demonstrated that the apoptosis rates of KYSE30 and KYSE410 cells in the miR-1-3p mimic group [(9.22±0.05)% and (6.55±0.37)%, respectively] were significantly higher than those in the miRNA mimic NC group [(0.81±0.17)%, P＜0.001); (1.04±0.12)%, P＜0.001]. Conversely, the apoptosis rates of KYSE30 and KYSE410 cells in the miR-1-3p mimic + SLC7A11-OE group [(0.73±0.04)% and (1.19±0.05)%, respectively] were significantly lower than those in the miR-1-3p mimic+EV group [(9.83±0.41)%, P＜0.001); (6.09±0.17)%, P＜0.00)]. MiR-1-3p mimic downregulated SLC7A11 protein expression and the LC3Ⅱ/LC3I ratio ( P＜0.05), upregulated P62 protein expression ( P＜0.05), this phenomenon can be rescued by overexpressing SLC7A11 ( P＜0.05). Additionally, miR-1-3p mimic increased ROS levels and decreased mitochondrial membrane potential (JC-1 aggregate/monomer ratio), this phenomenon can be rescued by overexpressing SLC7A11 ( P＜0.05). SLC7A11 expression was higher in ESCC tissues compared to normal esophageal epithelial tissues ( P＜0.001), and SLC7A11 serves as an independent prognostic factor in ESCC ( HR=2.15, 95% CI: 1.27-3.65, P=0.004). Conclusion:miR-1-3p inhibits mitophagy in esophageal squamous cell carcinoma by targeting SLC7A11.