In recent years， repetitive transcranial magnetic stimulation （rTMS） has garnered significant attention as a therapeutic approach for sleep disorders in the elderly. However， the prevailing rTMS protocols are predominantly developed based on normative neurophysiological data derived from young adults and fail to incorporate individualized parameters tailored to the brain characteristics of the elderly. To address this gap， the consensus development group synthesized the latest evidence from 2010 to 2025 and established a standardized rTMS protocol specifically for elderly patients with sleep disorders. Adhering to the Appraisal of Guidelines for Research and Evaluation II （AGREE II） framework， systematically screened randomized controlled trials （RCTs） and systematic reviews regarding rTMS in the treatment of sleep disorders across various conditions. Meanwhile， the Grading of Recommendations Assessment， Development and Evaluation （GRADE） system was employed to rigorously grade the quality of evidence and the strength of recommendations. This consensus guideline delineates precise rTMS protocols for the management of sleep disorders in the elderly， highlights the adjustment of stimulation intensity according to scalp-cortex distance recommends either MRI‑guided neuronavigation or the Beam F3/F4 heuristic approach for accurate target localization， thereby providing precise rTMS intervention protocol for sleep disorders in the elderly， aiming to enhance clinical efficacy while ensuring treatment safety. ［Funded by National Key Research and Development Program （number， 2023YFC3603200）； General Program of Shenzhen Science and Technology Innovation Commission （number， JCYJ20240813112859008， JCYJ20240813112900002）； Youth Program of Shenzhen Kangning Hospital （number， KN2023A004）； www.guidelines-registry.cn number， PREPARE-2026CN530］

Objective To explore the application value of three mainstream large language models in the diagnosis, differential diagnosis, and treatment decision support of the primary diseases related to pediatric liver transplantation. Methods Seventy-nine cases of pediatric liver transplantation-related diseases diagnosed through pathological or clinical follow-up data were collected from Renji Hospital, Shanghai Jiao Tong University School of Medicine or published high-quality case reports. These cases covered 25 types of primary diseases such as cholestatic liver disease, metabolic diseases, and tumors. Standardized prompts were used to input the case information into the DeepSeek-R1, ChatGPT-4o and Grok-3 models, and the accuracy of their preliminary diagnosis and differential diagnosis based on basic clinical data was evaluated. The final diagnosis accuracy and the response time after supplementary examination were also assessed, as well as the completeness and rationality of their analysis of disease treatment principles. Results In the initial diagnosis and differential diagnosis stage, the comprehensive accuracy of DeepSeek-R1 was the highest [72.1%, 95% confidence interval (CI) 61.4% - 80.8%], and there was a statistically significant difference in the comprehensive accuracy of the three models for initial diagnosis (P = 0.008). After adding further examination information, the final diagnosis accuracy of the three models increased, with DeepSeek-R1 at 88.6% (95% CI 79.7% - 93.9%), ChatGPT-4o at 87.3% (95% CI 78.2% - 93.0%), and Grok-3 at 78.5% (95% CI 68.2% - 86.1%). There was no statistically significant difference among the three models (P = 0.05). The scores given by experts for the treatment principles showed good consistency (Kappa = 0.769). In addition, the response time of ChatGPT-4o is shorter than that of the other two models [(24 ± 7) s]. Conclusions Large language models demonstrate good efficacy in the diagnosis and treatment decision-making process of various pediatric liver diseases, have a good application prospect for auxiliary diagnosis and decision support, and are expected to help improve the accuracy and efficiency of clinical diagnosis and treatment of pediatric liver transplantation-related primary diseases.

Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.

Objective:To explore the correlations between the monocytes/high-density lipoprotein ratio (MHR), alkaline phosphatase (ALP), and all-cause mortality in patients undergoing maintenance peritoneal dialysis (PD), and to provide references for clinical prevention and treatment strategies.Methods:A retrospective analysis was conducted on the clinical data of 336 PD patients who were treated in the Affiliated Hospital of Jining Medical University from June 2014 to August 2023. According to the survival status of the patients during the follow-up period, they were divided into the death group ( n=55) and the survival group ( n=281). The differences in clinical data, blood routine, laboratory biochemical indicators, monocyte count, high-density lipoprotein cholesterol, and ALP indicators between the two groups were collected and compared. Multivariate Cox regression analysis was used to screen the risk factors for all-cause mortality in PD patients, and Pearson correlation analysis was used to evaluate the correlation between the survival time of patients and related indicators. Results:In this study, there were 55 patients who died of all causes. The causes of death were cardiovascular events in 26 cases (47.27%), gastrointestinal bleeding in 3 cases (5.45%), infection in 7 cases (12.73%), multiple organ failure in 8 cases (14.55%), and unexplained death in 11 cases (20.00%). There was no statistically significant difference in gender, age, weight, serum parathyroid hormone (PTH), and total cholesterol (TC) between the death group and the survival group (all P>0.05). The treatment time, neutrophil count, red blood cell volume distribution width (RDW), ALP, blood uric acid (UA), blood calcium, MHR and creatinine in the death group were all higher than those in the survival group (all P<0.05), while the lymphocyte count was lower than that in the survival group ( P<0.05). The Cox risk model showed that MHR, ALP, treatment duration, neutrophil count, lymphocyte count, RDW, UA, and creatinine were independent risk factors for all-cause mortality in PD patients ( OR=1.578, 2.881, 1.021, 1.122, 1.476, 2.231, 1.018, 1.008, all P<0.05); Pearson correlation analysis revealed that the survival time of PD patients was negatively correlated with MHR and ALP ( r=-0.305, -0.246, all P<0.05). Conclusions:The levels of MHR and ALP are closely related to the risk of all-cause mortality in PD patients and are independent risk factors for all-cause mortality in patients.

Objective To analyze the direct economic burden caused by surgical site infection(SSI)in orthopedics and joint surgery,and provide evidence-based support for intervention measures.Methods 3 348 hospitalized pa-tients in the department of orthopedics and joint surgery of a hospital from July 2021 to July 2023 were selected.They were divided into an infection group and a control group based on whether they had SSI.The propensity score matching(PSM)method was adopted to match the two groups of patients in a 1∶1 ratio.The length of hospital stay and various hospitalization expenses between patients with different types of SSI and control group were compared.Results Among 3 348 hospitalized patients,259 had SSI,with an incidence of 7.74％.Superficial incisional wound infection had the highest number of patients(n=177,68.34％),followed by deep incisional wound infection(n=65,25.10％),organ/space infection had the lowest number of patients(n=17,6.56％).After PSM matching,257 pairs were successfully matched,with a matching rate of 99.23％.Infection group extended length of hospital stay by 18 days compared with the control group(P＜0.001).The total hospitalization expenses and individual hos-pitalization expenses of infection group were all higher than those of the control group(all P＜0.001).Among the various expenses,difference in drug expense was the largest,with an increase of 5 067.83 Yuan in Western medi-cine(P＜0.001)and 957.30 Yuan in antimicrobial agents(P＜0.001).Patients with different types of SSI all had longer hospital stay compared with the control group.Patients with deep incisional wound infection,superficial inci-sional wound infection,and organ/space infection had an extended hospital stay of 26,18,and 13 days,respectively(all P＜0.05).The total hospitalization expenses,Western medicine expenses,and antimicrobial agent expenses of patients with different types of SSI were all higher than those of the control group(all P＜0.05).Conclusion The occurrence of postoperative SSI in patients in the department of orthopedics and joint surgery can prolong the length of hospital stay,resulting in huge economic losses for the patient and the hospital.Effective control of healthcare-associated infection is of great significance for optimizing medical resources,improving medical quality,and ensuring patient safety.

AIM To compare total sugar,total protein,total phenol,total flavonoid,calycosin-7-O-β-D-glucoside,liquiritin,lobetyolin,quercetin,isoferulic acid,hesperidin,glycyrrhizic acid contents and their antioxidant activities,hypoglycemic activities of big honey pill,small honey pill,water pill,concentrated pill,granule,mixture and decoction of Buzhong Yiqi Recipe.METHODS Anthraquinone-sulfuric acid method,Coomassie brilliant blue method,Folin-phenol colorimetry method,sodium nitrite-aluminum nitrate method and HPLC were adopted in the content determination of total sugar,total protein,total phenol,total flavonoid and seven constituents,respectively,after which the scavenging capacities,reducing powers on DPPH·free radical,ABTS+free radical,hydroxyl free radical,and inhibition capacity on α-glucosidase activity were detected.Subsequently,correlation analysis was performed.RESULTS Total sugar,total protein,total phenol and total flavonoid contents demonstrated significant differences among different dosage forms(P＜0.05,P＜0.01).Calycosin-7-O-β-D-glucoside,glycyrrhizin,codonoside and quercetin displayed the highest contents in the decoction,while those of isoferulic acid,hesperidin and glycyrrhizin were observable in the mixture.The water pill exhibited the strongest antioxidant activity,while those of the concentrated pill and mixture were weak;the big honey pill exhibited the strongest hypoglycemic activity,while that of the decoction was the weakest.Total protein,total phenol,total flavonoid and liquiritin contents displayed significant positive correlations between antioxidant activity(P＜0.05,P＜0.01),while hesperidin content displayed significant negative correlation between the latter(P＜0.05);total protein,calycosin-7-O-β-D-glucoside,codonoside and quercetin contents displayed significant negative correlations between hypoglycemic activity(P＜0.05,P＜0.01).CONCLUSION Active constituent contents and their biological activities of Buzhong Yiqi Recipe with different dosage forms exist differences,total sugar,total protein,total flavonoids,calycosin-7-O-β-D-glucoside,licorice glycoside,hesperidin,codonoside and quercetin can be taken as quality control indices for this prescription.

Non-small cell lung cancer(NSCLC)is one of the most common and deadly malignant tumors worldwide,with surgical resection being the primary treatment for early-stage NSCLC.Tumor spread through air spaces(STAS)is a novel pattern of tumor dissemination into the air spaces in the lung.Its occurrence after sublobar resection is closely associated with recurrence and distant metastasis,making its con-sideration a vital factor in surgical strategy selection and prognostic evaluation.Patients with STAS-positive status exhibit significantly higher postoperative recurrence rates than do STAS-negative patients,with molecular mechanisms involving tumor microenvironment remodeling,specific genetic mutations,and epithelial-mesenchymal transition(EMT).Imaging techniques including computed tomography(CT)and positron emission tomography/CT have shown potential for preoperative STAS prediction,although their accuracy and practicality require improvement.This paper reviews the definition,pathological characteristics,and related mechanisms of STAS,with a focus on surgical ap-proach selection for STAS-positive patients and its role in cancer recurrence after sublobar resection of early-stage NSCLC.Future research directions include optimization of preoperative diagnostic methods for STAS,exploration of molecular targeted therapies,and development of imaging-based precision prediction models.

Objective:To explore the correlations between the monocytes/high-density lipoprotein ratio (MHR), alkaline phosphatase (ALP), and all-cause mortality in patients undergoing maintenance peritoneal dialysis (PD), and to provide references for clinical prevention and treatment strategies.Methods:A retrospective analysis was conducted on the clinical data of 336 PD patients who were treated in the Affiliated Hospital of Jining Medical University from June 2014 to August 2023. According to the survival status of the patients during the follow-up period, they were divided into the death group ( n=55) and the survival group ( n=281). The differences in clinical data, blood routine, laboratory biochemical indicators, monocyte count, high-density lipoprotein cholesterol, and ALP indicators between the two groups were collected and compared. Multivariate Cox regression analysis was used to screen the risk factors for all-cause mortality in PD patients, and Pearson correlation analysis was used to evaluate the correlation between the survival time of patients and related indicators. Results:In this study, there were 55 patients who died of all causes. The causes of death were cardiovascular events in 26 cases (47.27%), gastrointestinal bleeding in 3 cases (5.45%), infection in 7 cases (12.73%), multiple organ failure in 8 cases (14.55%), and unexplained death in 11 cases (20.00%). There was no statistically significant difference in gender, age, weight, serum parathyroid hormone (PTH), and total cholesterol (TC) between the death group and the survival group (all P>0.05). The treatment time, neutrophil count, red blood cell volume distribution width (RDW), ALP, blood uric acid (UA), blood calcium, MHR and creatinine in the death group were all higher than those in the survival group (all P<0.05), while the lymphocyte count was lower than that in the survival group ( P<0.05). The Cox risk model showed that MHR, ALP, treatment duration, neutrophil count, lymphocyte count, RDW, UA, and creatinine were independent risk factors for all-cause mortality in PD patients ( OR=1.578, 2.881, 1.021, 1.122, 1.476, 2.231, 1.018, 1.008, all P<0.05); Pearson correlation analysis revealed that the survival time of PD patients was negatively correlated with MHR and ALP ( r=-0.305, -0.246, all P<0.05). Conclusions:The levels of MHR and ALP are closely related to the risk of all-cause mortality in PD patients and are independent risk factors for all-cause mortality in patients.

Objective:To compare the differences in the evaluation of hemolysis performance of cellulose hemostatic materials using different detection methods and test media,and to explore a m ore reasonable testing plan for such products.Methods:Hemolysis tests were conducted on cellulose hemostatic materials using the absorbance measurement hemolysis method and hemoglobin concentration measurement hemolysis method in accordance with YY/T 1651.1-2019 standard.We compared the changes in hemolysis rate,pH value,and osmotic pressure under different experimental media.Results:Under the same experimental method,compared to SC,the hemolysis results using PBS as the extraction medium are smaller,and the changes in pH and osmotic pressure are closer to the normal range of human body changes.Conclusions:The changes in pH and osmotic pressure may be one of the reasons for the high hemolysis rate of cellulose hemostatic materials.Choosing PBS with buffering effect as the leaching medium may be more suitable for evaluating the hemolysis performance of cellulose hemostatic materials.

Objective:To compare the differences in the evaluation of hemolysis performance of cellulose hemostatic materials using different detection methods and test media,and to explore a m ore reasonable testing plan for such products.Methods:Hemolysis tests were conducted on cellulose hemostatic materials using the absorbance measurement hemolysis method and hemoglobin concentration measurement hemolysis method in accordance with YY/T 1651.1-2019 standard.We compared the changes in hemolysis rate,pH value,and osmotic pressure under different experimental media.Results:Under the same experimental method,compared to SC,the hemolysis results using PBS as the extraction medium are smaller,and the changes in pH and osmotic pressure are closer to the normal range of human body changes.Conclusions:The changes in pH and osmotic pressure may be one of the reasons for the high hemolysis rate of cellulose hemostatic materials.Choosing PBS with buffering effect as the leaching medium may be more suitable for evaluating the hemolysis performance of cellulose hemostatic materials.