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.

Assisted reproductive technology （ART） can address the issues faced by infertile couples and help families achieve their desine to have children. Starting from both theoretical and practical basis， this paper introduced a discussion on the legitimacy of ART application for single women. The challenges encountered by single women in ART application were objectively analyzed， including untimely legislation， unclear applicable subjects， the commodification of sperm and eggs， inadequate institutional guarantees， and insufficient safeguarding of offspring’s rights and interests， etc. This paper proposed solutions to the problems encountered by single women in ART application， including adhering to the relevant principles， strengthening legislative norms， clarifying the applicable subjects， providing institutional guarantees， safeguarding the offspring’s rights and interests， and seeking a balance between ethics and law. It aimed to provide references for related wrok， assisting single women in achieving a balance between ethics and law in ART application and protecting the reproductive rights of single women to the greatest extent.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective To analyze the epidemiology and trends of measles,tuberculosis,pertussis,scarlet fever,influenza,mumps and rubella in Beijing between 2014 and 2023 in order to provide data for prevention and control of related diseases.Methods Data on the incidences of seven respiratory infectious diseases in Beijing between 2014 and 2023 was collected.Descriptive epidemiological methods were employed to analyze their demographic,temporal and spatial distribution.Joinpoint regression analysis was used to assess temporal trends in incidence.Results A total of 1 406 777 cases of seven respiratory infectious diseases were reported in Beijing between 2014 and 2023,which corresponded to an average crude rate of 649.76/100 000 reported annually.The crude rate of incidencewas higher among females than among males,with the most vulnerable age groups being 0-4 years and 5-19 years,and was higher in the six districts than on the outskirts.Most of the respiratory infectious diseases peaked in winter and spring.The annual increase in the incidence of respiratory infectious diseases in Beijing in this period averaged 27.27％,with no statistically significant differences in trends.The incidence rates of measles,tuberculosis,scarlet fever,mumps and rubella decreased significantly while those of pertussis and influenza increased,but with no statistically significant difference.Conclusion The overall incidence of major respiratory infectious diseases in Beijing is increasing.It is recommended that more people get vaccinated,surveillance of such diseases as pertussis and influenza be enhanced,and regional health resources be allocated more effectively,all of which will be critical to subsequent prevention and control of respiratory infectious diseases in Beijing.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

BACKGROUND:Osteoporosis is a disease in which bone density and structure are destroyed and fractures are caused by increased bone fragility,leading to high clinical disability and mortality rates. OBJECTIVE:To review the research progress in the role of bone immunity in physiological and pathological processes related to bone metabolism,providing ideas for the research and clinical application of bone immunity in bone diseases. METHODS:The first author searched PubMed and CNKI databases in November 2022 for relevant literature using the keywords of"osteoimmunology,immuno-skeletal interface,bone metabolism,skeletal metabolism,lymphocyte,immune factor"in English and Chinese,respectively.The time range of retrieval was mainly from January 2010 to November 2022,and a small number of classical long-term literatures were included.After reading the topic and abstract for preliminary screening and excluding repetitive studies,low-quality journals and unrelated literature,81 documents were finally included for review. RESULTS AND CONCLUSION:Osteoimmunology refers to that bone and immune cells share the same microenvironment and interact with each other to jointly perform the"bone immune system,"which includes all cells in the bone marrow.Immuno-skeletal interface has protective effects on bone under physiological conditions,but it may lead to bone destruction under pathological conditions.Osteoprotegerin is mainly derived from B cells and can inhibit osteoclast metabolism.However,when the body is in an inflammatory state,T cells and B cells work together to promote bone resorption.In addition,interleukin-1,interleukin-6 and tumor necrosis factor-α regulate the expression of receptor activator of nuclear factor-κB ligand in vivo and affect bone metabolism.In most clinical diseases(such as rheumatoid arthritis,estrogen deficiency,HIV infection,and hyperparathyroidism),the immuno-skeletal interface interacts with the bone immune system,resulting in the regulation of bone metabolism.In terms of clinical prospect,the interaction between bone immunity and bone metabolism should be studied in order to propose new strategies for therapeutic intervention to reduce the risk of fracture.

ObjectiveTo analyze the influence of Jianpi Yuwei decoction combined with omeprazole on ulcer area， gastrointestinal symptoms， and serum trefoil factor family 2 （TFF2） in patients with gastric ulcer （symptom of deficiency-cold in spleen and stomach）. MethodA total of 100 patients with gastric ulcer of symptom of deficiency-cold in spleen and stomach admitted to the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2020 to April 2022 were regarded as the research subjects. They were randomly grouped into two groups according to the number table method. 50 cases in the control group received omeprazole treatment， while 50 cases in the traditional Chinese medicine （TCM） group received Jianpi Yuwei decoction treatment on the basis of the control group. The clinical efficacy， periodic gastrointestinal symptom score， serum cytokines， gastrin indexes， and ulcer area of the two groups were compared. ResultAfter treatment， the total treatment efficiency of the TCM group was 94.00% （47/50）， while the total effective rate of the control group was 76.00% （38/50）. The total effective rate of the TCM group was higher than that of the control group （χ²=6.353， P<0.05）. After treatment， the scores of periodic upper abdominal pain， bloating， acid reflux， and belching symptoms in both groups decreased （P<0.05）. Compared with that in the control group after treatment， the score of periodic upper abdominal pain， bloating， acid reflux， and belching symptoms in the TCM group decreased more significantly （P<0.05）. After treatment， the levels of TFF2 increased in both groups （P<0.05）， and C-reactive protein （CPR） and tumor necrosis factor （TNF-α） decreased （P<0.05）. Compared with the control group after treatment， the TCM group showed a more significant increase in TFF2 levels （P<0.05）， and CRP and TNF-α levels decreased more significantly （P<0.05）. After treatment， the levels of motilin （MTL）， gastrin （GAS）， cholecystokinin （CCK）-33， and ulcer area decreased in both groups （P<0.05）. Compared with those in the control group after treatment， the levels of MTL， GAS， CCK-33， and ulcer area in the TCM group decreased more significantly （P<0.05）. ConclusionJianpi Yuwei decoction combined with omeprazole can reduce the ulcer area， alleviate periodic gastrointestinal symptoms， and increase serum TFF2 level in patients with gastric ulcer of symptom of deficiency-cold in spleen and stomach， with remarkable effects.

Multimodality therapy based on surgery is the main treatment method for hepatocellular carcinoma (HCC), and hepatectomy requires the removal of primary tumor and the preservation of normal liver tissue to the maximum extent. However in clinical surgery, it is difficult to accurately identify tumor tissue and its boundary with visual inspection and palpation, which often results in under-resection or over-resection. Near-infrared fluorescence (NIRF) imaging is a real-time noninvasive imaging technique with low costs and high sensitivity, and extensive studies have been conducted to investigate its application in guiding surgical resection of tumors. With the development of fluorescence imaging system and fluorescence probe, intraoperative tumor localization and boundary determination can be realized to make the surgery more accurate. This article reviews the development of various NIRF probes for intraoperative navigation in HCC and discusses current challenges and potential opportunities of these imaging probes.

Surgical resection is one of the important means to achieve long-term survival for patients with liver malignant tumor. However, most of the liver malignant tumor has been diagnosed in the middle and late stage, and lose the chance of surgical treatment. For these patients who have lost the chance of surgery, some surgeons have proposed the concept of planned liver resection, which is to reduce tumor stage and increase future liver remnant (FLR) in a planned way, so as to improve the safety of surgery and prolong the survival time of patients after surgery. For patients with FLR insufficiency after prior evaluation or/and treatment, the technique of hepatic hyperplasia is an important part of planned hepatectomy, that is, to effectively increase FLR in a short period of time by various means. Portal vein ligation (PVL) and portal vein embolization (PVE), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are three main techniques for hepatic hyperplasia. This article reviews the principle, effect and safety of three liver augmentation techniques.

Malignant obstructive jaundice is caused by direct invasion or compression of the biliary tract by malignant tumors of the bile duct, pancreas and other systems. Patients are often accompanied by symptoms such as malnutrition, low immune function, and organ damage. The treatments of active preoperative biliary drainage and reasonable reinfusion combined with enteral nutrition can help improve the safety of patients during the perioperative period, reduce postoperative complications, and improve the life quality of patients. This article reviewed the research progress of preoperative biliary drainage, bile recycling methods and precautions in patients with malignant obstructive jaundice, aiming to provide reference for clinical diagnosis and treatment practice.