ObjectiveTo construct a large language model （LLM）-based intelligent pre-consultation system for traditional Chinese medicine （TCM） to improve efficacy of clinical practice. MethodsA TCM large language model was fine-tuned using DeepSpeed ZeRO-3 distributed training strategy based on YAYI 2-30B. A weighted undirected graph network was designed and an agent-based syndrome differentiation model was established based on relationship data extracted from TCM literature and clinical records. An agent collaboration framework was developed to integrate the TCM LLM with the syndrome differentiation model. Model performance was comprehensively evaluated by Loss function， BLEU-4， and ROUGE-L metrics， through which training convergence， text generation quality， and language understanding capability were assessed. Professional knowledge test sets were developed to evaluate system proficiency in TCM physician licensure content， TCM pharmacist licensure content， TCM symptom terminology recognition， and meridian identification. Clinical tests were conducted to compare the system with attending physicians in terms of diagnostic accuracy， consultation rounds， and consultation duration. ResultsAfter 100 000 iterations， the training loss value was gradually stabilized at about 0.7±0.08， indicating that the TCM-LLM has been trained and has good generalization ability. The TCM-LLM scored 0.38 in BLEU-4 and 0.62 in ROUGE-L， suggesting that its natural language processing ability meets the standard. We obtained 2715 symptom terms， 505 relationships between diseases and syndromes， 1011 relationships between diseases and main symptoms， and 1 303 600 relationships among different symptoms， and constructed the Agent of syndrome differentiation model. The accuracy rates in the simulated tests for TCM practitioners， licensed pharmacists of Chinese materia medica， recognition of TCM symptom terminology， and meridian recognition were 94.09%， 78.00%， 87.50%， and 68.80%， respectively. In clinical tests， the syndrome differentiation accuracy of the system reached 88.33%， with fewer consultation rounds and shorter consultation time compared to the attending physicians （P＜0.01）， suggesting that the system has a certain pre- consultation ability. ConclusionThe LLM-based intelligent TCM pre-diagnosis system could simulate diagnostic thinking of TCM physicians to a certain extent. After understanding the patients' natural language， it collects all the patient's symptom through guided questioning， thereby enhancing the diagnostic and treatment efficiency of physicians as well as the consultation experience of the patients.

OBJECTIVE To study the effect of 60Co-γ irradiation on the sterilization effect and main components of Rubus chingii Hu. METHODS Irradiated Rubus chingii Hu by 0, 6, 10, 15, 30 kGy doses of 60Co-γ, used the microbial count method to determine the microbial level of Rubus chingii Hu before and after irradiation. Analyzed the components of Rubus chingii Hu by high resolution mass spectrometry, investigated the effects of irradiation on the quality of Rubus chingii Hu by comparing the components of Rubus chingii Hu samples before and after irradiation, analyzing the quantitative results of ellagic acid and kaempferol 3-O-yunxiangoside, and evaluating the similarity of fingerprints. RESULTS The results of microbial examination of Rubus chingii Hu after different doses of irradiation all met the requirements, cluster analysis and principal component analysis of 20 components showed no significant difference. And there was no significant difference in the contents of ellagic acid and kaempferol 3-O-glucoside before and after irradiation. The similarity of fingerprints before and after irradiation was between 0.995 and 1.000. CONCLUSION Irradiation can effectively control the microbial level in Rubus chingii Hu, and there is no significant effect on the chemical composition of Rubus chingii Hu, the results provide a basis for the application of irradiation in the sterilization process of Rubus chingii Hu.

Objective:To investigate the distribution characteristics and clinical significance of non-bacterial respiratory pathogens in children with respiratory tract infection.Methods:A total of 5 718 children with respiratory tract infection treated in outpatient, emergency and inpatient of Children′s Hospital Affiliated to Capital Institute of Pediatrics from January to December 2019 were retrospectively analyzed.Pharyngeal swabs were collected and nucleic acids of 7 common non-bacterial respiratory pathogens were detected and analyzed by double amplification technique. Chi square test was used to compare the rates. Results:A total of 5 718 children were included in the study.At least one respiratory pathogen nucleic acid positive was detected in 1 835 cases (32.09%). A total of 98 children had mixed infection of more than 2 pathogens (1.71%), which were mainly Mycoplasma pneumoniae (MP) and parainfluenza virus (PIV). The positive rates of 7 respiratory pathogens from high to low were MP (12.31%), PIV (6.23%), RSV (6.14%), influenza A virus (4.62%), adenovirus (2.80%), influenza B virus (1.40%) and chlamydia pneumoniae (0.33%). The positive rate of pathogens in male patients was 32.07% (1 073/3 346 cases), which was 32.12% (762/2 372 cases) in female patients.There was no significant difference in the positive rate of pathogens between males and females ( χ2=0.002, P=0.964). The positive rate of MP infection in male patients was significantly lower than that in females (11.48% vs. 13.49%) ( χ2=5.217, P=0.022). The total positive rate of infection in the 6 to <12 years old group was the highest (42.41%). The total positive rate (44.93%) and mixed infection rate (3.33%) were significantly higher in the fourth quarter than those of the others (30.43% vs.27.31% vs.34.59% vs.44.93%, 1.23% vs.1.10% vs.1.40% vs.3.33%; χ2=110.971, 26.968, all P<0.001). The total positive rate of pathogen infection in the outpatient and emergency department was 41.74% (606/1 452 cases), which was significantly higher than that of hospitalized children (31.13%) (1 328/4 266 cases) ( χ2=54.438, P<0.001). Conclusions:Non-bacterial respiratory pathogens are important pathogens leading to respiratory tract infections in children, among which MP infection is the most prevalent.Timely and accurate detection of pathogens is helpful for the diagnosis and treatment of respiratory tract infection and avoiding the abuse of antibiotics.

Objective:To explore the clinical effect of digital endoscopic-assisted one-stage rhinoplasty and septoplasty by using subjective and objective methods.Methods:Thirty-two patients with skeletal crooked nose and nasal septum deviated who underwent endoscopic-assisted rhinoplasty and septoplasty were included in this study from January 2015 to January 2020. This study used objective measurements such as 3D digital imaging technology and CT scans, as well as subjective measurements such as Visual Analogue Scale (VAS), Rhinoplasty Outcomes Evaluation (ROE) scale, Nasal Obstruction Symptom Evaluation (NOSE) and Functional Rhinoplasty Outcome Inventory (FROI-17) to evaluate the crooked nose morphology and nasal respiratory function before and after surgery.Results:Compared with preoperatively, postoperative 3D facial imaging results showed that the deviation distance and deviation angle of the crooked nose were significantly improved (both P<0.05), and the long-term effect of the operation was stable. Subjectively, the patient＇s appearance VAS score and ROE score were significantly higher than those before surgery, while the NOSE score and FROI-17 score of nasal congestion symptoms were lower than those before surgery. Conclusions:Endoscope-assisted one-stage rhinoplasty and septoplasty can achieve the purpose of repairing the nose appearance and improving the nasal respiratory function at the same time. Through a combination of subjective and objective evaluations, our study found that this procedure had the advantages of minimally invasive, stable effect and shorter recover time; meanwhile, this procedure has high patients＇ satisfaction and is worthy of clinical promotion.

Objective:To compare the clinical effects of the two methods in surgical treatment of gynecomastia.Methods:The clinical data of 46 patients with gynecomastia were retrospectively analyzed, who received total removal of the glands through mastoscopic assistance (mastoscopic group) or traditional areola incision (traditional group) from Mar. 2017 to Mar. 2018. The two groups were compared in terms of blood loss, the mean operation duration, extubation time, the average hospitalization time, postoperative complications, the total cost and patients’ satisfaction at 6 month after operation. Chi-square test was used to compare the count data between groups, paired t test was used to compare the measurement data between groups, and SPSS18.0 statistical software was used for statistical analysis.Results:The operation was completed in both groups. There were no differences between the two group in age (0.473) , BMI (0.353) , lesion location (0.198) , Simon classification (0.683) , the mean blood loss ( P=0.999) , mean operation duration ( P=0.596) , extubation time ( P=0.755) , the average hospitalization time ( P=0.676) , postoperative complications and ( P=0.370) or the total cost ( P=0.486) . The difference of patients’ satisfaction at 6 month after operation had statistical significance ( P=0.012) . conclusion:Compared with traditional open surgery, mastoscopic surgery for gynecomastia is minimally invasive, beautiful and safe, which can be widely used in clinical practice.

Objective: We predicted the molecular mechanism of Panax notoginseng in the treatment and improvement of scar hyperplasia, by using the methods of network pharmacology and bioinformatics. Methods: We collected of related active constituents and targets of Panax notoginseng by retrieving TCM systems pharmacology database and analysis platform (TCMSP), and collected of related active constituents and targets of scar by Genecards database and OMIM database. Cytoscape 3.6.1 software was used to construct "drugs-chemical components-targets-diseases" interaction network diagram. The protein in teraction network map (PPI) was constructed by STRING database. The key targets were used to analyze gene ontology (GO) enrichment and kyoto encyclopedia of genes and genome (KEGG) pathway enrichment. Results: Totally 7 chemical compponents, including beta-sitosterol, quercetin, Stigmasterol and etc. and 108 targets, including AKT1, JUN, MAPK1, IL6 and ect. Panax notoginseng exerts its effects on scar mainly by acting on signal pathways, including PI3K-AKt signal pathway, MAPK signal pathway, TNF signal pathway and ect. Conclusions Based on the methodology of network pharmacology, this study preliminarily predicted the major targets and pathways Panax notoginseng in the treatment of scar, providing a direction for further studies.

Objective To explore the effect of social relationship quality intervention on blood pressure and mental state of patients after hypertensive hemorrhage. Methods From November 2014 to March 2016,48 patients with hypertensive intracerebral hemorrhage were assigned as control group and another 48 patients with the same disease in our hospitalfrom April 2016 to August 2017 as observation group:The former received routine nursing care and the latter was treated with social relationship quality intervention plus the routine nursing care.The blood pressure and mental states before intervention were compared with those 1 month after intervention. Result After intervention,the systolic and diastolic blood pressures in the observation group were significantly lower than those in the control group,and the scores on resilience,optimism and strength were all significantly higher than those in the control group (P<0.01, P<0.001). Conclusions The social relationship quality intervention is effective in the care to patients with hypertensive cerebral hemorrhage. It can effectively improve the clinical efficacy, reduce blood pressure and improve mental state, worthy of clinical application and promotion.

Objective To evaluate the applied value of septal cartilage combined with perpendicular plate of ethmoid bone graft in short nose plasty in Chinese people with insufficient septal cartilage.Methods From February 2015 to March 2017,thirty-five women with short noses underwent septal extension grafting in our institute.We used perpendicular plate of ethmoid bone to enhance the L-strut structure.An L-strut,comprising 0.6 cm segments of the caudal and dorsal cartilaginous septum,was left altered to harvest more cartilages for septal extension.The harvested septal cartilage was grafted on one side of the caudal septum.Then the alar cartilage was fixed at the end of the septal cartilage graft.Nasal lengths and nasolabial angles were measured pre-and postoperatively.Results The average nasal lengthening was (3.37±1.87) mm (P＜0.001).There was no infection,cerebral spinal fluid leakage,hemorrhage and other complications postoperatively.The average follow-up was 10 months (6 months to 2 years).After operation,33 patients were satisfied with the nasal contour,1 patient complained of high tip projection whereas one patient complained of low tip projection,and the dissatisfactions were corrected by revision surgeries.Conclusions Combining the septal cartilage with perpendicular plate of ethmoid bone graft presents an adequate nose lengthening and a decreased nostril show,even in patients with very little septal cartilage.With minimum complications,this novel technique provides promising clinical outcomes and high patient satisfaction.

Objective: To investigate the morphology and structure of the perpendicular plate of ethmoid and measure its anatomical parameters among Chinese population. To discuss the safety range of harvesting perpendicular plate of ethmoid in rhinoplasty. Methods: Sixty-four healthy Chinese were included in accordance with certain requirements and their paranasal sinus was examined using 64 slices computed tomography (CT). The three-dimensional (3D) structure of their perpendicular plate of ethmoid was reconstructed, and the area, length, height and thickness were measured by Mimics 17.0 software. Statistical analysis was completed by SPSS 22.0 software and was checked out by t-test. Results: According to the result from 3D anatomical analysis, the length of the anterior border of perpendicular plate of ethmoid was (28.58±2.91) mm, the inferior border was (26.17±5.76) mm and the posterior border was (19.84±3.17) mm. The thickness of the anterior border three sections were (3.07±0.72) mm, (3.09±0.73) mm and (1.75±0.55) mm respectively. The thickness of the inferior border in three sections were (1.96±0.62) mm, (1.94±0.73) mm and (1.87±0.67) mm, respectively. The length of the middle and lower third of the perpendicular plate of ethmoid anterior border was (10.04±2.39) mm. As to the superior border, the length was (35.31±6.52) mm. The total area of the perpendicular plate of ethmoid was (1 057.85±184.38) mm^2, the lower section area was (474.09±109.60) mm^2, and the ratio of middle and lower third to the total area was 0.45±0.07. Conclusions The thickness of the lower 1/3 segment of the vertical plate of the ethmoid bone is thinner than that of the upper segment, and it is far away from the skull base, which is easily to harvest and meet the application in surgery.

Objective To compare the effect and survival period of endoscopic treatment group and non endoscopic treatment group of esophageal gastric varices bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus, in order to define the significance of endoscopic therapy for prolonging the survival period of patients. Methods 76 patients diagnosed as esophageal gastric varices bleeding with hepatocellular carcinoma and portal vein tumor thrombus from Jan. 2013 to Dec. 2015 were enrolled, of all these cases, 27 were non endoscopic treatment group and 49 were endoscopic treatment group. The medical records were analyzed retrospectively. Then compare the effect of emergency treatment, the main causes of death and survival time of the two groups. Results In the non endoscopic treatment group, 40.7% (11/27) patients died in one week after bleeding, 81.5% (22/27) patients died of esophageal gastric varices bleeding, the mean survival period was (42.03 ± 13.94) days; In the endoscopic treatment group, only 16.3% (8/49) patients died in one week (P < 0.05), 55.1% (27/49) patients died of esophageal gastric varices bleeding (P < 0.05), the mean survival time was (174.24 ± 34.42) days (P < 0.05). Conclusions Endoscopic therapy can effectively reduce the risk of death from acute hemorrhage and prolong the survival time in patients with hepatocellular carcinoma and portal vein tumor thrombus.