The integration of large language model （LLM） and traditional Chinese medicine （TCM） promotes the informatization of TCM，and also provides a new direction for the inheritance and innovation of TCM in the new era. Based on the research background of LLM，the development process of LLM based on the Transformer architecture is summarized，and the research progress of LLM in TCM is reviewed. The main process of constructing TCM LLMs and the key techniques used by researchers during model development are summarized. Based on the related literature， the main application scenarios of TCM LLMs and the research explorations conducted by TCM researchers using LLMs are outlined. Meanwhile，the current challenges faced in the development of TCM LLMs are analyzed. Further improvements are urgently needed in the construction of high-quality data，the evaluation methodology of TCM LLMs，the interpretability of the model， multimodal fusion of TCM LLMs， and the development of TCM prescription recommendation models. Looking forward to the future development of LLM in TCM，it is expected to provide a reference for the deeper integration of LLMs and TCM，and facilitate the modernization of TCM.

Purpose: Due to the preservation of the entire stomach after endoscopic resection, the occurrence of metachronous gastric cancer (MGC) remains a possibility. In this study, we investigated the incidence and risk factors for MGC in patients with early gastric cancer who underwent endoscopic submucosal dissection (ESD) and successfully eradicatedHelicobacter pylori. Materials and Methods: A retrospective analysis was conducted of 1,191 patients who underwent ESD and successfully eradicated H. pylori at the Affiliated Drum Tower Hospital of Nanjing University. Endoscopic surveillance was performed at 3, 6, and 12 months post-resection, and annually thereafter. MGC was defined as the development of a new cancer at a site other than the primary gastric cancer site, at least 1 year after the initial endoscopic resection. Results: A total of 77 patients were diagnosed with MGC during a median follow-up of 41.5 months. Kaplan-Meier analysis showed a 5-year cumulative incidence of MGC of 9.4% after successful H. pylori eradication. Multivariate analysis of the training set using Cox proportional hazards models identified male sex, severe atrophic gastritis, multiple gastric cancers before H. pylori eradication, and smoking history as independent risk factors for MGC.The nomogram exhibited favorable discrimination, with area under the curves of 0.767 and 0.822 in the training set and 0.724 and 0.745 in the testing set at 3 and 5 years, respectively. Conclusions Patients with gastric cancer who undergo endoscopic resection, even after successful H. pylori eradication, should undergo annual and continuous endoscopic surveillance for MGC.

Gastroesophageal varices （GOV） bleeding is a severe complication of portal hypertension with a high mortality rate. Animal models are indispensable tools for investigating its pathogenesis and developing novel therapeutic strategies. This article systematically reviews the methods for establishing various GOV models， with a particular focus on their efficacy in simulating the key pathological processes such as an increase in hepatic venous pressure gradient and the risk of bleeding， and it also proposes targeted strategies for model selection. Finally， this article discusses the application prospects of emerging techniques in the era of precision medicine， such as organoids and gene editing， in order to provide model selection and a theoretical reference for exploring the mechanism and clinical translation of GOV.

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is higher among individuals with inflammatory bowel disease (IBD) than in the general population. Emerging evidence indicates that the development of MASLD in patients with IBD may occur independently of traditional metabolic risk factors, suggesting a unique pathophysiological mechanism distinct from conventional MASLD pathways. Bile acids (BAs), which act as critical signaling molecules in enterohepatic circulation, play an essential role in maintaining gastrointestinal homeostasis through bidirectional gut–liver axis communication. These molecules are increasingly recognized as pivotal regulators in the progression of both MASLD and IBD. While previous studies have characterized the dynamics of BA in blood or fecal samples under both conditions, a comprehensive understanding of their metabolic profiles and the associated interactions within the gut–liver axis is still lacking. This review synthesizes current evidence from studies employing BA metabolomics to investigate IBD and MASLD. By focusing on BA signatures, we summarize conserved alterations between these two conditions and their potential mechanisms of disease progression. Our review advances understanding of BA-mediated pathways in IBD and MASLD, providing a foundation for assessing their roles in contributing to the pathogenesis of MASLD in patients with IBD.

ObjectiveTo explore the mechanism of modified Xiehuangsan in treating tic disorders （TD） based on microglial polarization and the Toll-like receptor 4 （TLR4）/myeloid differentiation factor 88 （MyD88）/nuclear factor （NF）-κB pathway. MethodsSeventy-two Sprague-Dawley （SD） rats were randomly assigned into six groups： control， model， tiapride （0.025 g·kg^-1）， and low-， medium-， and high-dose （12， 24， 48 g·kg^-1， respectively） modified Xiehuangsan， with 12 rats in each group. Except the control group， the other groups received intraperitoneal injection of 3，3'-iminodipropionitrile （IDPN） for 7 consecutive days for the modeling of TD. After successful modeling， the control and model groups were given normal saline via gavage， and the other groups were administrated with corresponding drugs by gavage. After 28 days of continuous intervention， rat behaviors were observed， and the modified Xiehuangsan group showing the best anti-TD effect was selected for deciphering the treatment mechanism. Hematoxylin and eosin staining was conducted to observe morphological changes in the rat striatum. Immunohistochemistry was employed to detect the expression of CD16 and CD206 in the striatum. Real-time PCR was employed to measure the mRNA levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， IL-4， TLR4， MyD88， and NF-κB p65 in the striatum. Western blot was employed to determine the protein levels of ionized calcium-binding adapter molecule 1 （Iba1）， Fc receptor family for immunoglobulin （Ig）G type Ⅲ （CD16）， mannose receptor （CD206）， TLR4， MyD88， and NF-κB p65 in the striatum. ResultsCompared with the control group， the model group showed increased stereotyped behaviors， locomotor activity， total movement distance， and movement speed， shortened resting time （P<0.01）， and noticeable pathological changes in the striatum. Compared with the model group， the tiapride group and modified Xiehuangsan groups exhibited reduced stereotyped behavior， locomotor activity， total movement distance， and movement speed， prolonged resting time （P<0.05， P<0.01）， and alleviated pathological changes in the striatum. Among the modified Xiehuangsan groups， the high-dose group had the best intervention effect and the mildest pathological changes. Therefore， the high-dose group was selected for further research. Compared with the control group， the modeling of TD increased Iba1 and CD16 expression （P<0.05， P<0.01）， up-regulated the mRNA levels of IL-1β and TNF-α （P<0.05， P<0.01）， down-regulated the mRNA level of IL-4 （P<0.05）， up-regulated the mRNA and protein levels of TLR4 and MyD88 （P<0.05， P<0.01）， and up-regulated the protein level of NF-κB p65 （P<0.01）. Compared with the model group， modified Xiehuangsan reduced Iba1 and CD16 expression （P<0.05， P<0.01）， up-regulated the protein level of CD206 （P<0.05， P<0.01）， down-regulated the mRNA levels of IL-1β and TNF-α （P<0.05）， up-regulated the mRNA level of IL-4 （P<0.01）， and down-regulated the mRNA and protein levels of TLR4， MyD88， and NF-κB p65 （P<0.05， P<0.01）. ConclusionModified Xiehuangsan demonstrated a definite therapeutic effect on TD in rats. It may reduce neuroinflammation in TD rats by regulating the polarization of microglia in the striatum via the TLR4/MyD88/NF-κB signaling pathway.

Objective:To evaluate the effect of liposomal bupivacaine transversus abdominis plane block (TAPB) on the postoperative quality of recovery in patients undergoing laparoscopic colorectal surgery.Methods:In this randomized controlled trial, 100 patients of either sex, aged 18-75 yr, with a body mass index of 18.5-29.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective laparoscopic colorectal surgery, were allocated into 2 groups ( n=50 each) in a 1∶1 ratio using a random number table method: liposomal bupivacaine TAPB group (LB group) and hydrochloric bupivacaine TAPB group (HB group). Before anesthesia induction, ultrasound-guided bilateral TAPB was performed, liposomal bupivacaine (266 mg) 40 ml (20 ml per side) was injected in LB group, and bupivacaine hydrochloride (100 mg) 40 ml (20 ml per side) was injected in HB group. When pain scores at rest ≥4 within 72 h after the end of surgery, patient-controlled intravenous analgesia with morphine injectio 3 mg was used. The Quality of Recovery-15 scale score was recorded at 24, 48 and 72 h postoperatively. The time to first rescue analgesia and total consumption of morphine within 72 h after operation were recorded. The occurrence of adverse reactions, including nausea and vomiting, urinary retention, pruritus, local anesthetic toxicity and hematoma at the puncture site, was recorded within 72 h after surgery. Results:Compared to HB group, Quality of Recovery-15 scale scores were significantly increased at 24, 48 and 72 h postoperatively, the time to first rescue analgesia was prolonged, the consumption of morphine was reduced within 72 h postoperatively, and the incidence of postoperative nausea and vomiting was decreased( P<0.05), and no statistically significant changes in the incidence of urinary retention or pruritus were found within 72 h postoperatively in LB group ( P>0.05). No local anesthetic toxicity or hematoma at the puncture site occurred in either group. Conclusions:Liposomal bupivacaine TAPB can improve the postoperative quality of recovery in the patients undergoing laparoscopic radical resection for colorectal cancer.

Objective:To evaluate the effectiveness of fosaprepitant in preventing postoperative nausea and vomiting (PONV) following gynecological laparoscopic surgery.Methods:In this randomized parallel-controlled trial, 100 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 18-64 yr, undergoing elective gynecological laparoscopic surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University, were selected and divided into 2 groups ( n=50 each) in a ratio of 1∶1 using blocked randomization: fosaprepitant group (group F) and tropisetron group (group T). At 30 min before anesthesia induction, fosaprepitant 150 mg was intravenously infused in group F, and tropisetron 5 mg was intravenously infused in group T, both diluted in 150 ml of normal saline. Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and cisatracurium. Anesthesia was maintained by intravenous infusion of remifentanil and propofol. Patient-controlled intravenous analgesia was performed with hydromorphone at the end of operation until 48 h after operation. Metoclopramide was given as rescue antiemetic. The PONV, requirement for antiemetic drugs and related adverse reactions were recorded within 24 h after surgery. Results:The incidence of PONV (10% vs 30%), the incidence of vomiting(2% vs 16%) and the rescue rate of antiemetic drugs(2% vs 12%)were significantly lower in group F than in group T ( P<0.05). There was no significant difference in the incidence of related adverse reactions between the two groups ( P>0.05). Conclusions:Intravenous infusion of fosaprepitant 150 mg at 30 min before anesthesia induction effectively prevents PONV in patients undergoing gynecological laparoscopic surgery, and the efficacy is superior to that of the conventional use of tropisetron.

AIM:To explore suitable methods for the induction and cryopreservation of mouse bone marrow-derived macrophages(BMDMs).METHODS:Mouse fibroblasts(L929 cells)were cultured under varying conditions of temperature,seeding density,and serum concentration.The concentration of macrophage colony-stimulating factor(M-CSF)in the cell supernatant was measured using ELISA to determine the optimal conditions.Mouse bone marrow cells were extracted,and a differential adherence method was employed to pre-culture the bone marrow cells for 4 h,followed by flow cytometry to assess the proportion of resident macrophages.Flow cytometry was utilized to assess the ratio of F4/80 positive cells among the suspended and adherent cells.Induction of BMDMs was conducted using L929 cell supernatant or recombinant M-CSF for 7 d,and flow cytometry was applied to evaluate the proportion of F4/80 and CD11b double-positive cells.The morphologic changes during cell induction were observed under an inverted microscope,and the phagocytic ca-pacity and inflammatory response levels of BMDMs derived from C57BL/6N and C57BL/6J mice were evaluated using neu-tral red and ELISA methods.The cells were immediately cryopreserved after extraction,and then induced after recovery,or cryopreserved after successful induction and recovered.The cell morphology was observed under an inverted micro-scope,cell viability was assessed using the CCK-8 method,and phagocytic ability was measured using the neutral red method.RESULTS:The M-CSF concentration in the supernatant from L929 cells cultured at 33℃,10%fetal bovine se-rum(FBS)for 7 d was rich.Following 4 h of pre-culture,the proportion of F4/80 positive cells in adherent cells was sig-nificantly higher than that in suspended cells(P＜0.01).After 7 d of induction with L929 cell supernatant or recombinant M-CSF,the proportions of F4/80+CD11b+cells showed no significant difference(P＞0.05).Compared with the BMDMs derived from C57BL/6J mice,those from C57BL/6N mice exhibited stronger phagocytic capacity(P＜0.01),and released lower levels of TNF-α(P＜0.01)and IL-6(P＜0.05),and higher levels of IL-1β(P＜0.05).Compared with the BMDMs that were induced after recovery from initial cryopreservation,those cryopreserved immediately after extraction and in-duced upon recovery exhibited better macrophage morphology,higher cell viability(P＜0.01),and enhanced phagocytic ability(P＜0.01).CONCLUSION:The supernatant from L929 cells cultured at 33℃,10%FBS for 7 d is rich in M-CSF,successfully inducing bone marrow cells to differentiate into mouse BMDMs.The differential adherence method for pre-culturing can eliminate resident macrophages from the original bone marrow.The phagocytic capacity and inflammato-ry response levels differ between BMDMs derived from the C57BL/6N and C57BL/6J mouse subtypes.Cryopreserving bone marrow cells immediately after extraction and subsequently inducing them upon recovery is a preferable method for BMDM cryopreservation.

Objective To analyze the composition patterns and indications of formulas containing the herbal pair of Bupleuri Radix and Scutellariae Radix(abbreviated as herbal pair Chaihu-Huangqin).Methods With Zhong Yi Fang Ji Da Ci Dian(Encyclopedia of Chinese Medicinal Formulas)as the data source,formulas containing herbal pair Chaihu-Huangqin were screened.Excel 2019,SPSS Modeler,and Cytoscape were employed to investigate the composition patterns and indications of the formulas containing the herbal pair.Results A total of 928 formulas containing the herb pair were identified,involving 293 herbs.Beyond Bupleuri Radix and Scutellariae Radix,high-frequency herbs of Glycyrrhizae Radix et Rhizoma,Ginseng Radix et Rhizoma,Angelicae Sinensis Radix,Paeoniae Radix Alba,Pinelliae Rhizoma,Gardeniae Fructus,and Poria are the primary ingredients of formulas containing herbal pair Chaihu-Huangqin.The herbs as the ingredient combinations were predominantly cold in nature and were bitter,pungent,or sweet in flavors,primarily acting on the liver and lung meridians.Association rule analysis revealed that herbal pair Chaihu-Huangqin was frequently use together with herbal groups of"Pinelliae Rhizoma-Ginseng Radix et Rhizoma-Glycyrrhizae Radix et Rhizoma"and"Poria-Ginseng Radix et Rhizoma-Glycyrrhizae Radix et Rhizoma".Formulas containing herbal pair Chaihu-Huangqin were indicated for 184 kinds of diseases,in particular for exogenous febrile diseases,heat syndrome,and ocular disorders.Complex network analysis and dosage analysis indicated that common combined herbs of Pinelliae Rhizoma,Ginseng Radix et Rhizoma,Gardeniae Fructus,and Puerariae Lobatae Radix were indicated for exogenous febrile diseases;common combined herbs of Paeoniae Radix Rubra,Coptidis Rhizoma,and Gardeniae Fructus were indicated for heat syndrome;and common combined herbs of Plantaginis Semen,Cimicifugae Rhizoma,and Cassiae Semen were indicated for ocular disorders.The dosage ratio of Bupleuri Radix-Scutellariae Radix consistently maintained a 1∶1 ratio across all above indications.Conclusion The herbal pair Chaihu-Huangqin functions to harmonize shaoyang meridian and demonstrates broad clinical applicability.The data mining study has revealed its dominant indications and combinatorial patterns,which will provide evidence-based insights for modern clinical practice.

Uric acid is the end product of purine metabolism in the human body. In recent years, the role of uric acid in female fertility and assisted reproductive technology (ART) has gained increasing attention. Dysregulation of uric acid metabolism can lead to hyperuricemia (HUA). HUA is not only closely related to metabolic syndrome and cardiovascular diseases but may also adversely affect female fertility by influencing ovarian function and embryos development. In this review, we explored the role of uric acid in female fertility, including its association with female subfertility, infertility, adverse pregnancy outcomes and metabolic syndrome, as well as its potential impact on ART like in vitro fertilization-embryo transfer and intracytoplasmic sperm injection. Further studies are needed to clarify the threshold and clinical intervention value of uric acid levels in women of childbearing age, providing a basis for reproductive health counseling and personalized pregnancy assistance for HUA patients of childbearing age.