Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.

Driven by the growing practical need to accelerate drug development and the continuous innovation of trial design in recent years， the number of protocol amendments during clinical trials have gradually increased， and the changed contents have become more flexible and complex， which significantly heightens the difficulty of ethical review on amendments. Against this backdrop， it is of great importance to fully leverage the role and responsibilities of ethics committees， effectively control clinical trial risks， and ensure subject safety. This paper analyzed development trends of protocol amendments in recent years， sorted out requirements for protocol amendments in Chinese regulations and guiding principles， and examined difficulties of amendment ethical review in practical work. Based on these， targeted strategies and recommendations were proposed， namely， strengthening the integration with scientific review， enhancing the formal review， adjusting the scope of review according to approval notifications， and adopting appropriate review methods， with a view to providing insights and references for the management of the amendment ethical review in drug clinical trials.

Objective: To develop QingNangTCM, a specialized large language model (LLM) tailored for expert-level traditional Chinese medicine (TCM) question-answering and clinical reasoning, addressing the scarcity of domain-specific corpora and specialized alignment. Methods: We constructed QnTCM_Dataset, a corpus of 100 000 entries, by integrating data from ShenNong_TCM_Dataset and SymMap v2.0, and synthesizing additional samples via retrieval-augmented generation (RAG) and persona-driven generation. The dataset comprehensively covers diagnostic inquiries, prescriptions, and herbal knowledge. Utilizing P-Tuning v2, we fine-tuned the GLM-4-9B-Chat backbone to develop QingNangTCM. A multi-dimensional evaluation framework, assessing accuracy, coverage, consistency, safety, professionalism, and fluency, was established using metrics such as bilingual evaluation understudy (BLEU), recall-oriented understudy for gisting evaluation (ROUGE), metric for evaluation of translation with explicit ordering (METEOR), and LLM-as-a-Judge with expert review. Qualitative analysis was conducted across four simulated clinical scenarios: symptom analysis, disease treatment, herb inquiry, and failure cases. Baseline models included GLM-4-9B-Chat, DeepSeek-V2, HuatuoGPT-II (7B), and GLM-4-9B-Chat (freeze-tuning). Results: QingNangTCM achieved the highest scores in BLEU-1/2/3/4 (0.425/0.298/0.137/0.064), ROUGE-1/2 (0.368/0.157), and METEOR (0.218), demonstrating a balanced and superior normalized performance profile of 0.900 across the dimensions of accuracy, coverage, and consistency. Although its ROUGE-L score (0.299) was lower than that of HuatuoGPT-II (7B) (0.351), it significantly outperformed domain-specific models in expert-validated win rates for professionalism (86%) and safety (73%). Qualitative analysis confirmed that the model strictly adheres to the “symptom-syndrome-pathogenesis-treatment” reasoning chain, though occasional misclassifications and hallucinations persisted when dealing with rare medicinal materials and uncommon syndromes. Conclusion Combining domain-specific corpus construction with parameter-efficient prompt tuning enhances the reasoning behavior and domain adaptation of LLMs for TCM-related tasks. This work provides a technical framework for the digital organization and intelligent utilization of TCM knowledge, with potential value for supporting diagnostic reasoning and medical education.

Background Public places are important areas for daily human activities. Frequent contact with public items promotes their role as vehicles for microbial spread, creating a substantial risk for the transmission of pathogenic microorganisms. Objective To understand the hygiene status and influencing factors of public items in typical public places in Shanghai from 2010 to 2024, and to provide a scientific basis for optimizing the hygiene management of public items. Methods Based on the monitoring data of public items in public places in Shanghai from 2010 to 2024, the hygiene status was evaluated in three stages: 2010–2019, 2020–2022, and 2023–2024. Chi-square test and logistic regression were used to analyze the impact of factors such as monitoring stages, public place types, and public item categories on the hygiene status. Results The public items in 13807 public places were monitored. A total of 1 022 bed sheets and 9 271 towels were tested for pH value, with qualified rates of 77.66% and 87.81%, respectively. The OR (95%CI) for the pH compliance of towels relative to bed sheets was 1.77 (1.45, 2.15). Compared with bathing places, the ORs for pH compliance of towels in hair salons and beauty salons were 2.24 (1.75, 2.87) and 2.15 (1.57, 2.95), respectively. Additionally, a total of 221 650 samples from various public items were tested for microorganisms, yielding 215554 qualified samples, with an average qualified rate of 97.25%. The qualified rates for total bacterial count, total fungal count, coliforms, and Staphylococcus aureus were 92.66%, 94.63%, 98.85%, and 99.84%, respectively. The logistic regression analysis showed that, compared to the 2016–2019 baseline, no statistically significant differences were observed in the qualified rates of total fungal count across different stages; however, significantly higher qualified rates for total bacterial count, total fungal count, coliforms, and Staphylococcus aureus were recorded during 2020–2022, with ORs (95%CI) of 1.27 (1.16, 1.38), 23.20 (8.42, 63.94), and 12.08 (1.63, 89.92), respectively. Conclusion The pH compliance ranks among the top tier nationwide for cotton textile goods in Shanghai, suggesting minimal detergent retention. Furthermore, continuous improvement in cleaning and disinfection measurements has markedly enhanced the microbial hygiene of public items in public places.

ObjectiveGastric hemorrhage is one of the most common and life-threatening emergencies of the upper digestive tract. Early identification and continuous monitoring are essential for reducing rebleeding rates and mortality, particularly within the critical early hours after onset. Although endoscopy and radiological imaging can accurately localize bleeding sites, these approaches are invasive, resource-intensive, and unsuitable for continuous bedside monitoring. Electrical impedance tomography (EIT), as a noninvasive and radiation-free functional imaging technique, offers real-time visualization of conductivity distribution and has the potential for detecting intragastric bleeding based on the electrical contrast between blood and surrounding gastric tissues. In this study, a three-dimensional gastric EIT (3D-gEIT) framework is proposed to achieve noninvasive, real-time, and dynamic monitoring of gastric hemorrhage, with emphasis on spatial localization and quantitative volume assessment. MethodsA three-dimensional upper-abdominal simulation model incorporating the stomach, gastric wall, gastric contents, and surrounding tissues was established. Three electrode configurations, namely the dual layer ring, the four layer staggered ring, and the opposed dual plane array, were designed and systematically compared to evaluate their influence on depth sensitivity and spatial resolution. Based on the Tikhonov-Noser hybrid regularization scheme, a region-clustering constraint was introduced to develop the TK-Noser-RCC algorithm. This approach aggregates spatially adjacent elements with similar conductivity variations, thereby enhancing structural continuity and suppressing isolated noise artifacts. To validate the proposed framework, an upper-abdominal physical phantom was constructed using agar to simulate background tissue conductivity. Hemispherical high-conductivity inclusions with volumes ranging from 10 ml to 50 ml were attached to the inner gastric wall to mimic localized bleeding under different gastric filling states. Boundary voltages were acquired under a 120 kHz excitation current and reconstructed using the TK-Noser-RCC algorithm. Furthermore, an in vivo animal experiment was performed using a porcine model with adult-scale abdominal dimensions. A total of 100 ml of autologous blood was injected incrementally into the stomach to simulate progressive gastric hemorrhage, and time-difference EIT reconstruction was conducted at each injection stage to assess the dynamic system response under physiological conditions. ResultsSimulation results demonstrated that the opposed dual-plane electrode array achieved superior depth sensitivity distribution and spatial resolution. For a 40 ml hemorrhage model, the average ICC and SSIM improved by 55.9% and 38.8% compared with the dual-layer ring configuration, and by 64.0% and 39.5% compared with the four-layer staggered configuration. The proposed region-clustering constraint significantly enhanced reconstruction stability. Under added Gaussian noise of 40 dB and 30 dB, ICC values remained approximately 0.85, indicating effective artifact suppression and preservation of boundary integrity. In physical phantom experiments, reconstructed hemorrhage volumes increased approximately linearly with the preset hemispherical volumes, and the reconstructed high-conductivity regions closely matched the actual bleeding locations. Both empty-stomach and full-stomach conditions were evaluated, demonstrating that the opposed dual-plane configuration maintained stable imaging performance across varying gastric contents. In the animal experiment, reconstructed low-impedance regions expanded progressively with increasing injected blood volume. The spatial localization of the hemorrhage remained stable throughout the procedure, and no significant artifacts were observed. Quantitative analysis showed that reconstructed volume and average conductivity variation exhibited an approximately linear growth trend with injected blood volume, confirming the sensitivity of the system to dynamic intragastric conductivity changes. ConclusionThe proposed 3D-gEIT framework enables quantitative reconstruction of gastric hemorrhage volume and spatial distribution with improved depth sensitivity, structural continuity, and noise robustness compared with conventional EIT approaches. By integrating optimized electrode configuration and a region-clustering-constrained reconstruction algorithm, the system provides stable dynamic monitoring under both controlled phantom conditions and in vivo physiological environments. This method offers a noninvasive, real-time, and low-cost imaging strategy for early diagnosis, postoperative monitoring, and bedside surveillance of gastric bleeding.

Objective To explore the feasibility of magnetic compression technique (MCR) in the treatment of severe single mid-ureteral stricture in a rabbit model. Methods After 10 female New Zealand rabbits were selected, the distal end of the right ureter was ligated with silk thread. Two weeks after the operation, when the right ureter was dilated, the mid-ureter was ligated again with silk thread to create a severe single mid-ureteral stricture animal model. Longitudinal incisions were made at the upper and lower ends of the ligation site, and cylindrical NdFeB magnets with central holes (sub-magnets and main magnets) were placed to anastomose and recanalize the mid-ureteral stricture. The magnets were adjusted to the appropriate position to automatically align and attract each other. The longitudinal incision sites of the ureter were sutured with 6-0 Prolene thread, and the abdominal cavity was closed layer by layer. The operation time was recorded. X-ray films were taken every two days to confirm the position of the magnets and record the time of magnet detachment. Three weeks after the operation, the anastomotic specimens were obtained, and the formation of the anastomosis was evaluated with gross observation and histological staining. Results Two weeks after ligation, all experimental rabbits showed obvious dilation of the right ureter. The mid-ureteral ligation and placement of the male and female magnets were successfully completed in all 10 experimental rabbits, with an operation time of (24.00±5.15)minutes. The male and female magnets attracted each other well. X-ray examination showed that the magnets detached and entered the distal ureter (14.0±1.9) days after magnetic compression. The recanalization of the severe single mid-ureteral stricture was successfully achieved. The gross specimens and histological examination of the anastomosis showed that the anastomosis remained patent and the mucosal healing was good. All experimental rabbits survived well after the operation without serious complications. Conclusion MCT provides a new idea and novel method for the treatment of mid-ureteral stricture. This study confirmed the feasibility of this technique in treating severe single mid-ureteral stricture in a rabbit model. The operation is relatively simple and has potential for clinical application.

Objective: To explore the epidemiological characteristics and related factors of overweight and obesity among preschool children in Xuzhou City, so as to provide scientific basis for the formulation of corresponding prevention and control strategies. Methods: From October to November 2021, a random cluster sampling method was adopted to select 2 082 preschool children aged 3-7 years from 6 kindergartens in Xuzhou City and their parents for a questionnaire survey. Multivariate Logistic regression and decision tree model were used to analyze the related factors of overweight and obesity among preschool children. Results: The detection rates of overweight and obesity among preschool children were 19.8% and 12.4%, respectively. Multivariate Logistic regression analysis showed that preschool children with overweight fathers ( OR=1.40, 95%CI =1.01-1.96), obese fathers ( OR= 2.32 , 95%CI =1.56-3.45), mothers with insufficient gestational weight gain ( OR=2.11, 95%CI =1.24-3.59), cesarean section ( OR=1.42, 95%CI =1.06-1.92), artificial feeding within the first 6 months of life ( OR=2.33, 95%CI =1.35-4.04), and daily screen time ≥1 h ( OR=1.54, 95%CI =1.14-2.08) had higher risks of obesity; children born to pre pregnancy underweight mothers had a lower risk of obesity ( OR=0.23, 95%CI =0.12-0.44); preschool children with obese fathers ( OR=1.66, 95%CI = 1.19- 2.32) and macrosomic infants ( OR=1.82, 95%CI =1.32-2.51) had higher risks of overweight (all P <0.05). The decision tree model revealed that the factors associated with overweight and obesity among preschool children were ranked by importance from highest to lowest as follows: paternal body mass index, residential location, maternal pre pregnancy body mass index, gestational weight gain, birth weight, children s daily screen time, and feeding pattern with the first 6 months of life. Conclusions The problem of overweight and obesity among preschool children in Xuzhou City is prominent. In addition to considering prenatal factors, early life feeding practices, and behavioral factors, prevention and control strategies should also focus on paternal factors.

Chronic obstructive pulmonary disease （COPD） is a respiratory disease characterized by airflow limitation， and its high morbidity and disability rates pose a severe challenge to global public health. Traditional Chinese medicine （TCM） has demonstrated definite efficacy and distinctive characteristics in the treatment of COPD. Based on the understanding of ancient and modern physicians regarding the etiology， pathogenesis， and stage-based syndrome differentiation of COPD， this article systematically elaborates on the etiology， pathogenesis， and clinical principles of syndrome differentiation and treatment of COPD. COPD is characterized by deficiency at root and excess in manifestation， with the coexistence of deficiency and excess. Qi deficiency is the fundamental pathogenesis underlying the occurrence and development of COPD and runs throughout the entire disease course. The disease begins with deficiency of lung qi and gradually affects the spleen and kidney， leading to the internal generation of dampness， phlegm， and blood stasis. Phlegm and blood stasis are not only pathological products but also deep-rooted causes of recurrent disease. Together with qi deficiency， they are mutually causal and form a vicious cycle. During the acute exacerbation stage of COPD， phlegm and blood stasis constitute the predominant underlying pathology and are often induced by invasion of pathogenic factors due to deficiency of healthy Qi. In addition， innovative understandings of the etiology and pathogenesis of COPD have emerged from the perspectives of collateral disease， latent pathogens， smoke toxins， and dysfunction of the Shaoyang pivot. During the stable stage， deficiency of Qi in the lung， spleen， and kidney predominates and is often accompanied by phlegm and blood stasis. In the clinical differentiation and treatment of COPD， treatment should be based on different disease stages and syndrome characteristics. During the acute exacerbation stage， eliminating pathogenic factors is the primary principle， with treatment determined according to syndrome differentiation. For wind-cold attacking the lung， the treatment is to ventilate the lung， disperse cold， and relieve cough. For phlegm-dampness accumulating in the lung， the treatment is to dry dampness， resolve phlegm， and direct qi downward. For phlegm-heat obstructing the lung， the treatment is to clear the lung， resolve phlegm， and relieve asthma. For phlegm and blood stasis obstructing the lung， the treatment is to eliminate phlegm， remove blood stasis， and relieve asthma. During the stable stage， reinforcing healthy Qi is the key principle. For lung-spleen qi deficiency， the treatment is to tonify the lung and strengthen the spleen， resolve phlegm， and direct Qi downward to relieve asthma. For deficiency of both lung and kidney， the treatment is to tonify the lung and benefit the kidney， resolve phlegm， promote Qi reception， and relieve asthma. When accompanied by phlegm and blood stasis， the treatment should focus on tonifying deficiency， resolving phlegm， and removing blood stasis. This article aims to systematically summarize the TCM etiology， pathogenesis， syndrome differentiation and treatment principles of COPD， as well as the current shortcomings in related research， in order to provide a reference for the clinical treatment of COPD with TCM， give full play to the advantages of TCM in the prevention and treatment of COPD， and optimize the whole-course management of COPD.

Chronic obstructive pulmonary disease （COPD） is a respiratory disease characterized by airflow limitation， and its high morbidity and disability rates pose a severe challenge to global public health. Traditional Chinese medicine （TCM） has demonstrated definite efficacy and distinctive characteristics in the treatment of COPD. Based on the understanding of ancient and modern physicians regarding the etiology， pathogenesis， and stage-based syndrome differentiation of COPD， this article systematically elaborates on the etiology， pathogenesis， and clinical principles of syndrome differentiation and treatment of COPD. COPD is characterized by deficiency at root and excess in manifestation， with the coexistence of deficiency and excess. Qi deficiency is the fundamental pathogenesis underlying the occurrence and development of COPD and runs throughout the entire disease course. The disease begins with deficiency of lung qi and gradually affects the spleen and kidney， leading to the internal generation of dampness， phlegm， and blood stasis. Phlegm and blood stasis are not only pathological products but also deep-rooted causes of recurrent disease. Together with qi deficiency， they are mutually causal and form a vicious cycle. During the acute exacerbation stage of COPD， phlegm and blood stasis constitute the predominant underlying pathology and are often induced by invasion of pathogenic factors due to deficiency of healthy Qi. In addition， innovative understandings of the etiology and pathogenesis of COPD have emerged from the perspectives of collateral disease， latent pathogens， smoke toxins， and dysfunction of the Shaoyang pivot. During the stable stage， deficiency of Qi in the lung， spleen， and kidney predominates and is often accompanied by phlegm and blood stasis. In the clinical differentiation and treatment of COPD， treatment should be based on different disease stages and syndrome characteristics. During the acute exacerbation stage， eliminating pathogenic factors is the primary principle， with treatment determined according to syndrome differentiation. For wind-cold attacking the lung， the treatment is to ventilate the lung， disperse cold， and relieve cough. For phlegm-dampness accumulating in the lung， the treatment is to dry dampness， resolve phlegm， and direct qi downward. For phlegm-heat obstructing the lung， the treatment is to clear the lung， resolve phlegm， and relieve asthma. For phlegm and blood stasis obstructing the lung， the treatment is to eliminate phlegm， remove blood stasis， and relieve asthma. During the stable stage， reinforcing healthy Qi is the key principle. For lung-spleen qi deficiency， the treatment is to tonify the lung and strengthen the spleen， resolve phlegm， and direct Qi downward to relieve asthma. For deficiency of both lung and kidney， the treatment is to tonify the lung and benefit the kidney， resolve phlegm， promote Qi reception， and relieve asthma. When accompanied by phlegm and blood stasis， the treatment should focus on tonifying deficiency， resolving phlegm， and removing blood stasis. This article aims to systematically summarize the TCM etiology， pathogenesis， syndrome differentiation and treatment principles of COPD， as well as the current shortcomings in related research， in order to provide a reference for the clinical treatment of COPD with TCM， give full play to the advantages of TCM in the prevention and treatment of COPD， and optimize the whole-course management of COPD.

Five saponins were isolated from the kernels of Momordica cochinchinensis, by macroporous resin, silica gel, ODS column chromatography, and semi preparative HPLC. Based on MS and NMR analysis, combining with alkaline hydrolysis and acid hydrolysis, their structures were identified as: gypsogenin-3-O-{β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonosyl}-28-O-β-D-xylopyranosyl (1→3)-[β-D-xylopyranosyl (1→4)]-α-L-rhamnopyranosyl (1→2)-β-D-fucopyranoside (1), quillaic acid-3-O-{β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonosyl}-28-O-β-D-xylopyranosyl (1→3)-[β-D-xylopyranosyl (1→4)]-α-L-rhamnopyranosyl (1→2)-β-D-fucopyranoside (2), gypsogenin-3-O-β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonoside sodium (3), quillaic acid-3-O-β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonoside sodium (4), 18α-quillaic acid-3-O-β-D-galactopyranosyl (1→2)-[α-L-rhamnopyranosyl (1→3)]-β-D-glucuropyranonoside (5). Compounds 1-5 were new compounds, and named as mubezhisides A, B, C, D, E, respectively. They all could obviously inhibited the growth of Candida albicans, C. parapsilosis, and C. tropicalis.