Intrahepatic cholangiocarcinoma (ICC) is a highly malignant primary tumor originating from the intrahepatic bile duct epithelium. Current clinical consensus emphasizes that early detection,timely diagnosis,and R0 resection (when feasible) are critical strategies for improving outcomes. Advances in surgical techniques and multidisciplinary approaches have facilitated precision medicine-guided systemic therapies,including adjuvant and neoadjuvant regimens. These interventions significantly delay postoperative recurrence and improve 5-year survival rates. Systemic treatments have also modestly enhanced prognoses for advanced ICC patients. Artificial intelligence-driven radiomics and deep learning technologies show substantial efficacy in ICC diagnosis,prognostic assessment,and lymph node metastasis prediction,advancing precision medicine applications. Despite these therapeutic advances,survival outcomes-particularly for advanced-stage ICC-remain suboptimal. Future efforts should prioritize molecular signature-guided therapies,novel combination regimens,and artificial intelligence-assisted comprehensive management to establish a molecularly driven precision treatment framework.

Intrahepatic cholangiocarcinoma (ICC) is a highly malignant primary tumor originating from the intrahepatic bile duct epithelium. Current clinical consensus emphasizes that early detection,timely diagnosis,and R0 resection (when feasible) are critical strategies for improving outcomes. Advances in surgical techniques and multidisciplinary approaches have facilitated precision medicine-guided systemic therapies,including adjuvant and neoadjuvant regimens. These interventions significantly delay postoperative recurrence and improve 5-year survival rates. Systemic treatments have also modestly enhanced prognoses for advanced ICC patients. Artificial intelligence-driven radiomics and deep learning technologies show substantial efficacy in ICC diagnosis,prognostic assessment,and lymph node metastasis prediction,advancing precision medicine applications. Despite these therapeutic advances,survival outcomes-particularly for advanced-stage ICC-remain suboptimal. Future efforts should prioritize molecular signature-guided therapies,novel combination regimens,and artificial intelligence-assisted comprehensive management to establish a molecularly driven precision treatment framework.

Atherosclerosis(AS)is a chronic inflammatory disease involving disorders of lipid and iron metabolism.The establishment of suitable animal models is required to further the study of the etiology,pathogenesis,prevention,and therapeutic measures of AS.The main animal models of AS related to iron and lipid metabolism are mice and miniature piglets,especially male ApoE-/-mice.Single-factor high-fat diet-induced iron and lipid metabolism disorders are a common type of AS model,manifesting as elevated blood lipid levels,large plaques and iron deposition in the aorta,and significant increases in serum and liver iron levels.This review compares the effects of different intervention factors on iron and lipid metabolism in AS animal models,and summarizes the method of establishing AS animal models using dietary induction,chemical intervention,and gene modification,to provide references and inspiration for future research into AS and metabolic diseases and the development of new drugs.

Objective To address the challenges of constructing large language models for traditional Chinese medicine(TCM)classics,which are complex and expensive to fine-tune,this study explores a lightweight fine-tuning method for such models,aiming to develop a question-answering model centered on TCM classics,particularly various editions of Shang Han Lun through the ages.Methods Dataset construction involved designing prompts to guide GPT-4 in generating Q&A pairs based on Shang Han Lun and integrating them with the ShenNong_TCM_Dataset and cMedQA2 datasets.Five general-purpose large models were selected for Lora fine-tuning.The best model was chosen through evaluation,and the performance of multiple quantized versions was validated.Results After fine-tuning,the BLEU,ROUGE-1,ROUGE-2,and ROUGE-L metrics for the Qwen-7B-Chat model improved by 17.61,19.63,14.3,and 21.4,respectively,compared to the base model.Conclusion The selected model in this study is capable of effectively understanding and utilizing professional terms and concepts from TCM classics,such as Shang Han Lun,to provide accurate answers to user queries.Compared to similar models,it requires lower fine-tuning costs and computational power,contributing to the dissemination of TCM knowledge and the development of intelligent systems.

As China has become the second largest market for medical devices in the world,the domestic medical device industry has been growing.As an important part of preclinical evaluation of medical devices,large animal research directly affects the research and application of medical devices.Large animals are widely used in the evaluation of safety and feasibility of medical devices because they are closer to humans in terms of body size,anatomical structure and physiological functions.In large animal experimental research,the selection of suitable experimental animals and the establishment of suitable animal disease models are the basis for ensuring the smooth progress of experiments.In this paper,the selection of experimental animals and the establishment of disease models in medical device large animal experimental research are systematically sorted out,and the existing problems and deficiencies are pointed out.

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in acute myocardial infarction (AMI) with in-hospital cardiac arrest (IHCA).Methods:The data of 70 patients with AMI-IHCA-ECPR in extracorporeal life support center of the first affiliated hospital of Nanjing medical university from January 2017 to December 2024 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, with/without combined intra-aortic balloon pump (IABP). Age, sex, Charlson comorbidity index, initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO treatment time, 90-day survival rate were analyzed.Results:Among the 70 patients with AMI-IHCA-ECPR, 22 (31.4%) patients survived at 90 days, of whom 19 (86.4%) patients had good neurological outcomes. About 50% of AMI-IHCA-ECPR patients had severe multi-vessel coronary artery lesions, and there was no significant difference in survival outcomes among different vascular lesions. In the IABP group, the success rate of ECMO withdrawal was low, the duration of ECMO treatment was long, and the combination of IABP did not reduce the mortality. Compared with the death group, the 90-day survival group had a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value.Conclusions:AMI-IHCA-ECPR combined with IABP did not show significant survival benefits, and about 50% of patients had severe lesions of multiple coronary arteries. It is difficult to evaluate the prognosis based on a single offender vessel. It is recommended to evaluate the outcome of patients by quantification of the severity of coronary artery lesions by Gensini score.

Objective To address the challenges of constructing large language models for traditional Chinese medicine(TCM)classics,which are complex and expensive to fine-tune,this study explores a lightweight fine-tuning method for such models,aiming to develop a question-answering model centered on TCM classics,particularly various editions of Shang Han Lun through the ages.Methods Dataset construction involved designing prompts to guide GPT-4 in generating Q&A pairs based on Shang Han Lun and integrating them with the ShenNong_TCM_Dataset and cMedQA2 datasets.Five general-purpose large models were selected for Lora fine-tuning.The best model was chosen through evaluation,and the performance of multiple quantized versions was validated.Results After fine-tuning,the BLEU,ROUGE-1,ROUGE-2,and ROUGE-L metrics for the Qwen-7B-Chat model improved by 17.61,19.63,14.3,and 21.4,respectively,compared to the base model.Conclusion The selected model in this study is capable of effectively understanding and utilizing professional terms and concepts from TCM classics,such as Shang Han Lun,to provide accurate answers to user queries.Compared to similar models,it requires lower fine-tuning costs and computational power,contributing to the dissemination of TCM knowledge and the development of intelligent systems.

As China has become the second largest market for medical devices in the world,the domestic medical device industry has been growing.As an important part of preclinical evaluation of medical devices,large animal research directly affects the research and application of medical devices.Large animals are widely used in the evaluation of safety and feasibility of medical devices because they are closer to humans in terms of body size,anatomical structure and physiological functions.In large animal experimental research,the selection of suitable experimental animals and the establishment of suitable animal disease models are the basis for ensuring the smooth progress of experiments.In this paper,the selection of experimental animals and the establishment of disease models in medical device large animal experimental research are systematically sorted out,and the existing problems and deficiencies are pointed out.

Atherosclerosis(AS)is a chronic inflammatory disease involving disorders of lipid and iron metabolism.The establishment of suitable animal models is required to further the study of the etiology,pathogenesis,prevention,and therapeutic measures of AS.The main animal models of AS related to iron and lipid metabolism are mice and miniature piglets,especially male ApoE-/-mice.Single-factor high-fat diet-induced iron and lipid metabolism disorders are a common type of AS model,manifesting as elevated blood lipid levels,large plaques and iron deposition in the aorta,and significant increases in serum and liver iron levels.This review compares the effects of different intervention factors on iron and lipid metabolism in AS animal models,and summarizes the method of establishing AS animal models using dietary induction,chemical intervention,and gene modification,to provide references and inspiration for future research into AS and metabolic diseases and the development of new drugs.

Objective To analyze the expression of microRNA(miR)-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis(TBM)and their predictive value for disease severity and prognosis.Methods A total of 187 patients with tuberculous meningitis who visited Qingdao Chest Hospital from January 2018 to December 2022 were regarded and separated into stage Ⅰ(n=62),stage Ⅱ(n=76)and stage Ⅲ(n=49)according to the severity of the condition.There were 131 cases in the good prognosis group and 56 cases in the poor prognosis group according to the prognosis.The qRT-PCR method was applied to detect the expression levels of miR-200a and miR-4652-3p in cerebrospinal fluid.Spearman method was used to analyze correlation among miR-200a,miR-4652-3p and clinical data.ROC curve was applied to analyze the predictive value of cerebrospinal fluid miR-200a and miR-4652-3p levels in evaluating the severity and prognosis of tuberculosis meningitis patients.Multivariate logistic regression was applied to analyze the influencing factors of poor prognosis in patients.Results The expression levels of miR-200a(1.05±0.14,0.91±0.14,0.76±0.13)and miR-4652-3p(0.92±0.11,0.78±0.11,0.65±0.10)in the cerebrospinal fluid of patients with stage Ⅰ,Ⅱ,and Ⅲ tuberculous meningitis were decreased sequentially,and the differences were significant(F=61.079,87.203,all P＜0.05).The expression levels of miR-200a(0.95±0.14)and miR-4652-3p(0.82±0.11)in cerebrospinal fluid of patients with good prognosis tuberculous meningitis were higher than those of patients with poor rognosis(0.84±0.13,0.73±0.10),and the differences were statistically significant(t=5.025,5.262,all P＜0.05),while the levels of cerebrospinal fluid adenosine deaminase,TNF-α,IL-23,LTB4,CRP and mRS scores in patients with good prognosis were lower than those in patients with poor prognosis(t=5.649,7.721,11.150,9.455,11.314,14.407,all P＜0.05).There was a positive correlation between the levels of miR-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis(r=0.405,P＜0.001).The levels of miR-200a and miR-4652-3p in cerebrospinal fluid were negatively correlated with LTB4,TNF-ot,CRP,mRS scores,IL-23 and adenosine deaminase(r=-0.472,-0.466,-0.461,-0.435,-0.422,-0.419;-0.459,-0.531,-0.471,-0.417,-0.513,-0.408,all P＜0.05).The AUC(95％CI)of miR-200a and miR-4652-3p to assess disease severity were 0.881(0.825～0.923)and 0.878(0.822～0.921),respectively.The AUC(95％CI)of both combination in assessing the severity of patients was 0.945(0.902～0.973),which was higher than the single detection,and the differences were significant(Z=3.008,2.960,all P=0.003).The AUC(95％CI)of poor prognosis patients evaluated by cerebrospinal fluid miR-200a and miR-4652-3p levels were 0.749(0.681～0.809)and 0.756(0.688～0.816),and the AUC of poor prognosis patients evaluated by both combination was 0.839(0.778～0.889),which was higher than that measured separately,and the differences were significant(Z=2.994,2.697,P=0.003,0.007).Adenosine deaminase[OR(95％CI):1.106(1.033～1.185)],miR-200a[OR(95％CI):0.529(0.369～0.744)],miR-4652-3p[OR(95％CI):0.471(0.310～0.715)],C-reactive protein[OR(95％CI):4.423(1.459～13.412)],TNF-α[OR(95％CI):1.196(1.061～1.348)],IL-23[OR(95％CI):4.809(1.086～3.013)],and LTB4[OR(95％CI):1.327(1.064～1.655)]were influencing factors for poor prognosis in patients with tuberculous meningitis(all P＜0.05).Conclusion The expressions of miR-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis were down-regulated,and they were closely related to the severity and prognosis of the disease.The combination of the miR-200a and miR-4652-3p could better predict the severity and prognosis of tuberculous meningitis,which may have a certain clinical value.