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.

Objective To analyze the global pattern, long-term trends, and regional and population heterogeneity in the burden of 375 diseases and injuries and 88 risk factors from 1990 to 2023 using data from the Global Burden of Disease Study 2023 (GBD 2023). Methods Publicly available GBD 2023 estimates were extracted for incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and age-standardized rates at the global level and by socio-demographic index (SDI), GBD region, age group, and sex. Descriptive analysis, ranking comparison, stratified analysis, and trend analysis were performed, and 95% uncertainty interval was used to assess the stability of estimates. Results In 2023, non-communicable diseases were the leading contributor to global DALYs, accounting for 64.39% of DALYs across the three major disease and injury groups (communicable, maternal, neonatal, and nutritional diseases, non-communicable diseases, and injuries), and also had the highest age-standardized DALYs rate. From 1990 to 2023, age-standardized DALYs rates declined for three major disease and injury groups, with estimated annual percentage changes of −2.69%, −0.78%, and −1.47%, respectively. Cardiovascular diseases ranked first by both DALYs and deaths in 2023, whereas respiratory infections and tuberculosis ranked first by incidence. Non-communicable diseases were the leading cause of disease burden across all SDI strata. As the SDI level declined, the burden of communicable, maternal, neonatal, and nutritional diseases, as well as injuries, increased markedly. Behavioral and metabolic risks remained the main contributors to attributable deaths and DALYs. Conclusion From 1990 to 2023, the global burden of disease continues to shift toward non-communicable diseases; however, some regions still face a double burden of infectious, maternal and child, injury-related, and chronic diseases. Integrating deaths, DALYs, YLLs, YLDs, and risk-attributable burden helps identify priority areas for prevention and resource allocation across regions and populations.

OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

OBJECTIVE: To determine the impact of the lower limb weight bearing line ratio (WBLR) on motor function recovery after high tibial osteotomy (HTO). METHODS: A retrospective analysis was conducted on 55 patients with unilateral compartment knee osteoarthritis who underwent open-wedge HTO between August 2020 and October 2023 and met the selection criteria. Based on the postoperative Lysholm score, patients were divided into two groups: the good knee function group (Lysholm score≥90, group A) and the poor knee function group (Lysholm score<90, group B). Lysholm score, American Knee Society (AKS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and visual analogue scale (VAS) score for pain were compared between the two groups. Univariate analysis was performed on baseline data including gender, age, body mass index (BMI), affected side, disease duration, Kellgren-Lawrence grade, and radiographic parameters [preoperative and postoperative medial proximal tibial angle, lateral distal femoral angle, femoral-tibial angle, hip-knee-ankle angle (HKA), WBLR, posterior tibial slope angle, and joint line convergence angle] to identify factors influencing functional recovery. Multivariate logistic regression analysis was further used to identify independent factors. Additionally, receiver operating characteristic (ROC) curve analysis was employed to determine the optimal cut-off value of postoperative WBLR for predicting motor function recovery, and the area under curve (AUC) was calculated to assess diagnostic performance. RESULTS: All 55 patients were followed up 10-14 months (mean, 11.8 months). According to the postoperative Lysholm score, there were 30 patients in group A and 25 in group B. All postoperative clinical scores in group A were significantly better than those in group B ( P<0.05). Univariate analysis indicated that age, BMI, postoperative HKA, and postoperative WBLR were influencing factors for motor function recovery ( P<0.1). Further multivariate logistic regression analysis identified a postoperative WBLR≤55.5% as an independent factor influencing motor function recovery ( P<0.05). ROC curve analysis yielded an AUC of 0.788 and determined the optimal postoperative WBLR cut-off value for predicting motor function recovery to be 55.5% ( P<0.001). CONCLUSION A postoperative WBLR of 55.5% is associated with optimal motor function recovery after HTO.
Humans ; Male ; Female ; Osteotomy/methods* ; Retrospective Studies ; Tibia/surgery* ; Recovery of Function ; Middle Aged ; Osteoarthritis, Knee/physiopathology* ; Weight-Bearing ; Knee Joint/surgery* ; Lower Extremity ; Aged ; Adult ; Treatment Outcome

OBJECTIVE To observe and compare the synergistic rates of combined use of polymyxin B with 12 types of traditional antibiotics against carbapenem-resistant Klebsiella pneumoniae(CRKP)in vitro antimicrobial ac-tion.METHODS Totally 30 strains of CRKP were randomly drawn from 312 strains of CRKP that were isolated from the clinical departments of Shiyan People's Hospital between 2020 to 2023.The carbapenemases were detec-ted by Carba NP test.The six genotypes KPC,OXA-48,OXA-23,NDM,VIM and IMP were detected by means of fluorescent quantitative polymerase chain reaction(PCR),the drug resistance of the strains was detected by mi-cro broth dilution method,and the synergistic effect of polymyxin B combined with 12 types of traditional antibi-otics on in vitro antimicrobial action was detected by using micro chessboard dilution method.RESULTS All of the isolated CRKP strains produced carbapenemases,with the KPC genotype dominant.The drug resistance rates to cephalosporins,carbapenems and quinolones reached up to 100.00％,and no polymyxin B-resistant strains were detected.The synergistic rates of minocycline and rifampicin combined with polymyxin B to the in vitro antimicro-bial action were the highest,which were 73.33％and 50.00％,respectively;the synergistic rates of levofloxacin and ciprofloxacin combined with polymyxin B were the lowest,and both were 0.The synergistic rates of meropen-em and imipenem combined with polymyxin B to the in in vitro antimicrobial action were 36.67％and 30.00％,re-spectively.The synergistic rates of ceftazidime,cefepime,piperacillin-tazobactam and cefoperazone-sulbactam combined with polymyxin B to the in vitro antimicrobial action were less than 30.00％.CONCLUSIONS Polymyxin B combined with minocycline and rifampicin should be taken as the first choice for treatment of the CRKP-induced infection.The synergistic rate of the carbapenems combined with polymyxin B is higher than that of the cephalo-sporins combined with polymyxin B to the antimicrobial action.Levofloxacin and ciprofloxacin combined with pol-ymyxin B do not have synergistic effect on the in vitro antimicrobial action.

Objective To evaluate the relationship between nutritional parameters and the risk of venous thromboembolicism(VTE)in patients with tuberculosis so as to identify the risk factors and predictors of thrombosis and assist in the early identification of high-risk factors for VTE in patients with the pulmonary tuberculosis.Methods A total of 323 patients diagnosed with the pulmonary tuberculosis and hospitalized in Kunming Third People's Hospital from August 2021 to August 2023 were collected.According to the VTE risk assessment of non-operative patients,they were divided into the high-risk group and the low-risk group respectively with 116 and 207 in each group.The nutritional indicators with statistically significant differences between the two groups were screened by Lasso regression.Multivariate Logistic regression was used to screen the independent risk factors for high VTE risk in pulmonary tuberculosis patients,and a nomogram prediction model was constructed.The prediction model was evaluated by receiver operating characteristic curve(ROC),calibration curve,decision curve,and influence curve.Results Patients in the high-risk group were significantly older than those in the low-risk group(59 vs.41,P<0.001),hypertension,gender,and Type 2 diabetes did not differ significantly(P values were 0.084,0.724 and 0.488,respectively).9 variables were selected from the inter-group comparison and Lasso regression,including ALB,HCT,NRS2002 scores,HBDH,RDW-SD,RDW-CV,TG,CONUT scores,and NEFA.Multivariate Logistic regression analysis showed that ALB,NRS2002 scores,RDW-SD,and CONUT scores were independent influencing factors for the high risk of VTE scores in patients with tuberculosis(P<0.005).Area under the ROC curve showed that the AUC(0.892)for high-risk VTE scores in patients with the pulmonary tuberculosis was greater than that of ALB(0.803),NRS2002 score(0.735),RDW-SD(0.685),and CONUT score(0.774).Fitting prediction model:Logit(P):Y=0.433×NRS-0.136×ALB+0.411×CONUT score+0.072×RDW-SD-1.770,P=1/(1+e-Y)(Y:prediction index,P:prediction probability).Calibration curve showed that the model prediction tended to be consistent with the actual results(U:>0.05),and the decision curve and influence curve showed that the model can bring clinical benefits.Conclusion ALB,NRS2002 scores,RDW-SD,and CONUT scores are independent influencing factors for the high risk of VTE scores in patients with tuberculosis.They can guide the clinical practice,improve these indicators as soon as possible,reduce VTE scores,and reduce the thrombosis risk.At the same time,the prediction model performs well in the verification cohort,with its discrimination ability,calibration accuracy and clinical utility(decision curve analysis)all reaching a satisfactory level.

Objective:To analyze the incidence of surgical site infection (SSI) in patients undergoing colorectal cancer (CRC) surgery and to identify risk factors associated with SSI in an attempt to provide a reference for clinical prevention strategies.Methods:A retrospective cohort study was conducted. Clinical data were retrospectively collected from a total of 2,248 patients who underwent surgery for pathologically confirmed CRC between 2017 and 2022 at two centers: Huangshan Shoukang Hospital ( n=649) and Northern Jiangsu People's Hospital ( n=1 599). Inclusion criteria consisted of the following: (1) age >18 years; (2) pathologically confirmed CRC treated with curative resection, including extended resections (e.g. pelvic exenteration); (3) no surgical incisions other than abdominal or perineal; and (4) no use of prosthetic implants. The incidence of SSI was analyzed, and multivariate logistic regression was used to identify independent its risk factors. Results:A total of 121 patients (5.4%) developed SSI. Among them, 68 cases (56.2%) were organ/space infections, 35 cases (28.9%) were deep incisional infections, and 18 cases (14.9%) were superficial incisional infections. The median postoperative hospital stay was significantly longer in patients with SSI compared to those without (21.0 days vs. 13.0 days, U=65,754, P<0.001). The median hospitalization cost was also significantly higher in the SSI group (56,550 yuan vs. 43,645 yuan, U=72,008, P<0.001). Multivariate logistic regression analysis identified body mass index (BMI) ≤ 20 kg/m 2 (OR=4.25, 95%CI: 3.38-5.34, P<0.001), diabetes mellitus (OR=3.44, 95%CI: 1.89-6.24, P<0.001), open surgery (OR=4.23, 95%CI: 2.37-7.56, P<0.001), and colostomy or ileostomy (OR=1.67, 95% CI: 1.04-2.69, P=0.034) as independent risk factors for SSI. Conclusion:To prevent SSI following CRC surgery, attention should be given to optimizing body weight and glycemic control, promoting minimally invasive surgical approaches when feasible, and cautiously considering the necessity of colostomy or ileostomy.

Objective To develop a Knowledge-Attitude-Practice Questionnaire for Nursing Assistants on Humanistic Care and test its reliability and validity,in order to provide a valid tool for evaluating their humanistic care competence.Methods Based on the theory of knowledge,attitude and practice,the first draft of the questionnaire was developed through literature review,semi-structured interviews,2 rounds of Delphi expert consultation,and pre-surveys.All nursing assistants from 4 tertiary hospitals in Hubei Province were investigated by convenient sample,and the reliability and validity were tested from May to July,2024.Results 412 questionnaires were distributed and 399 valid questionnaires were recovered,with a valid questionnaire recovery rate of 96.84％.The final knowledge-attitude-practice questionnaire include 3 dimensions of knowledge,attitude and practice,with a total of 24 items and cumulative contribution rate was 65.338％.The CVI of each item in the questionnaire ranged from 0.800 to 1.000,with an average of 0.981.The confirmatory factor analysis showed that the scale model had a good fit.The total Cronbach's α coefficient of the questionnaire was 0.941,and the test-retest reliability coefficient of the questionnaire after 2 weeks was 0.923.Conclusion The knowledge-attitude-practice questionnaire has good reliability and validity,and it can be used as a valid tool for evaluating the competence of humanistic care of nursing assistants.

Objective To observe the characteristics of affected shoulder joint range of motion in patients with breast cancer after ax-illary lymph node dissection before radiotherapy.Methods From January,2022 to December,2023,185 female patients from the Fourth Hospital of Hebei Medical Uni-versity after unilateral breast cancer who underwent axillary lymph node dissection were reviewed.Their general data were collected;affected shoulder joint range of motion was evaluated by progoniometer;lymphedema of af-fected upper extremities was evaluated by water volume replacement;Verbal Rating Scale(VRS)was used to evaluate the pain in the upper extremity of the operative side.Results The angles of anterior flexion and abduction of the affected shoulder joint were(158.90±17.17)° and(147.70±24.59)°.There were significant differences in the angles of affected shoulder anterior flexion and abduction among patients at different ages(more than 55 years and less than 55 years)and those with or without lymphede-ma.Multiple linear regression showed that the angle of affected shoulder flexion was smaller in patients aged more than 55 years(β=-7.766,95%CI-13.161 to-2.360,P=0.005),and with lymphedema(β=-10.991,95%CI-19.063 to-2.925,P=0.008);was larger in patients with longer duration after operation(β=0.463,95%CI 0.012 to 0.924,P=0.049),and BMI 24 to 27.9 kg/m2(β=6.211,95%CI 0.660 to 11.761,P=0.030)(compared with BMI<24 kg/m2).The angle of affected shoulder abduction was smaller in patients aged more than 55 years(β=-10.047,95%CI-17.358 to-2.747,P=0.008),and with lymphedema(β=-14.171,95%CI-25.191 to-3.150,P=0.013).Conclusion Shoulder joint range of motion has reduced in flexion and abduction in patients at early stage after axillary lymph node dissection for breast cancer,which is related to age and lymphedema.

Objective:To explore the relationship between general demographic characteristics,inflammatory indicators,nutritional indicators,pathological data and lymph node metastasis in endometrial cancer(EC)pa-tients,and to construct and validate a model for preoperative prediction of lymph node status in endometrial canc-er patients.Methods:The preoperative clinical data of 473 patients with EC who underwent surgical treatment in the Zhu Jiang Hospital of Southern Medical University from January 2010 to April 2024 were retrospectively ana-lyzed.The independent risk factors of lymph node metastasis of endometrial cancer were screened by univariate and multivariate Logistic regression analyses,and the nomogram prediction model was constructed by R soft-ware.The performance of the model was evaluated by the receiver operating characteristic(ROC)curve,calibra-tion curve and clinical decision curve.Results:Menopausal status,high grade biopsy pathology,CA125 ≥24.47U/ml,systemic immune inflammatory index(SII)≥710.91,and prognostic nutritional index(PNI)＜52.90 were in-dependent risk factors for lymph node metastasis in endometrial cancer(OR＞1,P＜0.05).The nomogram model constructed based on these five factors had an AUC of 0.853 in the training set and 0.871 in the test set.The cali-bration curve fitted well,and the clinical decision curve shows a positive benefit.Conclusions:The endometrial cancer lymph node metastasis prediction model constructed based on menopausal status,biopsy pathology,CA125,SII,and PNI has good accuracy and fit,with certain clinical application value.