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.

ObjectiveThis study systematically analyzed the arginine metabolic dysregulation in the rat model of heart failure （HF）， providing a modern scientific basis for elucidating the pathogenesis of HF and offering new insights for the prevention and treatment of HF with traditional Chinese medicine （TCM）. MethodsA thoracotomy was performed to ligate the left anterior descending coronary artery of rats， which induced acute myocardial ischemia and thus led to the development of post-myocardial infarction heart failure. The rats were divided into a sham surgery group and a model group， with eight rats in each group. Serum targeted metabolomics analysis was performed using ultra-performance liquid chromatography-triple quadrupole mass spectrometry （UPLC-TQ-S）， and the spatial distribution of metabolites in cardiac tissue was observed using airflow-assisted desorption electrospray ionizationmass spectrometry imaging （AFADESI-MSI）. Targets associated with HF and arginine metabolism were screened from databases including GeneCards and the Gene Expression Omnibus （GEO）， a protein-protein interaction （PPI） network was constructed， and enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway and Gene Ontology （GO） was performed. Finally， molecular docking was conducted to verify the binding between core metabolic components and key targets， and potential TCMs were predicted based on the core pathways and targets. ResultsCompared with the sham surgery group， the levels of arginine and citrulline in the serum of model rats were significantly decreased （P<0.01）， while those of proline， ornithine， creatine， creatinine and glutamate were significantly increased （P<0.05， P<0.01）. Cardiac mass spectrometry imaging showed a decreased abundance of arginine in the local myocardial tissue. Bioinformatics analysis identified 24 core functional targets， such as the angiotensin-converting enzyme （ACE）， neuronal nitric oxide synthase （NOS1）， 5-hydroxytryptamine receptor 2A （HTR2A）， and epidermal growth factor receptor （EGFR）， and enrichment analysis indicated that these targets were significantly involved in the calcium signaling pathway， neuroactive ligand-receptor interactions， and phosphatidylinositol signaling pathway. Molecular docking confirmed strong binding activities between arginine， citrulline and HTR2A， as well as between creatine， creatinine and EGFR. Based on pathway-target prediction， potential TCM interventions， such as ginseng and magnolia， were identified. ConclusionThis study revealed characteristic arginine metabolic disorder in HF， and the core targets of HF were closely associated with the phosphatidylinositol signaling pathway. It provides a modern biological interpretation of the pathogenesis of HF in TCM from the perspectives of metabolites and signaling pathways， and offers valuable insights for targeted therapy of HF and the development of TCM.

ObjectiveThis study systematically analyzed the arginine metabolic dysregulation in the rat model of heart failure （HF）， providing a modern scientific basis for elucidating the pathogenesis of HF and offering new insights for the prevention and treatment of HF with traditional Chinese medicine （TCM）. MethodsA thoracotomy was performed to ligate the left anterior descending coronary artery of rats， which induced acute myocardial ischemia and thus led to the development of post-myocardial infarction heart failure. The rats were divided into a sham surgery group and a model group， with eight rats in each group. Serum targeted metabolomics analysis was performed using ultra-performance liquid chromatography-triple quadrupole mass spectrometry （UPLC-TQ-S）， and the spatial distribution of metabolites in cardiac tissue was observed using airflow-assisted desorption electrospray ionizationmass spectrometry imaging （AFADESI-MSI）. Targets associated with HF and arginine metabolism were screened from databases including GeneCards and the Gene Expression Omnibus （GEO）， a protein-protein interaction （PPI） network was constructed， and enrichment analysis of the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway and Gene Ontology （GO） was performed. Finally， molecular docking was conducted to verify the binding between core metabolic components and key targets， and potential TCMs were predicted based on the core pathways and targets. ResultsCompared with the sham surgery group， the levels of arginine and citrulline in the serum of model rats were significantly decreased （P<0.01）， while those of proline， ornithine， creatine， creatinine and glutamate were significantly increased （P<0.05， P<0.01）. Cardiac mass spectrometry imaging showed a decreased abundance of arginine in the local myocardial tissue. Bioinformatics analysis identified 24 core functional targets， such as the angiotensin-converting enzyme （ACE）， neuronal nitric oxide synthase （NOS1）， 5-hydroxytryptamine receptor 2A （HTR2A）， and epidermal growth factor receptor （EGFR）， and enrichment analysis indicated that these targets were significantly involved in the calcium signaling pathway， neuroactive ligand-receptor interactions， and phosphatidylinositol signaling pathway. Molecular docking confirmed strong binding activities between arginine， citrulline and HTR2A， as well as between creatine， creatinine and EGFR. Based on pathway-target prediction， potential TCM interventions， such as ginseng and magnolia， were identified. ConclusionThis study revealed characteristic arginine metabolic disorder in HF， and the core targets of HF were closely associated with the phosphatidylinositol signaling pathway. It provides a modern biological interpretation of the pathogenesis of HF in TCM from the perspectives of metabolites and signaling pathways， and offers valuable insights for targeted therapy of HF and the development of TCM.

Objective: To analyze the association between different sleep statuses and overweight/obesity among primary school students, so as to provide a basis for the development of childhood overweight and obesity prevention and control strategies. Methods: In November 2023, a total of 3 391 primary school students of grade 1-6 from seven schools in Baoan District, Shenzhen, were surveyed by questionnaires and physical examinations by using multistage cluster sampling. The Logistic regression analysis was used to explore the association between primary school students sleep status and overweight/obesity. Results: The detection rate of overweight/obesity in primary school students was 22.59%, the detection rate of overweight/obesity in boys (27.04%) was higher than that in girls (17.44%), the only child (25.81%) had higher rates than nononly child (21.76%), and the differences were statistically significant (χ2=51.48, 5.98, P＜0.05). Multivariate Logistic regression analysis showed that, after controlling for confounders, primary school students weekend nighttime sleep duration (OR=0.83, 95%CI=0.75-0.91), weekly average nighttime sleep duration (OR=0.76,95%CI=0.64-0.89), and weekend compensated sleep duration (OR=0.89,95%CI=0.81-0.97) were negatively associated with the risk of developing overweight/obesity (P＜0.05). Compared with to primary school students with school days nap durations <0.5 h, those whose napped for 0.5-＜1 h and ≥1 h on school days had a 20% (OR=1.20, 95%CI=1.02-1.42) and 37% (OR=1.37, 95%CI=1.02-1.83) increased risk of overweight/obesity, respectively (P＜0.05). Conclusions Increasing weekend nighttime sleep duration, average weekly nighttime sleep duration, and weekend compensatory sleep duration can reduce the risk of overweight and obesity in primary school students. School days nap duration is a risk factor for overweight/obesity among primary school students.

Objective:To investigate the temporal expression of Growth Differentiation Factor-15 (GDF15) in the serum of patients with Acute Coronary Syndrome (ACS) and explore the clinical significance of GDF15 in protecting cardiomyocytes in ACS.Methods:A retrospective study was conducted on 289 ACS patients admitted to the emergency departments from February to October 2023. Data on gender, age, troponin T (TnT), creatine kinase isoenzyme (CK-MB), GDF15, and B-type natriuretic peptide (BNP) within 30 minutes of admission were recorded. Differences in these indicators among different groups were compared. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the diagnostic value of GDF15, TnT, and BNP for ACS. Among the patients, 15 exhibited a temporal expression pattern of GDF15, and their blood samples were re-measured using a GDF15 fluorescent quantitative immunochromatographic assay kit. Fifteen patients without temporal expression were randomly selected as controls, and their samples were also re-measured to exclude detection errors. Fifteen patients with temporal expression were included in the temporal expression group, and 15 without temporal expression were included in the non-temporal expression group. Laboratory indicators such as fasting blood glucose, glycated hemoglobin, triglycerides, creatinine, and uric acid were compared between the groups. Additionally, patient age, gender, body mass index (BMI), coronary angiography results, echocardiography, Gensini score, left ventricular ejection fraction (LVEF), and GRACE risk score were recorded to assess their correlation with GDF15 temporal expression. Statistical analysis was performed using SPSS 27 software, with continuous data expressed as mean ± standard deviation (Mean ± SD) and compared using t-tests and χ2 tests. Results:The overall trend in ACS patients showed a higher proportion of males than females (73.36% vs. 26.64%). The oldest group was the Unstable Angina (UA) group, with a mean age of (63.98 ± 15.19) years, while the youngest group was the non-ACS chest pain group, with a mean age of (54.29 ± 16.39) years. A higher proportion of patients in the UA, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI) groups had a history of smoking. The combination of GDF15 and TnT showed high diagnostic value for ACS, with an area under the ROC curve (AUC) of 0.843, consistent with previous studies. Among all ACS patients, 15 exhibited a temporal expression pattern of GDF15, where GDF15 levels peaked at 4 hours, gradually decreased, and peaked again at 24 hours. Patients in the temporal expression group had higher LVEF and left ventricular end-systolic diameter compared to the non-temporal expression group. The Gensini score was lower in the temporal expression group, and the GRACE risk score was significantly lower in the temporal expression group (00.7±14.72) compared to the non-temporal expression group (116.1±23.46), with a statistically significant difference ( P = 0.0115). There were no significant differences in general characteristics (age, gender, BMI) or clinical biochemical indicators (fasting blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, creatinine, uric acid) between the temporal and non-temporal expression groups ( P > 0.05). Conclusions:GDF15 demonstrates significant diagnostic and prognostic predictive value in ACS. Patients with temporally dynamic expression of serum GDF15 exhibit milder myocardial injury and a lower probability of mortality. These findings provide novel therapeutic targets and research directions for further exploring the role of GDF15 in ACS management.

Objective To conduct a unique and pioneering molecular epidemiological investigation of a case of Eurasian avian-like H1N1 swine influenza identified in Yunnan Province in 2022(the fourth such case in the province)and to understand its genetic characteristics so as to reveal its potential impact on human health.Methods Real-time fluorescent quantitative PCR detection technology was used for the nucleic acid testing of the case's pharyngeal swab samples,close contacts,and environmental samples from the living area.Positive samples were subjected to virus isolation using MDCK cells.Cell cultures were authenticated using erythrocyte agglutination assay with guinea pig blood and real-time fluorescence quantitative RT-PCR.Whole genome sequencing was performed using the Illumina MiseqNext-generation sequencing platform,and a phylogenetic tree was constructed using MEGA 7.0 software to analyze the genetic molecular characteristics.Results The first G5 genotype Eurasian avian-like H1N1 swine influenza virus in Yunnan Province was successfully isolated,and the whole genome sequence of the virus was obtained.This virus possessed the molecular characteristics associated with increased adaptability,virulence,or transmissibility in mammals and had a nucleotide consistency of 99.2％～99.7％with a porcine strain isolated in Jiangsu province.These findings underscored the potential threat this virus poses to human health.Conclusion The study underscores the importance of further monitoring swine influenza in preventing new influenza virus subtypes that can infect humans.

Objective: To understand current state of physical health levels of first year students in different body mass index (BMI) categories in Ningxia universities, and to explore the correlation between BMI and physical fitness index (PFI), so as to provide a reference for enhancing physical health levels of university students. Methods: In November 2024, physical fitness test data from 16 631 first year students across four universities in Yinchuan City, Ningxia from 2019 to 2023 were collected by adopting convenience and stratified cluster random sampling methods. The PFI was calculated using the Z score of the physical fitness test results, and a nonlinear quadratic model was established via least squares regression to examine the relationship between BMI and PFI among university students. Results: The BMI for males was (21.69±3.53)kg/m 2, while for females was (20.78±2.94)kg/m 2. The composite score for males physical fitness (69.86±9.25) was lower than that for females (72.24± 8.15 ), with a statistically significant difference ( t =-17.54, P <0.01). Moreover, the failure rates of various physical fitness indicators (vital capacity, sit and reach, standing long jump, pull ups/1 minute sit ups, 1 000 m/800 m run) were higher among males than females ( χ 2=103.48, 72.45, 14.38, 5 134.85, 188.89, all P <0.01). Comparisons across BMI categories revealed that among males, the normal weight group outperformed other groups in the 50 m sprint, standing long jump, 1 000 m sprint, composite score, and PFI ( F =89.17, 113.90, 179.02, 573.35, 593.08); among female students, the normal weight group outperformed other groups in the 50 m sprint, sit and reach, 800 m run, composite score, and PFI ( F =10.67, 19.58 , 96.45, 294.05, 183.45) (all P <0.01). The relationship between BMI and PFI among first year students exhibited a parabolic change trend, students with a moderate BMI demonstrated higher PFI, and as BMI increased, PFI decreased (all P <0.01). Conclusions The physical health level of male students in Ningxia universities is lower than that of female students. There is a correlation between BMI classification and PFI. Tailored intervention measures should be implemented according to the physical characteristics of students across different genders and BMI classifications to enhance university students physical health.

Objective To investigate the predictive value of combining polygenic risk score(PRS)with the National Institutes of Health Stroke Scale(NIHSS)socre for the development of deep venous thrombosis(DVT)in patients with ischemic stroke.Methods A total of 150 patients with ischemic stroke who were hos-pitalized in Jilin Provincial People's Hospital from December 2023 to May 2024 were selected as study sub-jects.After excluding patients who did not meet the criteria,139 patients were successfully followed up and di-vided into two groups based on whether DVT occurred.PRS strategy and fluorescence in situ hybridization(FISH)technology were used to detect the mutation of the gene loci associated with the risk of venous throm-boembolism(VTE).Based on these genotype data and the effect size of single nucleotide polymorphism(SNP)loci,the PRS score of patients was calculated through the model formula.The degree of neurological impairment was evaluated by NIHSS score.Receiver operating characteristics(ROC)curve was used to ana-lyze the efficacy of PRS score,NIHSS score and their combination in predicting ischemic stroke with lower limb DVT,and clinical data related to VTE formation were collected.Results There were no statistically sig-nificant differences between the two groups in terms of gender,age,body mass index(BMI),smoking,alcohol consumption,hypertension,diabetes,D-dimer(D-D),total cholesterol(TC),triglycerides(TG),and lipopro-tein(a)[(LP(a)]levels(P＞0.05).The PRS score,NIHSS score,and Barthel index in the DVT group were significantly higher than those in the non-DVT group,and the proportion of patients with bed rest exceeding 72 h and homocysteine(Hcy)levels were also relatively higher,with statistical significance(P＜0.05).Logis-tic regression analysis showed that PRS score＞2.55,NIHSS score ≥-3 and Barthel index＜60 were inde-pendent risk factors for lower limb DVT after ischemic stroke(P＜0.05).ROC curve analysis results showed that the area under the curve(AUC)of PRS score,NIHSS score and combined prediction of ischemic stroke combined with lower limb DVT were 0.655,0.747 and 0.763,respectively,and the AUC of combined predic-tion was higher than that of single prediction(P＜0.05).Conclusion PRS score combined with NIHSS score has good predictive efficacy for ischemic stroke complicated with DVT.

Objective:To investigate impact of PD-L2 gene knockout on splenic immune phenotype of C57BL/6 mice.Methods:Body weight of female and male wild-type(WT)and PD-L2 gene knockout(KO)mice aged 3～12 weeks were continuously measured.Tissue structure differences in heart,liver,spleen,lung,kidney,thymus,ovary,uterus and testis of four groups of mice were observed by HE staining.Urease UV rate method was employed to measure urea level in mouse serum,and creatinine concentra-tion in serum was determined by creatine oxidase method.Flow cytometry was used to assess proportions of immune cells and cytokine differences in spleens of mice.Results:PD-L2 gene knockout had no apparent effect on body weight or organ structure of mice.Serum urea and creatinine levels were higher in female KO mice compared to WT mice,but no significant differences were observed among males.Female KO mice exhibited reduced proportions of CD4+T cells,CD8+T cells,Treg,NK cells and dendritic cells(DC)in spleen compared to WT mice.Conversely,proportions of Tfh,B cells,plasma cells,na?ve B cells and B2 cells were elevated,proin-flammatory cytokines such as IL-17,IL-6 and IL-22 were increased,while anti-inflammatory cytokines like IL-10 and IL-4 were decreased.Differences among male mice were either not significant or absent.Conclusion:PD-L2 gene knockout primarily affects splenic immune phenotype of female mice,leading to increased inflammatory responses and weakened immune suppression after knockout.

Objective:To explore the impact of group interpersonal psychotherapy (IPT-G) on depressive symptoms and social cognitive function of adolescents with depression.Methods:From June 2021 to December 2023, a total of 75 adolescent inpatients diagnosed with depression were recruited from Hangzhou Seventh People’s Hospital. They were divided into intervention group and control group according to the general information matching principle.Finally, 30 patients in each group completed the study.The patients in control group received antidepressant medication, psychiatric care, and general recreational activities.While the patients in intervention group received IPT-G based on the treatment of control group. Children's depression inventory (CDI), interpersonal trust scale (ITS), self-esteem scale (SES) and the adolescent cognitive style questionnaire (ACSQ) were adopted to assess the depressive symptoms and social cognitive function of adolescent inpatients before and after the intervention and at 3 and 6 months of follow-up, respectively. SPSS 25.0 software was used for statistical analysis. Chi-square test, independent sample t-test and repeated measure ANOVA were used for inter or intra group comparisons. Results:1.Comparison of depression: The time and group interaction effect of CDI scores between the two groups was significant ( F=6.405, P<0.01). Inter group comparison showed that the CDI scores of the intervention group at 3 and 6 months (12.10±5.20, 7.93±2.98) were lower than those of the control group(18.13±7.28, 15.77±5.52) (both P<0.05), and the scores of both groups at the end of the intervention, 3 months after the intervention, and 6 months after the intervention were lower than that before intervention (all P<0.05).2.Comparison of social cognitive function: (1)There were significant time and group interaction effect of ITS score and SES score( F=5.871, 6.594, both P<0.01).Inter group comparison showed that the ITS score(78.97±7.63, 83.03±7.42) and the SES score(28.00±4.00, 30.30±3.21) of intervention group at 3 months and 6 months after intervention were all higher than those of control group(ITS: (71.70±12.29, 73.90±12.79); SES: (24.37±5.08, 25.80±4.10)(all P<0.05).Intra group comparison showed that the ITS and the SES scores of the intervention group at 3 months and 6 months after intervention were all higher than before intervention( P<0.05).The ITS score of the control group at 6 months after intervention was higher than before intervention( P<0.05).The SES scores of the control group at three time points after intervention were all higher than those before intervention(all P<0.05).(2)Comparison of ACSQ scores: There were significant time and group interaction effects for the scores of academic stability, academic specificity, interpersonal introversion and extroversion, and interpersonal stability, interpersonal specificity( F=5.414, 9.294, 3.440, 8.231, 10.669, all P<0.05). Inter group comparison showed that the academic stability, academic specificity, interpersonal stability, and interpersonal specificity scores of the intervention group were lower than those of the control group at 3 and 6 months after intervention (all P<0.05).Intra group comparison showed that the academic stability, academic specificity, interpersonal introversion and extroversion, interpersonal stability, and interpersonal specificity scores of the intervention group at 3 months and 6 months after the intervention were lower than those before the intervention (all P<0.05).After 3 and 6 months of intervention, the academic stability, academic specificity, interpersonal introversion and extroversion, interpersonal stability, and interpersonal specificity scores of the control group were all lower than those before intervention (all P<0.05). Conclusion:IPT-G can not only alleviate depressive symtoms, but also improve social cognitive function.