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.

"Sinew prescription correspondence" is the principle of selecting prescriptions for channel sinew diseases. On the basis of the theory of syndrome differentiation and treatment， the pulse manifestation corresponds to the channel sinew syndrome， which can improve the flexibility and standardization of clinical prescriptions. From the perspective of systematic dialectical sphygmology， this paper explains the dialectical relationship between channel sinew theory and pulse body elements， pulse wall elements， pulse elements and blood flow elements， and clarifies the internal relationship between pulse manifestation and prescriptions at the level of channel sinew disease. The prescription is derived from the method， while the method is established with the syndrome， and the prescription is unified by the method. According to the theory of "sinew prescription correspondence"， the treatment ideas of channel sinew diseases were analyzed from the perspective of channel sinew distribution， functional characteristics and structural changes. On this basis， the diagnosis of channel sinew disease and the application of prescriptions are expanded， and the research on the internal treatment and diagnosis mode of "pulse manifestation-channel sinew-zang fu （脏腑）" is prospected， so as to expand the differentiation and treatment methods of channel sinew theory.

Based on a review of classical literature combined with modern anatomical and biomechanical research， this paper proposes the "four intersections" of channel sinew diseases from the perspective of structural interfaces， which involves sinew-bone， sinew-sinew， sinew-joint， and sinew-vessel intersections， and analyzes the corresponding pathological characteristics. It is believed that the dynamic evolution of channel sinew diseases can be summarized as "starting with mechanical imbalancew， with interface transmission as the pivot， compensation continuation as the variation， and neurological adaptation as the consolidation". Furthermore， the pathological changes at the "four intersections" structural interfaces correspond respectively to clinical manifestations of enthesial pain， referred pain， joint dysfunction and sensory abnormalities. Understanding channel sinew diseases based on the "four intersections" structural interface is conducive to deepening the understanding of the pathogenesis， thereby providing a reference for clinical identification and precise treatment.

This study aims to investigate the isolate and identify of infectious bronchitis virus(IBV)in chickens,and study its genetic variation and pathogenicity.In 2023,two strains named CK/CH/HN/SQ202301 and CK/CH/HN/SQ202302 were obtained from suspected infectious bronchitis(IB)infected materials collected in a region of Henan Province,China.Further analysis showed that the two isolates belong to the G Ⅰ-13 and GⅥ genotypes,respectively.The cleavage sites of S protein were all RRSRR.The prediction of glycosylation sites showed that the two isolates had 18 and 12 N-glycosylation sites respectively,but no O-glycosylation site.Recombinant analysis shows that C2023-1 was a recombinant strain.Pathogenicity was assessed by infecting 1-day-old SPF chicks with the two isolates,and the results showed that C2023-1 strain infection could cause clini-cal symptoms such as depression and head shaking,as well as death in chicks,with a mortality rate of 37.5％.There were no clinical symptoms or deaths after infection with C2023-2 strain.Viral load test results showed that both isolates continued to detoxify until the 10th day,and had strong rep-lication capacity in the kidney,trachea and bursa of Fabricius.The results indicate significant differences in the genetic characteristics and pathogenicity of the two isolates due to their different genotypes.This study not only provides new epidemiological data on IB,which contributes to a bet-ter understanding of IBV's epidemiological features and control challenges,but also adds valuable bioinformatics resources for IBV by analyzing its variation mechanisms and biological information.

Objective Under the guidance of the Social Ecosystems Theory(SET)framework,this study explores the experience of social isolation among patients with chronic obstructive pulmonary disease(COPD),providing a basis for the development of targeted clinical interventions.Methods This study employed purposeful sampling methods.Semi-structured interviews were conducted from April to July 2024 with patients diagnosed with COPD at a tertiary hospital in Shanxi Province,China,who met the inclusion and exclusion criteria.Data were analyzed using Colaizzi's seven-step analysis method and NVivo 12.0 software.Results This study involved in-depth interviews with 15 patients suffering from COPD,totaling approximately 405 minutes of interview time and yielding over 40,000 words in transcribed text.Totally 3 main themes and 9 sub-themes were distilled,among which the microsystem level reflects the intricate interplay of individual experiences(physical functional limitations,severe negative emotions,heightened emotional imbalance,and weakened social roles);the mesosystem level pertains to the support and challenges from family and social networks(intense need for familial emotional support,widening social gaps in interactions with friends and relatives,and pronounced interpersonal communication barriers);the macrosystem level involves the integrated influence of societal and policy environments(restricted living conditions and urgent demands for policy support and service accessibility).Conclusion The social isolation experienced by patients with COPD manifests in multiple dimensions of experience.It is necessary to develop interdisciplinary and multi-level comprehensive intervention strategies for the future,to create more social opportunities and emotional connections for patients,thereby improving their quality of life.

Objective To investigate the factors influencing the efficacy of intravesical Bacille Calmette-Guérin(BCG)instillation after transurethral resection of bladder tumor(TURBT)in patients with intermediate-and high-risk non-muscle invasive bladder cancer(NMIBC),and to construct a prediction model for recurrence after BCG treatment.Methods A retrospective cohort study was conducted on the subjected patients diagnosed with intermediate-and high-risk NMIBC undergoing TURBT followed by standard BCG instillation.The 110 patients treated in Department of Urology of Army Medical Center of PLA from January 2018 to December 2023 were assigned into a training set,while the 52 patients treated at Department of Urology of General Hospital of Central Theater Command from January 2015 to December 2020 were into an external validation set.A total of 17 variables were included and analyzed.Univariate and multivariate Cox regression analyses were performed to identify factors associated with recurrence after BCG instillation,and nomograms were plotted to predict 1-year,3-year,and 5-year recurrence-free survival(RFS).Calibration curve,decision curve analysis(DCA),and receiver operating characteristic(ROC)curve analysis were conducted for internal and external validation to evaluate the predictive performance and clinical utility of the model.Results In the training set,26 patients(23.64%)experienced recurrence during the follow-up period,with a median RFS of 32.00(18.00～50.50)months.Univariate Cox regression analysis suggested that platelet count,eosinophil to lymphocyte ratio(ELR),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),systemic immune inflammation(SII)index,and neutrophil-monocyte to lymphocyte ratio(NMLR),pathological T1 stage(pT1)tumor and hemoglobin,albumin,lymphocyte,and platelet(HALP)score were potential factors influencing recurrence after BCG instillation.Multivariate Cox regression analysis identified high HALP score(HR=0.185,95%CI:0.046～0.736,P=0.017)as an independent protective factor,while high ELR(HR=3.599,95%CI:1.505～8.608,P=0.004)and pT1 stage(HR=3.240,95%CI:1.191～8.818,P=0.021)were independent risk factors for recurrence.Based on this,a nomogram prediction model was constructed.The calibration curves demonstrated good agreement between predicted and actual 1-,3-,and 5-year recurrence risks.Decision curve analysis indicated clinical utility across a wide threshold probability range.In the training set,the model showed strong predictive performance for 1-(AUC=0.842),3-(AUC=0.847),and 5-year(AUC=0.887)recurrence risks,which was further validated in the external cohort.Conclusion Higher HALP score prior to BCG instillation therapy is a protective factor against tumor recurrence,while higher ELR and pT1 stage are risk factors.Our nomogram prediction model based on HALP score,ELR and pathological T stage,can identify individuals at high risk of recurrence after BCG instillation therapy.

Objective To investigate risk factors for residual lesions after initial transurethral resection of bladder tumors(TURBT)and risk factors for tumor recurrence after second TURBT in patients with non-muscle-invasive bladder cancer(NMIBC)in order to provide reference for clinical management.Methods A case-control study design was adopted to include 120 NMIBC patients who underwent initial TURBT and then second surgery within 2～8 weeks in our department from January 2017 to January 2025.Based on the presence of residual lesions after the initial TURBT or not,the patients were divided into a residual lesion group(n=34)and a non-residual lesion group(n=86).Chi-square test and multivariate logistic regression analysis were performed to identify potential risk factors for residual lesions following the initial TURBT.Univariate and multivariate Cox regression models were used to analyze potential risk factors for tumor recurrence after the second TURBT.Results The residual lesion rate after initial TURBT was 28.33％.Chi-square test analysis revealed that tumor stage T1(Chi-square=5.756,P=0.016)and broad tumor base(Chi-square=4.331,P=0.037)were factors influencing residual lesions after initial TURBT.Multivariate logistic regression analysis identified tumor stage T1(OR=3.047,95％CI:1.128～8.226,P=0.028)as an independent risk factor for residual lesions after initial TURBT.The tumor recurrence rate after second TURBT was 17.5％.Multivariate Cox regression analysis identified tumor stage T1(OR=4.258,95％CI:1.248～14.532,P=0.021),intravesical chemotherapy instillation after second TURBT(OR=3.539,95％CI:1.284～9.752,P=0.015),history of urinary system tumors(OR=3.002,95％CI:1.145～7.873,P=0.025)and high platelet-to-lymphocyte(PLR)ratio(OR=2.798,95％CI:1.115～7.023,P=0.028)as independent risk factors for tumor recurrence after second TURBT.Conclusion Tumor stage T1 and broad tumor base are risk factors for residual lesions after initial TURBT,while tumor stage T1,intravesical chemotherapy instillation after second TURBT,history of urinary system tumors and high PLR ratio are risk factors for tumor recurrence after second TURBT.Comprehensive analysis on above 4 indicators can effectively assess the risk of tumor recurrence in NMIBC patients following second TURBT,and timely early medical intervention is beneficial for improving patient outcomes.

Objective To explore the rehabilitative effects of flash cupping combined with respiratory training in patients with occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis"). Methods A total of 94 patients with pneumoconiosis were selected as the study subjects by the convenient sampling method. Participants were divided into treatment group and control group based on pneumoconiosis stage using the stratified block randomization method, with 47 cases in each group. The patients in the control group received routine symptomatic treatment, and the patients in the treatment group received flash cupping therapy combined with respiratory training in addition to the routine treatment for six weeks. Diaphragmatic displacement (DD), 6-minutes walking distance (6MWD), metabolic equivalents of task (MET), predicted percentage of forced vital capacity (FVC%), predicted percentage of forced expiratory volume in one second (FEV₁%), Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score, and the modified British Medical Research Council Respiratory Questionnaire (mMRC) were assessed before treatment, after six weeks of treatment, and three months after completion of treatment. Results Before treatment, no significant differences were observed in patients between the two groups in DD, 6MWD, MET, FVC%, FEV₁%, CAT score, or mMRC grade (all P>0.05). DD, 6MWD, and MET of patients in the treatment group were higher than those before treatment in the same group and those of the control group at the corresponding time points after six weeks of treatment (all P<0.05). In addition, the CAT score of patients in the treatment group was lower than that before treatment (P<0.05). At three months after treatment, 6MWD and MET of patients in the treatment group were higher than those before treatment and those of the control group at the same time points (all P<0.05). There were no significant differences in FVC%, FEV₁% and mMRC grade of patients between the two groups (all P>0.05). Conclusion Flash cupping combined with respiratory training can improve the diaphragmatic function, exercise endurance and quality of life of patients with pneumoconiosis, and has improved exercise endurance, which can be used as a useful supplementary treatment in the pulmonary rehabilitation of pneumoconiosis.

Cytochrome P450 (CYP450) enzymes, as versatile biocatalysts with the broadest range of catalytic reactions in nature, play critical roles in the metabolism of medicinal plants. They are involved in various oxidative modification processes of active ingredients, facilitating both the synthesis and degradation of bioactive substances. This review delves into the classification, structure, and catalytic mechanisms of CYP450 enzymes, emphasizing their indispensable roles in plant biosynthesis. Using representative cases, including the biosynthetic pathways of tanshinones, artemisinin, celastrol, paclitaxel, and berberine, this review highlights the functional importance of specific CYP450s. For instance, CYP71AV1 catalyzes the production of artemisinin and artemisinic aldehyde, with its activity directly affecting artemisinin yield. Similarly, CYP76AH1 and CYP76AK1 play pivotal roles in the backbone construction and postmodification of tanshinones, acting as key players in their metabolic network. In the case of celastrol, CYP712K1, CYP712K2, and CYP712K3 initiate the first oxidative reaction, providing a solid foundation for subsequent biosynthetic processes. These examples highlight the pivotal role of CYP450 enzymes in the biosynthesis of medicinal plants, showcasing both their complexity and significance in plant metabolic pathways. Furthermore, this review examines the oxidative metabolism of CYP450 enzymes under aerobic conditions and their reductive metabolism in specific environments, offering deeper insights into their catalytic mechanisms. A comprehensive understanding of these processes lays the groundwork for the effective application of CYP450 enzymes in biotechnology and plant metabolic engineering.

Objective:To screen the risk factors of acute kidney injury (AKI) in patients with multiple trauma, construct a prediction model accordingly, and evaluate its predictive value.Methods:A retrospective cohort study was performed to analyze the clinical data of 560 multiple trauma patients who were admitted to while Affiliated Hospital of Jiangsu University from January 2017 to June 2023, including 424 males and 136 females, aged 18-91 years [(55.5±15.0)years]. The patients were randomly divided into a training set ( n=392) and validation set ( n=168) with a ratio of 7∶3. Of all, 77 patients were combined with AKI in the training set, while 33 patients combined with AKI in the validation set. The AKI group and non-AKI group in the training set were compared in terms of gender, age, hypertension, diabetes, cause of injury, abbreviated injury scale (AIS) score of head and neck injury, AIS score of maxillofacial injury, AIS score of chest injury, AIS score of abdominal injury, AIS score of extremities and pelvic injury, AIS score of body surface injury, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, body temperature, red blood cell and plasma transfusion volume within 24 hours following admission, emergency surgery, mechanical ventilation, vasoactive drug therapy, Glasgow coma score (GCS) on admission, revised trauma score (RTS) on admission, acute physiology and chronic health assessment II (APACHE II) on admission, injury severity score (ISS) on admission, and laboratory test results on admission including white blood cell count, neutrophil count, lymphocyte count, C-reactive protein, hemoglobin, platelet count, activated partial thromboplastin time (APTT), prothrombin (PT), fibrinogen (FIB), thrombin time (TT), international normalized ratio (INR), D-dimer, blood lactate, base excess, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, globulin, urea nitrogen, serum creatinine, blood glucose, potassium, sodium and chloronium. In the training set, univariate analysis and Lasso regression analysis were used to screen the risk factors of AKI in patients with multiple trauma, which were then included into multivariate logistic regression analysis to identify the independent risk factors. A nomogram prediction model was constructed using the R software based on the above independent risk factors. Hosmer-Lemeshow (H-L) goodness-of-fit test was performed to evaluate the fitting degree of the prediction model in the training set and the validation set, and the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve (DCA) were plotted in the training set and the validation set to evaluate the predictive performance of the prediction model. Results:There were statistically significant differences in AIS score of abdominal injury, heart rate, body temperature, red blood cell and plasma transfusion volume within 24 hours following admission, emergency surgery, mechanical ventilation, vasoactive drug therapy, GCS on admission, RTS on admission, APACHE II on admission, ISS on admission as well as hemoglobin, platelet count, APTT, PT, FIB, TT, INR, blood lactate, base excess, AST, albumin, globulin, urea nitrogen, serum creatinine, blood glucose and sodium on admission between the AKI group and the non-AKI group ( P<0.05 or 0.01). The characteristic variables screened by Lasso regression analysis included AIS score of abdominal injury, red blood cell transfusion volume within 24 hours following admission, mechanical ventilation, vasoactive drugs therapy, blood lactate on admission, blood creatinine on admission, AST on admission, and blood sodium on admission. Multivariate logistic regression analysis showed that red blood cell transfusion volume within 24 hour following admission ( OR=1.09, 95% CI 1.01, 1.18), mechanical ventilation ( OR=2.49, 95% CI 1.06, 5.85), vasoactive drug therapy ( OR=2.04, 95% CI 1.03, 4.03), blood lactate on admission ( OR=1.10, 95% CI 1.01, 1.21) and serum creatinine on admission ( OR=1.02, 95% CI 1.01, 1.03) were independent risk factors for AKI in patients with multiple trauma ( P<0.05). The regression equation was constructed: Logit[ P/(1- P)]=0.086 2×"red blood cell transfusion volume within 24 hour following admission"+0.912 7×"mechanical ventilation"+0.713 2×"vasoactive drug therapy"+0.098 9×"blood lactate on admission"+0.019 2×"serum creatinine on admission" -4.822 3. H-L goodness-of-fit test showed χ2 value of 9.50 in the training set ( P>0.05) and 6.43 in the validation set ( P>0.05). The results of the ROC curve indicated that the area under the curve (AUC) was 0.84 (95% CI 0.78, 0.89) in the training set and 0.80 (95% CI 0.72, 0.88) in the validation set. The calibration curves showed good agreement with the actual curves, with the predicted probability consistent with the actual probability in both training set and validation set. DCA analysis showed that the threshold probability ranged from 2% to 70% with the net benefit rate of the prediction model greater than 0 in the training set, while the threshold probability ranged from 3% to 69% with the net benefit rate of the prediction model greater than 0 in the validation set. Conclusions:Red blood cell transfusion volume within 24 hours following admission, mechanical ventilation, vasoactive drug therapy, lactate and serum creatinine on admission are independent risk factors for AKI in patients with multiple trauma. The nomogram prediction model based on the above 5 predictive variables of AKI in patients with multiple trauma shows good predictive efficacy and clinical application value.