1.Application advances, ethical dilemmas, and future directions of large language models in lung cancer diagnosis and treatment
Zhizhen REN ; Yufan XI ; Xu ZHU ; Yijie LUO ; Geting HUANG ; Junqiao SONG ; Xiuyuan XU ; Nan CHEN ; Qiang PU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(03):353-362
Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide. Coupled with the substantial workload, the clinical management of lung cancer is challenged by the critical need to efficiently and accurately process increasingly complex medical information. In recent years, large language models (LLMs) technology has undergone explosive development, demonstrating unique advantages in handling complex medical data by leveraging its powerful natural language processing capabilities, and its application value in the field of lung cancer diagnosis and treatment is continuously increasing. The paper systematically analyzes that the exceptional potential of LLMs in lung cancer auxiliary diagnosis, tumor feature extraction, automatic staging, progression/outcome analysis, treatment recommendations, medical documentation generation, and patient education. However, they face critical technical and ethical challenges including inconsistent performance in complex integrated decision-making (e.g., TNM staging, personalized treatment suggestions) and "black box" opacity issues, along with dilemmas such as training data biases, model hallucinations, data privacy concerns, and cross-lingual adaptation challenges ("data colonization"). Future directions should prioritize constructing high-quality multimodal corpora specific to lung cancer, developing interpretable and compliant specialized models, and achieving seamless integration with existing clinical workflows. Through dual drivers of technological innovation and ethical standardization, LLMs should be prudently advanced for holistic lung cancer management processes, ultimately promoting efficient, standardized, and personalized diagnosis and treatment practices.
3.STAR Recommendations: A novel framework for generating recommendations.
Xu WANG ; Janne ESTILL ; Hui LIU ; Qianling SHI ; Jie ZHANG ; Shilin TANG ; Huayu ZHANG ; Xueping LI ; Zhewei LI ; Yaxuan REN ; Bingyi WANG ; Fan WANG ; Juan JUAN ; Huixia YANG ; Xiuyuan HAO ; Junmin WEI ; Yaolong CHEN
Chinese Medical Journal 2025;138(14):1643-1646
4.Study on the Application of Named Entity Recognition in Electronic Medical Records for Lymphedema Disease
Haocheng TANG ; Wanchun SU ; Xiuyuan JI ; Jianfeng XIN ; Song XIA ; Yuguang SUN ; Yi XU ; Wenbin SHEN
Journal of Medical Informatics 2024;45(2):52-58
Purpose/Significance The paper discusses the application of artificial intelligence technology to the key entity recognition ofunstructured text data in the electronic medical records of lymphedema patients.Method/Process It expounds the solution of model fine-tuning training under the background of sample scarcity,a total of 594 patients admitted to the department of lymphatic surgery of Beijing Shijitan Hospital,Capital Medical University are selected as the research objects.The prediction layer of the GlobalPointer model is fine-tuned according to 15 key entity categories labeled by clinicians,nested and non-nested key entities are identified with its glob-al pointer.The accuracy of the experimental results and the feasibility of clinical application are analyzed.Result/Conclusion After fine-tuning,the average accuracy rate,recall rate and Macro_F1 ofthe model are 0.795,0.641 and 0.697,respectively,which lay a foundation for accurate mining of lymphedema EMR data.
5.Population-based active screening strategy contributes to the prevention and control of tuberculosis.
Cheng DING ; Zhongkang JI ; Lin ZHENG ; Xiuyuan JIN ; Bing RUAN ; Ying ZHANG ; Lanjuan LI ; Kaijin XU
Journal of Zhejiang University. Medical sciences 2023;51(6):669-678
Despite the achievements obtained worldwide in the control of tuberculosis in recent years, many countries and regions including China still face challenges such as low diagnosis rate, high missed diagnosis rate, and delayed diagnosis of the disease. The discovery strategy of tuberculosis in China has changed from "active discovery by X-ray examination" to "passive discovery by self-referral due to symptoms", and currently the approach is integrated involving self-referral due to symptoms, active screening, and physical examination. Active screening could help to identify early asymptomatic and untreated cases. With the development of molecular biology and artificial intelligence-assisted diagnosis technology, there are more options for active screening among the large-scale populations. Although the implementation cost of a population-based active screening strategy is high, it has great value in social benefits, and active screening in special populations can obtain better benefits. Active screening of tuberculosis is an important component of the disease control. It is suggested that active screening strategies should be optimized according to the specific conditions of the regions to ultimately ensure the benefit of the tuberculosis control.
Humans
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Artificial Intelligence
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Tuberculosis/prevention & control*
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Mass Screening
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China
6.Development of the Scientific, Transparent and Applicable Rankings (STAR) tool for clinical practice guidelines.
Nan YANG ; Hui LIU ; Wei ZHAO ; Yang PAN ; Xiangzheng LYU ; Xiuyuan HAO ; Xiaoqing LIU ; Wen'an QI ; Tong CHEN ; Xiaoqin WANG ; Boheng ZHANG ; Weishe ZHANG ; Qiu LI ; Dong XU ; Xinghua GAO ; Yinghui JIN ; Feng SUN ; Wenbo MENG ; Guobao LI ; Qijun WU ; Ze CHEN ; Xu WANG ; Janne ESTILL ; Susan L NORRIS ; Liang DU ; Yaolong CHEN ; Junmin WEI
Chinese Medical Journal 2023;136(12):1430-1438
BACKGROUND:
This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability.
METHODS:
This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability.
RESULTS:
STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min.
CONCLUSION
The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
Reproducibility of Results
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Surveys and Questionnaires
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Practice Guidelines as Topic
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Humans
7.A highly sensitive bio-barcode immunoassay for multi-residue detection of organophosphate pesticides based on fluorescence anti-quenching
Xu LINGYUAN ; Zhang XIUYUAN ; El-Aty A.M.ABD ; Wang YUANSHANG ; Cao ZHEN ; Jia HUIYAN ; Salvador J.-PABLO ; Hacimuftuoglu AHMET ; Cui XUEYAN ; Zhang YUDAN ; Wang KUN ; She YONGXIN ; Jin FEN ; Zheng LUFEI ; Pujia BAIMA ; Wang JING ; Jin MAOJUN ; D.Hammock BRUCE
Journal of Pharmaceutical Analysis 2022;12(4):637-644
Balancing the risks and benefits of organophosphate pesticides(OPs)on human and environmental health relies partly on their accurate measurement.A highly sensitive fluorescence anti-quenching multi-residue bio-barcode immunoassay was developed to detect OPs(triazophos,parathion,and chlorpyrifos)in apples,turnips,cabbages,and rice.Gold nanoparticles were functionalized with monoclonal antibodies against the tested OPs.DNA oligonucleotides were complementarily hybridized with an RNA fluorescent label for signal amplification.The detection signals were generated by DNA-RNA hybridization and ribonuclease H dissociation of the fluorophore.The resulting fluorescence signal en-ables multiplexed quantification of triazophos,parathion,and chlorpyrifos residues over the concen-tration range of 0.01-25,0.01-50,and 0.1-50 ng/mL with limits of detection of 0.014,0.011,and 0.126 ng/mL,respectively.The mean recovery ranged between 80.3%and 110.8%with relative standard deviations of 7.3%-17.6%,which correlate well with results obtained by liquid chromatography-tandem mass spectrometry(LC-MS/MS).The proposed bio-barcode immunoassay is stable,reproducible and reliable,and is able to detect low residual levels of multi-residue OPs in agricultural products.
8.Risk factors related to patellar dislocation combined with osteochondral fracture
Jin JIANG ; Hongwei ZHAN ; Xiuyuan WANG ; Changjiang YAO ; Lihu XU ; Jiaxin JIN ; Yayi XIA ; Meng WU
Chinese Journal of Trauma 2022;38(12):1095-1099
Objective:To investigate the related risk factors related to patellar dislocation combined with osteochondral fracture (OCF).Methods:A case control study was conducted to analyze the clinical data of 278 patients with patellar dislocation admitted to Second Hospital of Lanzhou University from January 2016 to June 2020, including 98 males and 180 females; aged 12-41 years [(21.1±4.6)years]. The patients were divided into OCF group ( n=112) and non-OCF group ( n=166) according to the surgical records and occurrence of OCF or not under intraoperative arthroscopy. The data of the two groups were recorded, including basic characteristics (ie, sex, age, sides of injury, whether or not the epiphysis is closed), patella height, patellar inclination angle, tibial tubercle-trochlear groove (TT-TG), femoral trochlear shape, tibial lateral rotation angle and femoral anteversion angle. Univariate analysis was adopted to evaluate the correlation of the data with patellar dislocation combined with OCF. Multivariate Logistic regression analysis was used to determine the independent risk factors of patellar dislocation combined with OCF. Results:Univariate analysis showed that patellar dislocation combined with OCF was related to male, patellar inclination angle and femoral anteversion angle ( P<0.05 or 0.01), while not to age, epiphysis is closed or not, sides of injury, patella height, TT-TG, femoral trochlear shape and tibial lateral rotation angle (all P>0.05). Multivariate Logistic regression analysis showed that male ( OR=1.75, 95% CI 1.07-2.90, P<0.05) and increased femoral anteversion angle ( OR=3.12, 95% CI 1.89-5.17, P<0.05) were significantly correlated with patellar dislocation combined with OCF. Conclusion:Male and increased femoral anteversion angle are independent risk factors for patellar dislocation combined with OCF.
9. Echinacoside regulates prohibitin expression and inhibits MPP -induced apoptosis in SH-SY5Y ceils
Yao LIN ; Chang-Hui QIAN ; Lin WANG ; Qian XU ; Ming-Zhou YUAN ; Nai-Jie CHEN ; Xu-Zheng CHEN ; Jing CAI
Chinese Pharmacological Bulletin 2022;38(9):1375-1381
Aim To investigate the effeet of Eehinaeo- side ( ECH ) regulating the expression of prohibitin (PHB) on MPP+ -induced apoptosis of SH-SY5Y eells and the underlying mechanism.Methods SH-SY5Y eells were seleeted and divided into control group, MPP+ group, MPP+ + ECH group, NC + MPP + group, NC + MPP+ + ECH group, PHB-RNAi + MPP + + ECH group.Cell survival rate was determined by CCK-8 assay.Cell morphology was observed using an inverted phase contrast mieroscope; the apoptotie eells were observed by Hoechst33342 fluorescence staining, whereas apoptotie rate, reactive oxygen speeies eon- tent, and mitochondrial membrane potential were ana¬lyzed by flow eytometry.The relative protein expres¬sions of PHB, Akt, p-Akt, Bel-2, Bax, and cleaved- easpase3 were determined by Western blot.Results Compared with eontrol group, the eell survival rate of MPP+ group signifieantly deereased.The growth state of the eells beeame significantly worse.Intracellular ROS content inereased, mitoehondrial membrane po tential decreased, apoptosis-related protein expression increased and the apoptotic rate increased.Compared with MPP+ group, MPP+ + ECH group significantly increased cell viability.The growth status of cells was significantly improved.Intracellular ROS content de¬creased, mitochondrial membrane potential increased, apoptosis-related protein expression decreased, and the apoptotic rate decreased significantly.The expression levels of PHB and p-Akt significantly increased.Com¬pared with NC + MPP+ + ECH group, p-Akt level de¬creased and the cell apoptotic rate increased in PHB- RNAi +MPP+ + ECH group.Conclusions Echino- side can reduce MPP + - induced apoptosis of SH-SY5Y cells, which may be realized by upregulating PHB ex¬pression and phosphorylation of Akt to protect mito¬chondrial function.
10.Emodin reduces FFAs-induced fatty degeneration in HepG2 cells via the AMPK/SREBP-1 pathway
Yiling XU ; Guodong WANG ; Bo LIU ; Bo YU ; Qifei HUANG ; Xiuyuan SU ; Huixia LIU
Journal of Chinese Physician 2017;19(4):506-509,513
Objective To investigate the effects of emodin on the triglyceride metabolism and oxidative stress in steatosis in HepG2 cells and possible underlying mechanisms.Methods The appropriate concentration of emodin on HepG2 cells were detected by methyl thiazolyl tetrazolium (MTT) assay.HepG2 cells were induced to fat overaccumulation by 1 mmol/L free fatty acids (FFA) (oleate∶ palmitate =2∶1).The model group exposed to 10 μmol/L,20 μmol/L,40 μmol/L emodin.The intracellular lipid accumulation was documented by Oil Red O staining and the content of triglyceride and total cholesterol was observed.Reactive oxygen species (ROS) was determined by flow cytometry.Western blotting was performed to analyze the protein levels of adenosine monophosphate-activated protein kinase (AMPK),phosphorylated AMPK,and sterol regulatory element-binding protein 1 (SREBP-1).Results Emodin reduced lipid accumulation and triglycerides (TG) content (P < 0.05).At the same time,it significantly reduced ROS production (P < 0.05).Moreover,the levels of AMPK and p-AMPK protein were significantly upregulated,and SREBP-1 protein was significantly downregulated with the treatment of emodin (P < 0.01).Conclusions This study has demonstrated that emodin can reduce fatty degeneration induced by FFAs in hepatocytes,and this effect may be partially mediated by the AMPK/SREBP-1 pathway.

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