Objective:To investigate the current awareness of large language models (LLM) among Chinese clinical physicians and analyze the application needs of cardiovascular specialists.Methods:This is a cross-sectional study utilized convenience sampling. In December 2023, a self-designed questionnaire was distributed to 7 980 clinical physicians, including 930 cardiologists. The survey collected demographic information, including work city (categorized as first-tier, new first-tier, second-tier, third-tier, and fourth-tier and below), hospital level, professional title, and department. And the awareness of LLM, and their application demands in clinical decision-making support, information filtering, and scientific research work were also collected. Differences in awareness and application requirements across geographic regions, hospital tiers, professional ranks, and medical departments were analyzed. Besides, specific demands of cardiovascular specialists were further examined.Results:Among the 7 980 clinical physicians, the awareness rate of LLM was 76.3% (6 088/7 980), and the utilization rate was 11.8% (942/7 980). For the 930 cardiologists, the awareness rate was 78.5% (730/930) and the utilization rate was 11.4% (106/930). Significant differences in awareness and utilization rates were observed across city tiers, hospital grades, and departments (all P<0.05). No significant difference was found among professional titles ( P=0.053). Among the 6 088 physicians aware of LLM, demand rates for clinical information filtering, clinical decision support, and research assistance were 87.3% (5 312/6 088), 78.4% (4 774/6 088), and 75.8% (4 616/6 088), respectively. For the 730 cardiologists aware of LLM, these rates were 91.0% (664/730), 79.2% (578/730), and 75.9% (554/730), respectively. Significant differences in demands for clinical information filtering and research assistance were observed across city tiers, hospital grades, professional titles, and departments (all P<0.05), while no significant difference was noted for decision support demands across hospital grades ( P=0.085). In clinical information screening and acquisition, cardiologists from different city tiers exhibited statistically significant differences in the demand for literature interpretation. Similarly, variations in the demand for conference summaries, expert biographies, healthcare policies, and social news were noted among cardiologists with different professional titles, while disparities in patient education and science popularization needs were identified across city tiers and hospital grades (all P<0.05). In clinical decision-making support, cardiologists from diverse city tiers and professional titles demonstrated distinct differences in guideline and consensus inquiries, and those from various city tiers showed varied demands for pharmaceutical and medical device-related content (all P<0.05). For research support, cardiologists across city tiers and professional titles exhibited statistically significant differences in trial protocol design requirements, while those from varying city tiers differed in literature search/analysis and research application procedures. Additionally, physicians from different hospital grades displayed divergent needs for data collection (all P<0.05). Conclusions:The adoption of LLM is significantly influenced by regional disparities, institutional resources, and professional backgrounds. Implementing targeted interventions, such as enhancing technical training, optimizing LLM functionalities, and improving accessibility across diverse healthcare settings, could encourage widespread integration of LLM into clinical practice. Such measures could ultimately enhance the quality and efficiency of medical services in China and foster innovations in healthcare delivery.

Triple-negative breast cancer (TNBC) represents an aggressive breast cancer subtype with poor prognosis and limited targeted treatment options. This investigation examined the anti-cancer potential of Caerulomycin A (Cae A), a natural compound derived from marine actinomycetes, against TNBC. Cae A demonstrated selective inhibition of viability and proliferation in TNBC cell lines, including 4T1, MDA-MB-231, and MDA-MB-468, through apoptosis induction. Mechanistic analyses revealed that the compound induced sustained endoplasmic reticulum (ER) stress and subsequent upregulation of C/EBP homologous protein (CHOP) expression, resulting in mitochondrial damage-mediated apoptosis. Inhibition of ER stress or CHOP expression knockdown reversed mitochondrial damage and apoptosis, highlighting the essential role of ER stress and CHOP in Cae A's anti-tumor mechanism. Both oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) decreased in TNBC cells following Cae A treatment, indicating reduced mitochondrial respiratory and glycolytic capacities. This diminished energy metabolism potentially triggers ER stress and subsequent apoptosis. Furthermore, Cae A exhibited significant anti-tumor effects in the 4T1 tumor model in vivo without apparent toxicity. The compound also effectively inhibited human TNBC organoid growth. These results indicate that Cae A may serve as a potential therapeutic agent for TNBC, with its efficacy likely mediated through the disruption of glucose metabolism and the induction of ER stress-associated apoptosis.
Humans ; Endoplasmic Reticulum Stress/drug effects* ; Triple Negative Breast Neoplasms/genetics* ; Apoptosis/drug effects* ; Cell Line, Tumor ; Female ; Animals ; Glucose/metabolism* ; Mice ; Cell Proliferation/drug effects* ; Transcription Factor CHOP/genetics* ; Antineoplastic Agents/pharmacology* ; Mitochondria/metabolism* ; Mice, Inbred BALB C

Objective:To analyze the current status and factors influencing clinician participation in remote patient management in China.Methods:In December 2023, a structured electronic questionnaire was administered to 7 980 clinicians, including 930 cardiologists. The survey assessed clinicians′ participation in online doctor-patient interactions; differences in hospital support across city tiers, hospital grades, professional titles, and departments; and factors influencing the willingness of clinicians to invest time in remote patient management.Results:Among the 7 980 surveyed clinicians, online consultations had the highest participation rate (72.2%). Among cardiologists, participation rates for online consultations, health education, and post-consultation management were 73.3%, 66.9%, and 38.5%, respectively, which were relatively higher than those of other specialties. Hospital-based support for physicians in remote patient management showed significant variations across specialties and regions. Among cardiologists, 68.4% received "encouraging" policies, with the majority falling under "encouragement without incentive policies" (42.6%). In tier 3 cities, the proportion of physicians receiving "encouragement without incentive policies" was the highest (47.9%), while the proportion in the "cautious, requiring reporting" category was the lowest (3.9%). During remote patient management, the proportions of clinicians receiving support from professional teams were highest among those in tier 3 cities (29.6%) and cardiologists (30.5%). A significant interaction effect was observed between hospital policy and specialty (cardiologists vs. all clinicians) regarding physicians′ willingness to invest time in remote patient management ( F=5.95, P<0.001). Among cardiologists, those working in institutions with "encouraging, with incentives" policies reported a significantly longer median weekly investment time (10.0 h) compared to those under "neutral, unrestricted" policies (7.0 h, P<0.001). Cardiologists with team support reported a significant increase in the time they were willing to invest (10 h/week) than those without team support (7.0 h/week, P<0.001), although no significant interaction effect was found when compared with all clinicians ( P=0.186). Cardiologists with a high online income (>5 000 Yuan/month) reported a significantly longer weekly investment time in remote management (25.0 h) compared to those with lower income (<200 yuan/month; 8.0 h, P<0.001). However, whether the income met their personal expectations had no significant effect on their time commitment ( P=0.638). Conclusions:Clinicians from tertiary hospitals and tier 3 cities demonstrated a higher level of engagement in remote patient management. Strengthening hospital policy support, enhancing team-based collaborations, and increasing online income levels may help promote the broader adoption of telemedicine.

Objective:To analyze the current status and factors influencing clinician participation in remote patient management in China.Methods:In December 2023, a structured electronic questionnaire was administered to 7 980 clinicians, including 930 cardiologists. The survey assessed clinicians′ participation in online doctor-patient interactions; differences in hospital support across city tiers, hospital grades, professional titles, and departments; and factors influencing the willingness of clinicians to invest time in remote patient management.Results:Among the 7 980 surveyed clinicians, online consultations had the highest participation rate (72.2%). Among cardiologists, participation rates for online consultations, health education, and post-consultation management were 73.3%, 66.9%, and 38.5%, respectively, which were relatively higher than those of other specialties. Hospital-based support for physicians in remote patient management showed significant variations across specialties and regions. Among cardiologists, 68.4% received "encouraging" policies, with the majority falling under "encouragement without incentive policies" (42.6%). In tier 3 cities, the proportion of physicians receiving "encouragement without incentive policies" was the highest (47.9%), while the proportion in the "cautious, requiring reporting" category was the lowest (3.9%). During remote patient management, the proportions of clinicians receiving support from professional teams were highest among those in tier 3 cities (29.6%) and cardiologists (30.5%). A significant interaction effect was observed between hospital policy and specialty (cardiologists vs. all clinicians) regarding physicians′ willingness to invest time in remote patient management ( F=5.95, P<0.001). Among cardiologists, those working in institutions with "encouraging, with incentives" policies reported a significantly longer median weekly investment time (10.0 h) compared to those under "neutral, unrestricted" policies (7.0 h, P<0.001). Cardiologists with team support reported a significant increase in the time they were willing to invest (10 h/week) than those without team support (7.0 h/week, P<0.001), although no significant interaction effect was found when compared with all clinicians ( P=0.186). Cardiologists with a high online income (>5 000 Yuan/month) reported a significantly longer weekly investment time in remote management (25.0 h) compared to those with lower income (<200 yuan/month; 8.0 h, P<0.001). However, whether the income met their personal expectations had no significant effect on their time commitment ( P=0.638). Conclusions:Clinicians from tertiary hospitals and tier 3 cities demonstrated a higher level of engagement in remote patient management. Strengthening hospital policy support, enhancing team-based collaborations, and increasing online income levels may help promote the broader adoption of telemedicine.

Objective:To investigate the current awareness of large language models (LLM) among Chinese clinical physicians and analyze the application needs of cardiovascular specialists.Methods:This is a cross-sectional study utilized convenience sampling. In December 2023, a self-designed questionnaire was distributed to 7 980 clinical physicians, including 930 cardiologists. The survey collected demographic information, including work city (categorized as first-tier, new first-tier, second-tier, third-tier, and fourth-tier and below), hospital level, professional title, and department. And the awareness of LLM, and their application demands in clinical decision-making support, information filtering, and scientific research work were also collected. Differences in awareness and application requirements across geographic regions, hospital tiers, professional ranks, and medical departments were analyzed. Besides, specific demands of cardiovascular specialists were further examined.Results:Among the 7 980 clinical physicians, the awareness rate of LLM was 76.3% (6 088/7 980), and the utilization rate was 11.8% (942/7 980). For the 930 cardiologists, the awareness rate was 78.5% (730/930) and the utilization rate was 11.4% (106/930). Significant differences in awareness and utilization rates were observed across city tiers, hospital grades, and departments (all P<0.05). No significant difference was found among professional titles ( P=0.053). Among the 6 088 physicians aware of LLM, demand rates for clinical information filtering, clinical decision support, and research assistance were 87.3% (5 312/6 088), 78.4% (4 774/6 088), and 75.8% (4 616/6 088), respectively. For the 730 cardiologists aware of LLM, these rates were 91.0% (664/730), 79.2% (578/730), and 75.9% (554/730), respectively. Significant differences in demands for clinical information filtering and research assistance were observed across city tiers, hospital grades, professional titles, and departments (all P<0.05), while no significant difference was noted for decision support demands across hospital grades ( P=0.085). In clinical information screening and acquisition, cardiologists from different city tiers exhibited statistically significant differences in the demand for literature interpretation. Similarly, variations in the demand for conference summaries, expert biographies, healthcare policies, and social news were noted among cardiologists with different professional titles, while disparities in patient education and science popularization needs were identified across city tiers and hospital grades (all P<0.05). In clinical decision-making support, cardiologists from diverse city tiers and professional titles demonstrated distinct differences in guideline and consensus inquiries, and those from various city tiers showed varied demands for pharmaceutical and medical device-related content (all P<0.05). For research support, cardiologists across city tiers and professional titles exhibited statistically significant differences in trial protocol design requirements, while those from varying city tiers differed in literature search/analysis and research application procedures. Additionally, physicians from different hospital grades displayed divergent needs for data collection (all P<0.05). Conclusions:The adoption of LLM is significantly influenced by regional disparities, institutional resources, and professional backgrounds. Implementing targeted interventions, such as enhancing technical training, optimizing LLM functionalities, and improving accessibility across diverse healthcare settings, could encourage widespread integration of LLM into clinical practice. Such measures could ultimately enhance the quality and efficiency of medical services in China and foster innovations in healthcare delivery.

A two-stage-based generative adversarial network incorporating contextual transformer is proposed for synthesis and multiclass classification of pulmonary nodules.Contextual transformer adopts a channel-enhanced multi-head contextual transformer mechanism which combines channel attention and multi-head contextual transformer to better deal with the complex semantic relationship in the feature space,thereby effectively enhancing the feature extraction capability of the model.A two-stage-based generative adversarial network framework is used to achieve the injection of pulmonary nodules in the designated lung area,and divide the synthesis task into two stages.In the first stage,pulmonary nodule regions of interest images are generated and then fused with designated lung parenchyma through a Poisson blending module to generate preliminary samples;in the second stage,an improved CycleGAN model is used to fine-tune the preliminary samples.Meanwhile,the skip layer excitation module and auxiliary classifier are introduced into the discriminator for realizing the re-correction of the feature channel and the classification of pulmonary nodules.Experiments on LIDC-IDRI dataset reveal that the proposed method has a FID,IS and KID of 115.153,2.619±0.095 and 0.062 on pulmonary nodule synthesis,and achieves an accuracy,sensitivity,F1 value and AUC of 70.23%,68.66%,68.92%and 87.59%on pulmonary nodule malignancy classification,respectively,outperforming GAN-based classification models such as ADGAN,as well as benchmark networks such as VGG16.

A two-stage-based generative adversarial network incorporating contextual transformer is proposed for synthesis and multiclass classification of pulmonary nodules.Contextual transformer adopts a channel-enhanced multi-head contextual transformer mechanism which combines channel attention and multi-head contextual transformer to better deal with the complex semantic relationship in the feature space,thereby effectively enhancing the feature extraction capability of the model.A two-stage-based generative adversarial network framework is used to achieve the injection of pulmonary nodules in the designated lung area,and divide the synthesis task into two stages.In the first stage,pulmonary nodule regions of interest images are generated and then fused with designated lung parenchyma through a Poisson blending module to generate preliminary samples;in the second stage,an improved CycleGAN model is used to fine-tune the preliminary samples.Meanwhile,the skip layer excitation module and auxiliary classifier are introduced into the discriminator for realizing the re-correction of the feature channel and the classification of pulmonary nodules.Experiments on LIDC-IDRI dataset reveal that the proposed method has a FID,IS and KID of 115.153,2.619±0.095 and 0.062 on pulmonary nodule synthesis,and achieves an accuracy,sensitivity,F1 value and AUC of 70.23%,68.66%,68.92%and 87.59%on pulmonary nodule malignancy classification,respectively,outperforming GAN-based classification models such as ADGAN,as well as benchmark networks such as VGG16.

Objective:To apply CBL combined with PBL based on SMART (specific, measurable, attainable, relevant and time-based) principle in nursing practice teaching in radiotherapy.Methods:A total of 100 nurses who performed nursing practice in the Department of Radiotherapy in Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2016 to May 2020 were selected as the research objects. They were divided into a control group and a study group according to their admissions, with 50 people in each group. The study group used CBL combined with PBL teaching based on SMART principle, and the control group used traditional practice teaching. After the clinical practice, the two groups were assessed on theoretical and clinical practice skills, and the two groups' teaching satisfaction and teaching effects were evaluated through seminars and questionnaire surveys. SPSS 22.0 was used for t test and chi-square test. Results:The theoretical and clinical practice performance assessment scores of the practical nurses in the study group were higher than those in the control group, with statistically significant differences ( P<0.001). The teaching satisfaction rate of the practice nurses in the control group was 62.00% (31/50), and that of the practice nurses in the study group was 96.00% (48/50), with significant differences ( P<0.001). In terms of improving independent learning ability, information acquisition and problem analysis ability, improving clinical thinking ability, mobilizing learning enthusiasm, enhancing teamwork ability, nurse-patient communication ability, and recognition of innovation ability, the teaching satisfaction of the research group was higher than that of the control group. Conclusion:The application of SMART principle in teaching has the advantages of clear goals and quantifiable evaluation. The combination of CBL and PBL based on SMART principle can help to improve the mastery of theoretical and practical skills of radiotherapy practice nurses, and achieve satisfactory teaching results.

Objective:To investigate the safety and effectiveness of multi-stent overlapping assisted coil embolization for ruptured intracranial blood blister-like aneurysms (BBA).Methods:Patients with intracranial BBA admitted to the Affiliated Quanzhou First Hospital of Fujian Medical University and treated with multi-stent overlapping assisted coil embolization from January 2013 to January 2019 were enrolled retrospectively. The embolization rate immediately after procedure, modified Rankin Scale (mRS) score at discharge, aneurysm embolization rate, recurrence rate and mRS scores at 3 months after procedure were collected.Results:A total of 38 patients with BBA were enrolled, including 21 females (55.3%) and 17 males (44.7%); their age was 54±9.3 years (range, 29-71 years); the maximum diameter of aneurysm was 5.1±1.0 mm, and the diameter of aneurysm neck was 4.9±0.7 mm. Raymond grading showed that the complete embolization rate immediate after procedure was 71.1%, the residual rate of aneurysmal neck was 18.4%, and the residual rate of aneurysmal body was 10.5%. During the perioperative period, 2 patients had stent thrombosis and 2 had intraoperative aneurysm hemorrhage. Imaging follow-up at 3 months after procedure showed that the aneurysms of 31 cases (83.8%) disappeared completely, 4 (10.8%) improved, and 2 (5.4%) recanalized. The good clinical outcome rate (mRS score ≤ 2) was 81.1%, 1 patient (2.6%) died, and no postoperative rebleeding occurred.Conclusion:Multi-stent overlapping assisted coil embolization is a safe and effective surgical method for the treatment of ruptured intracranial BBA.

Objective: In this study we analyzed the genetic characteristics of echovirus 30 (E-30) VP1 gene sequences from Yunnan province isolated from viral meningitis (VM) cases in 2010-2013. Methods: RT-PCR and VP1 gene sequencing were done for 9 E-30 strains isolated from VM cases in 2010-2013. VP1 gene sequences of E-30 reference strains were downloaded from the GenBank and their nucleotide (nt) and amino acid (aa) diversities were calculated by MEGA 5.1 software, the phylogenetic tree was constructed and the genetic characteristics and molecular epidemiology were analyzed. Results: In 2010-2013, 9 strains of E-30 viruses were detected from 79 VM cases caused by echoviruses, accounting for 11.39%(9/79), the overall positive rate was 1.63%(9/553). Phylogenetic analysis revealed that E-30 strains can be divided into four genotypes (genotype A, B, C and D), and genotype D can be further divided into seven sub-genotypes. Nine Yunnan VM isolates were distributed in D7 sub-genotype, and can be further clustered into 3 branches: 5 strains isolated in 2010 were clustered in branch 1, it is evident that these viruses were responsible for an aseptic meningitis outbreak in Kunming in that year; one 2011 isolate, together with 2013 isolate and one isolate from healthy children in 2010 were clustered in branch 2, these two branches were Yunnan special branches, and two 2011 isolates had the highest homology with 2003 VM outbreaks′ strains isolated from Shandong, Jiangsu, and Zhejiang, showing that these strains may have the same evolutionary sources. Conclusions Nine Yunnan VM isolates were distributed in D7 sub-genotype, and these strains have different evolutionary sources, showing that at different times E-30 viruses in the same sub-genotypes branch might prevail in different areas.