Objective:To describe the hotspots and application trends of artificial intelligence (AI) in epidemiology in the past decade and analyze its advantages and challenges.Methods:The literatures with AI and epidemiology related keywords were systematically retrieved from Web of Science and China National Knowledge Infrastructure from 2014 to 2024. CiteSpace was used for bibliometric analysis of publication volume, keyword co-occurrence, clustering, emergence and cited literature co-occurrence analysis.Results:A total of 5 389 English papers and 1 659 Chinese papers were included, showing an increasing publication trend. High-frequency Chinese keywords included prediction, influencing factor, and machine learning, while English keywords frequently used were machine learning, prediction, and artificial intelligence. The Chinese keywords formed 14 clusters such as epidemiological characteristic, dietary pattern, and elderly individual, and the English keywords formed 21 clusters including prediction model, risk factor, and adult. In international studies, health policy, COVID-19, and digital health were the emerging frontier keywords. Eleven core papers were selected, covering key areas like traffic accident risk assessment, public health big data application, and deep learning in medical diagnosis.Conclusions:This study systematically summarized the research hotspots and development trends of AI applications in epidemiology over the past decade by using bibliometric methods, which indicated that current AI-based epidemiological studies are still in the exploratory phase, with the coexisting of both advantages and challenges. Continued attention should be paid to the future development of this field.

Objective:To investigate the clinical efficacy of botulinum toxin type A（BTX-A）bladder injection in the treatment of neurogenic detrusor overactivity（NDO）with autonomic dysreflexia（AD）.Methods:The patients with spinal cord injury at or above T6，who were treated at Guangdong Provincial Work Injury Rehabilitation Hospital from January 2018 to December 2022，were included in this study prospectively. Inclusion criteria：①chronic spinal cord injury patients over 18 years old（with no progression of neurological symptoms within 3 months）；② presence of NDO and AD；③ inadequate response or intolerance to oral antimuscarinic agent（M-receptor antagonists or β 3-receptor agonists）④ perform clean intermittent catheterization to empty the bladder. Exclusion criteria：① primary disease in the acute or progressive phase；② previous surgeries that would affect lower urinary tract function，such as transurethral sphincterotomy，bladder neck resection，prostatectomy，or bladder surgery；③ allergy to BTX-A or its adjuvants，or those with allergic predisposition ④ patients who were pregnant，breastfeeding，or planning for pregnancy in the near future；⑤ patients did not accept or were unable to perform intermittent catheterization. Before treatment，all patients were required to maintain 3-5 day urine diary，along with urodynamic studies（UDS），incontinence specific quality of life instrument（I-QOL）and AD symptom severity assessment，and blood pressure monitored. Key UDS parameters recorded included maximum bladder capacity，maximum detrusor pressure during filling phase，changes in maximum systolic blood pressure（SBP）relative to baseline（ΔSBP）during UDS examination，and the frequency of 24-hour blood pressure exceeding baseline by 20 mmHg. After general anesthesia or epidural anesthesia，BTX-A（200 U）was injected into the bladder at 30 points（including the triangle）under the cystoscope using a special injection needle，6.7 U per injection，and then the catheter was kept for 3-5 days after treatment. Three months later，relevant indicators were collected and compared with pre-treatment data. Results:A total of 43 patients were included in this study，including 34 males and 9 females. The age was（39.23±13.17）years old and the disease course was（2.69±3.27）years old. There were 33 cervical and 10 thoracic cases. The American Spinal Injury Association Injury Scale score distribution was as follows：26（60%）A，4（9%）B，9（21%）C，and 4（9%）D. The presence of AD was confirmed in all patients during urodynamic examination（UDS），that was the systolic blood pressure（SBP）suddenly increased and exceeded 20 mmHg（1 mmHg = 0.133 kPa）. Before treatment，The AD symptoms severity score（consist of headache，sweating，goose bumps，anxiety and palpitation）were（14.53±2.51），Bladder-related AD frequency was 10.67 episodes/day. Baseline SBP was（103.51±9.64）mmHg，the maximum SBP was（150.40±22.75）mmHg，and the change in SBP（ΔSBP）from maximum to baseline SBP during UDS examination was（43.83±21.01）mmHg. The UDS indicated that the maximum detrusor pressure during storage phase was（54.95±24.68）cmH 2O，and the bladder capacity was（131.70±75.29）ml. Bladder diary showed the volume of catheterization each time from was（181.16±49.86）ml，and The I-QOL score was（44.07±8.60）. Three months after treatment，the AD symptoms severity score（consist of headache，sweating，goose bumps，anxiety and palpitation）were（11.37±2.39）. The frequency of bladder-related AD episodes was（7.51±2.37）episodes/day，showing statistically significant differences compared to pre-treatment（ P<0.05）.The SBP before UDS examination was（102.12±10.28）mmHg，with no statistically significant difference from baseline（ P = 0.518）. The maximum SBP in perfusion phase and the ΔSBP were（132.84±16.30）mmHg and（28.72 ± 14.02）mmHg，respectively，both demonstrating statistically significant differences（ P < 0.05）. The UDS examination revealed that the maximum detrusor pressure during the storage phase was（29.77±13.72）cmH 2O，showed a significant decrease，and the bladder capacity was（272.63±79.75）ml，which were both statistically different before and after surgery. Bladder diary showed the volume of catheterization each time was（326.74±63.71）ml；I-QOL score was（71.86±11.45），both were significant different after treatment（ P < 0.01）. Conclusion:BTX-A intravesical injection in the treatment of NDO can also alleviate the severity and frequency of bladder related AD.

This study summarizes the preoperative and intraoperative nursing experience in 5 cases of bridge-to-transplant heart transplantation with left ventricular assist device(LVAD)explant.Key points of nursing include:preoperative care and assessment of LVAD patients,preoperative discussion of the multidisciplinary team,safe transfer of patients to surgical rooms and other preoperative preparation,cardiomyocardial protection and multidisciplinary team cooperation during bridging transplantation,and intra-operative patient safety management.All 5 patients in this group successfully completed the surgery and were discharged.Pressure sores,wound infections,and other postoperative complications have not occurred.Postoperative cardiac function of 5 patients in this group were classified as New York Heart Association class Ⅰ～Ⅱ.The follow-up period for the 5 patients in this group ranged from 6 months to 6 years.The results of the most recent echocardiography follow-up showed that the left ventricular ejection fraction of all patients was all above 65％,with well prognosis.

Objective:To develop an intelligent surveillance system for identifying upper gastrointestinal high-risk patients and assigning surveillance intervals, and to verify its efficacy.Methods:The endoscopic and pathological reports of 23 035 patients undergoing endoscopy at Renmin Hospital of Wuhan University from January to October 2021 were collected retrospectively. A training set of 17 934 patients (January to August) and a test set of 5 101 patients (September to October) were established. Keywords in the endoscopic and pathological reports were extracted by the intelligent surveillance system, and high-risk patients were automatically identified and classified into 7 risk levels. Then the standardized surveillance intervals were assigned based on the guideline. Guideline-based surveillance intervals assigned by expert endoscopists based on endoscopic and pathological reports were used as the golden standard. The accuracy of the intelligent surveillance system was calculated. Of the patients within the test set, 189 were hospitalized and the surveillance intervals given by physicians could be obtained from the electronic health records. The accuracy of the intelligent surveillance system with that of physicians from different departments was compared. Then 67 patients were randomly selected from 189 patients by simple random sampling to evaluate the adjunctive effect of the system in assigning surveillance intervals among 3 endoscopists.Results:The overall accuracy of the intelligent surveillance system in identifying upper gastrointestinal high-risk patients was 99.94% (5 098/5 101), and that of assigning surveillance intervals to correctly included patients was 100.00% (534/534). The intelligent surveillance system achieved significantly higher accuracy compared with all physicians from different departments [98.94% (187/189) VS 35.45% (67/189), χ2=118.01, P<0.001] as well as physicians from department of gastroenterology [100.00% (117/117) VS 24.79% (29/117), χ2=86.01, P<0.001]. With the assistance of the intelligent surveillance system, the endoscopists' accuracy of assigning surveillance intervals to 67 patients was significantly improved [55.22% (111/201) VS 22.39% (45/201), χ2=58.68, P<0.001]. Conclusion:The intelligent surveillance system can accurately identify upper gastrointestinal high-risk patients and assign surveillance intervals according to risk levels, which can alleviate the workload of doctors and improve the follow-up rate of patients.

Objective:To explore status and influencing factors of surveillance in colorectal post-polypectomy patients.Methods:Patients who underwent colorectal polypectomy in Renmin Hospital of Wuhan University between April 1, 2019 and June 30, 2019 were retrospectively studied. The surveillance information was obtained through electronic health record and telephone call. Status and influencing factors of surveillance in colorectal post-polypectomy patients were evaluated. Logistic regression model was used for multivariate analysis to determine independent risk factors influencing surveillance.Results:A total of 268 colorectal post-polypectomy patients and their surveillance information were reviewed, of whom 153 (57.09%) patients received surveillance colonoscopy, and 115 (42.91%) patients did not. Univariate analysis showed that the source of patients (outpatients VS inpatients, χ 2=5.68, P=0.017), department (others VS department of gastroenterology, χ 2=6.64, P=0.010), and the number of polyps (1/(2~4)/≥5, χ2=7.32, P=0.026) influenced the outcome of surveillance. Logistic regression model indicated that department of gastroenterology ( P=0.039, OR=2.12, 95% CI:1.04-4.34), risk level 3 ( P=0.040, OR=1.92, 95% CI:1.03-3.58) and the number of polyps ≥5 ( P=0.016, OR=2.89, 95% CI:1.22-6.83) were independent risk factors influencing surveillance. Conclusion:Patients visit the department of gastroenterology or had a risk level 3 or ≥5 polyps are more likely to opt for surveillance following the procedure.

The emergence of artificial intelligence(AI)has had a significant impact on medical research and practice,both in terms of the number of studies and research paradigms,and has become an important tool for the development of pharmacoepidemiology.However,traditional AI has faced many challenges,while facilitating pharmacoepidemiology research,such as complex data processing,difficulty in identifying drug exposures and potential outcomes,and time-consuming and laborious study design and implementation.The rapid development of generative AI,represented by large language models(LLMs),has demonstrated a unique potential to enhance research efficiency,shift research paradigms,and facilitate knowledge discovery.LLMs are equipped with natural language understanding and generation capabilities.Through deep mining of multi-dimensional data resources,LLMs can quickly and accurately extract,analyze,summarize,and present the required information,which can not only help drug discovery,drug repurposing,pharmacovigilance and other pharmacoepidemiological tasks,but also provide powerful support for the whole process of research protocol design,data analysis,result interpretation and paper publication.Driven by LLMs,pharmacoepidemiology research is gradually moving into a new stage based on big data and automated analysis.Of course,LLMs also have problems of data bias,"illusion"of results,and ethical and legal regulation.By strengthening interdisciplinary cooperation,establishing a standardized evaluation system,improving ethical and regulatory guidance,enhancing data quality,strengthening practitioner training and capacity building,and promoting human-machine collaborative research modes,it is expected that the potential of LLMs in pharmacoepidemiology will be fully released,and it will provide a more scientific,rapid,and efficient technological support for drug regulation and public health decision-making.

The emergence of artificial intelligence(AI)has had a significant impact on medical research and practice,both in terms of the number of studies and research paradigms,and has become an important tool for the development of pharmacoepidemiology.However,traditional AI has faced many challenges,while facilitating pharmacoepidemiology research,such as complex data processing,difficulty in identifying drug exposures and potential outcomes,and time-consuming and laborious study design and implementation.The rapid development of generative AI,represented by large language models(LLMs),has demonstrated a unique potential to enhance research efficiency,shift research paradigms,and facilitate knowledge discovery.LLMs are equipped with natural language understanding and generation capabilities.Through deep mining of multi-dimensional data resources,LLMs can quickly and accurately extract,analyze,summarize,and present the required information,which can not only help drug discovery,drug repurposing,pharmacovigilance and other pharmacoepidemiological tasks,but also provide powerful support for the whole process of research protocol design,data analysis,result interpretation and paper publication.Driven by LLMs,pharmacoepidemiology research is gradually moving into a new stage based on big data and automated analysis.Of course,LLMs also have problems of data bias,"illusion"of results,and ethical and legal regulation.By strengthening interdisciplinary cooperation,establishing a standardized evaluation system,improving ethical and regulatory guidance,enhancing data quality,strengthening practitioner training and capacity building,and promoting human-machine collaborative research modes,it is expected that the potential of LLMs in pharmacoepidemiology will be fully released,and it will provide a more scientific,rapid,and efficient technological support for drug regulation and public health decision-making.

Objective:To describe the hotspots and application trends of artificial intelligence (AI) in epidemiology in the past decade and analyze its advantages and challenges.Methods:The literatures with AI and epidemiology related keywords were systematically retrieved from Web of Science and China National Knowledge Infrastructure from 2014 to 2024. CiteSpace was used for bibliometric analysis of publication volume, keyword co-occurrence, clustering, emergence and cited literature co-occurrence analysis.Results:A total of 5 389 English papers and 1 659 Chinese papers were included, showing an increasing publication trend. High-frequency Chinese keywords included prediction, influencing factor, and machine learning, while English keywords frequently used were machine learning, prediction, and artificial intelligence. The Chinese keywords formed 14 clusters such as epidemiological characteristic, dietary pattern, and elderly individual, and the English keywords formed 21 clusters including prediction model, risk factor, and adult. In international studies, health policy, COVID-19, and digital health were the emerging frontier keywords. Eleven core papers were selected, covering key areas like traffic accident risk assessment, public health big data application, and deep learning in medical diagnosis.Conclusions:This study systematically summarized the research hotspots and development trends of AI applications in epidemiology over the past decade by using bibliometric methods, which indicated that current AI-based epidemiological studies are still in the exploratory phase, with the coexisting of both advantages and challenges. Continued attention should be paid to the future development of this field.

This study summarizes the preoperative and intraoperative nursing experience in 5 cases of bridge-to-transplant heart transplantation with left ventricular assist device(LVAD)explant.Key points of nursing include:preoperative care and assessment of LVAD patients,preoperative discussion of the multidisciplinary team,safe transfer of patients to surgical rooms and other preoperative preparation,cardiomyocardial protection and multidisciplinary team cooperation during bridging transplantation,and intra-operative patient safety management.All 5 patients in this group successfully completed the surgery and were discharged.Pressure sores,wound infections,and other postoperative complications have not occurred.Postoperative cardiac function of 5 patients in this group were classified as New York Heart Association class Ⅰ～Ⅱ.The follow-up period for the 5 patients in this group ranged from 6 months to 6 years.The results of the most recent echocardiography follow-up showed that the left ventricular ejection fraction of all patients was all above 65％,with well prognosis.

Objective:To investigate the clinical efficacy of botulinum toxin type A（BTX-A）bladder injection in the treatment of neurogenic detrusor overactivity（NDO）with autonomic dysreflexia（AD）.Methods:The patients with spinal cord injury at or above T6，who were treated at Guangdong Provincial Work Injury Rehabilitation Hospital from January 2018 to December 2022，were included in this study prospectively. Inclusion criteria：①chronic spinal cord injury patients over 18 years old（with no progression of neurological symptoms within 3 months）；② presence of NDO and AD；③ inadequate response or intolerance to oral antimuscarinic agent（M-receptor antagonists or β 3-receptor agonists）④ perform clean intermittent catheterization to empty the bladder. Exclusion criteria：① primary disease in the acute or progressive phase；② previous surgeries that would affect lower urinary tract function，such as transurethral sphincterotomy，bladder neck resection，prostatectomy，or bladder surgery；③ allergy to BTX-A or its adjuvants，or those with allergic predisposition ④ patients who were pregnant，breastfeeding，or planning for pregnancy in the near future；⑤ patients did not accept or were unable to perform intermittent catheterization. Before treatment，all patients were required to maintain 3-5 day urine diary，along with urodynamic studies（UDS），incontinence specific quality of life instrument（I-QOL）and AD symptom severity assessment，and blood pressure monitored. Key UDS parameters recorded included maximum bladder capacity，maximum detrusor pressure during filling phase，changes in maximum systolic blood pressure（SBP）relative to baseline（ΔSBP）during UDS examination，and the frequency of 24-hour blood pressure exceeding baseline by 20 mmHg. After general anesthesia or epidural anesthesia，BTX-A（200 U）was injected into the bladder at 30 points（including the triangle）under the cystoscope using a special injection needle，6.7 U per injection，and then the catheter was kept for 3-5 days after treatment. Three months later，relevant indicators were collected and compared with pre-treatment data. Results:A total of 43 patients were included in this study，including 34 males and 9 females. The age was（39.23±13.17）years old and the disease course was（2.69±3.27）years old. There were 33 cervical and 10 thoracic cases. The American Spinal Injury Association Injury Scale score distribution was as follows：26（60%）A，4（9%）B，9（21%）C，and 4（9%）D. The presence of AD was confirmed in all patients during urodynamic examination（UDS），that was the systolic blood pressure（SBP）suddenly increased and exceeded 20 mmHg（1 mmHg = 0.133 kPa）. Before treatment，The AD symptoms severity score（consist of headache，sweating，goose bumps，anxiety and palpitation）were（14.53±2.51），Bladder-related AD frequency was 10.67 episodes/day. Baseline SBP was（103.51±9.64）mmHg，the maximum SBP was（150.40±22.75）mmHg，and the change in SBP（ΔSBP）from maximum to baseline SBP during UDS examination was（43.83±21.01）mmHg. The UDS indicated that the maximum detrusor pressure during storage phase was（54.95±24.68）cmH 2O，and the bladder capacity was（131.70±75.29）ml. Bladder diary showed the volume of catheterization each time from was（181.16±49.86）ml，and The I-QOL score was（44.07±8.60）. Three months after treatment，the AD symptoms severity score（consist of headache，sweating，goose bumps，anxiety and palpitation）were（11.37±2.39）. The frequency of bladder-related AD episodes was（7.51±2.37）episodes/day，showing statistically significant differences compared to pre-treatment（ P<0.05）.The SBP before UDS examination was（102.12±10.28）mmHg，with no statistically significant difference from baseline（ P = 0.518）. The maximum SBP in perfusion phase and the ΔSBP were（132.84±16.30）mmHg and（28.72 ± 14.02）mmHg，respectively，both demonstrating statistically significant differences（ P < 0.05）. The UDS examination revealed that the maximum detrusor pressure during the storage phase was（29.77±13.72）cmH 2O，showed a significant decrease，and the bladder capacity was（272.63±79.75）ml，which were both statistically different before and after surgery. Bladder diary showed the volume of catheterization each time was（326.74±63.71）ml；I-QOL score was（71.86±11.45），both were significant different after treatment（ P < 0.01）. Conclusion:BTX-A intravesical injection in the treatment of NDO can also alleviate the severity and frequency of bladder related AD.