Large language models (LLMs) such as ChatGPT, Claude, Llama, and Qwen are emerging as transformative technologies for the diagnosis and treatment of various diseases. With their exceptional long-context reasoning capabilities, LLMs are proficient in clinically relevant tasks, particularly in medical text analysis and interactive dialogue. They can enhance diagnostic accuracy by processing vast amounts of patient data and medical literature and have demonstrated their utility in diagnosing common diseases and facilitating the identification of rare diseases by recognizing subtle patterns in symptoms and test results. Building on their image-recognition abilities, multimodal LLMs (MLLMs) show promising potential for diagnosis based on radiography, chest computed tomography (CT), electrocardiography (ECG), and common pathological images. These models can also assist in treatment planning by suggesting evidence-based interventions and improving clinical decision support systems through integrated analysis of patient records. Despite these promising developments, significant challenges persist regarding the use of LLMs in medicine, including concerns regarding algorithmic bias, the potential for hallucinations, and the need for rigorous clinical validation. Ethical considerations also underscore the importance of maintaining the function of supervision in clinical practice. This paper highlights the rapid advancements in research on the diagnostic and therapeutic applications of LLMs across different medical disciplines and emphasizes the importance of policymaking, ethical supervision, and multidisciplinary collaboration in promoting more effective and safer clinical applications of LLMs. Future directions include the integration of proprietary clinical knowledge, the investigation of open-source and customized models, and the evaluation of real-time effects in clinical diagnosis and treatment practices.
Humans ; Large Language Models ; Tomography, X-Ray Computed

Objective:To analyze the genetic characteristics of coxsackievirus A16 (CVA16) related to hand, foot and mouth disease (HFMD) in Jiaxing from 2021 to 2023, and understand the biological and molecular evolutionary characteristics of CVA16 in this city.Methods:Real-time fluorescent quantitative PCR was used to detect enterovirus and its types in collected HFMD case samples. At the same time, virus isolation and cultivation were performed on positive samples using RD cells. Then high-throughput sequencing of the whole genome was performed on 23 strains of CVA16 identified from the isolated samples. Finally we obtained its whole genome sequence. DNAStar, MEGA 6.0, Simplot 3.5.1 and other bioinformatics software were used to compare and analyze the sequences, construct the phylogenetic tree of VP1 region, and realize the genotype composition. And these software were also used to analyze the homology of the whole genome nucleotide sequence and the encoded amino acids, while know well the amino acid mutation sites and gene recombination in the main regions.Results:The results showed that among the 1 836 HFMD specimens tested from 2021 to 2023, 1 432 (78.00%, 1 432/1 836) were positive for enterovirus general genes, of which 263 were positive for CVA16, accounting for 18.37% (263/1 432) of the confirmed positive cases. Twenty-three CVA16 strains were sequenced and all of them were B1 subtype, of which 6 strains belong to B1b and 17 strains belong to B1a, with B1a being dominant. B1a strains in Jiaxing showed genetic relatedness to strains isolated in Beijing, Yunnan, Guangzhou, Jiangsu and other places in 2018 to 2023, as well as strains from Vietnam, Thailand, and Australia from 2015 to 2017. B1b strains exhibited consistent amino acid mutations of L23M in the VP1 region and V217I in the VP2 region, while B1a strains exhibited amino acid mutations of S14N/D, T164K, and V251I in the VP1 region and R41H in the VP3 region. Compared with the prototype strain, the 23 strains of CVA16 in Jiaxing accumulated the largest number of amino acid mutations in the coding region, with 28 and 50 mutations in the VP1 and 3D regions, respectively. The recombination patterns of B1a and B1b strains were slightly different, with B1a type showing recombination with CVA8 in the 5′-UTR region instead of CVA4, B1a was similar to enterovirus A71 in most of P2 and P3 regions, and recombined with CVA5 in the 3D region of P3.Conclusions:The prevalent strain of CVA16 in Jiaxing may share a common trend of co-circulation and evolution with those in other provinces. The recombination mainly occurs in the 5′-UTR region and non-structural protein coding regions of P2 and P3. Continuous molecular surveillance of CVA16 is in need, and whole-genome sequencing can help understand the genetic variation, evolution, and recombination of strains.This information will provide a more robust basis for the monitoring and early warning, vaccine development, and prevention and control efforts against HFMD.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To investigate the expression levels of microRNA-34a(miR-34a),β-catenin and pro-grammed death receptor-1(PD-L1)in cancer tissues of patients with cervical cancer(CC)and their correla-tion with patients' prognosis.Methods A total of 83 patients with CC admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from June 2021 to January 2024 were selected as the research objects.General data,CC tissue and adjacent normal tissue samples of all patients were collected.The mRNA expres-sion levels of miR-34a,β-catenin and PD-L1 in CC tissues and adjacent normal tissues were detected by fluo-rescence quantitative PCR and compared.The expression levels of β-catenin and PD-L1 in CC tissues and adja-cent normal tissues were detected by immunohistochemistry.Multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in CC patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of miR-34a,β-catenin and PD-L1 expression levels in CC pa-tients with poor prognosis.Results Compared with adjacent normal tissues,the expression level of miR-34a of the CC tissues was lower,while the expression levels of β-catenin and PD-L1 were higher(P＜0.05).The positive expression rates of β-catenin and PD-L1 protein in CC tissues were higher than those of adjacent nor-mal tissues(89.16％vs.10.84％,78.31％vs.20.48％,x2=101.807,55.526,P＜0.05).There were no sig-nificant differences in age and body mass index(BMI)between the good prognosis group and the poor progno-sis group(t=1.508,1.820,both P＞0.05),while there were significant differences in International Federa-tion of Gynecology and Obstetrics(FIGO)stage and differentiation degree between the two groups(x2=8.451,9.115,both P＜0.05).Compared with the good prognosis group,the expression level of miR-34a of the poor prognosis group was lower,while the expression levels of β-catenin and PD-L1 were higher(P＜0.05).Multivariate Logistic regression analysis showed that increased expression of miR-34a was an protective factor for poor prognosis in CC patients,while the increased expression levels of β-catenin and PD-L1,Ⅱ a and Ⅱ b FIGO staging and low differentiation were independent risk factors for poor prognosis in CC patients(P＜0.05).ROC curve analysis showed that miR-34a,β-catenin and PD-L1 all had certain predictive value for the poor prognosis of CC patient,and the area under the curve(AUC)of the single detection was 0.765,0.836 and 0.797,respectively.The AUC of the combined detection was 0.914(Z=2.631,2.331,2.571,P=0.009,0.020,0.010).Conclusion The expression levels of miR-34a,β-catenin and PD-L1 mRNA affect the prognosis of CC patients.Increased expression of miR-34a is an protective factor for poor prognosis in CC patients,in-creased β-catenin and PD-L1 expressions are independent risk factors for poor prognosis in CC patients,and all three factors can be used as biomarkers to predict poor prognosis in CC patients,and the combined detection of the three has the highest prognostic value.

Objective:To construct a risk evaluation system for safe operation of medical equipment of the department of pediatric internal medicine on the basis of comprehensive weight,so as to reduce the risk of operating equipment.Methods:The risk evaluation model of managing medical equipment was constructed by using Delphi method,and the evaluation indicators were weighted by analytic hierarchy process(AHP)and entropy weight method,and then,the safety management for equipment was conducted after the relative weights of indicators at each level were determined.A total of 100 used medical equipment in the department of pediatric internal medicine of Yuncheng Central Hospital of Shanxi Province from January 2022 to December 2023 were selected,and they were managed respectively by conventional management mode(50 equipment)and the management mode with risk evaluation system for safe operation of medical equipment(50 equipment).The quality of equipment operation,safety of clinical use and risk control rate of equipment alarm between the two management modes were compared,as well as the recognition scores of the engineers of equipment,doctors,paramedics and managers of relative department,who used and managed equipment,for the two management modes.Results:The average values of maintenance implementation rate,quality inspection qualification rate,disinfection qualification rate and effective response rate of problems of equipment of using the management mode with risk evaluation system were respectively(93.65±3.65)%,(91.45±3.25)%,(93.14±3.69)%and(94.26±3.14)%,which were all higher than these of conventional management mode,and the differences were statistically significant(t=18.599,12.376,11.746,16.006,P＜0.05).The ratios of device-associated infection,stress injury and body fluid extravasation of risk events were respectively 4%(2/50),6%(3/50)and 6%(3/50),which were lower than those of conventional management mode,and the differences were statistically significant(x2=10.714,8.576,9.756,P＜0.05).The recognition scores of the engineers of equipment,doctors,paramedics and managers of relative department for the equipment management of adopting the management mode with risk evaluation system were respectively(92.14±4.01),(93.54±4.63),(93.65±3.36)and(91.57±3.98)points,which were all higher than these of adopting conventional management mode,and the differences were statistically significant(t=15.798,13.331,15.545,13.940,P＜0.05).The average value of qualified rate of threshold value of equipment alarm,and that of operation and maintenance of equipment of adopting the management mode with risk evaluation system were respectively(98.25±3.54)%and(97.36±4.65)%,which were higher than those of the conventional management mode,and the average value of alarm silence rate of the management mode with risk evaluation system was(2.36±1.54)%,which was lower than that of conventional management mode,and the differences were statistically significant(t=11.207,8.813,10.717,P＜0.05).Conclusion:The application of the risk evaluation system for safe operation of medical equipment of the department of pediatrics on the basis of comprehensive weight in the management for equipment can enhance the safety of operating equipment,and reduce the risk of using equipment,and improve the quality of managing equipment.

Objective:To explore the impact of childhood trauma on drug relapse tendency, as well as the mediating role of post-traumatic stress disorder (PTSD).Methods:From March to May 2017, a total of 403 compulsory drug rehabilitation personnel were selected for a cross-sectional study and then were investigated by the general demography scale, drug relapse risk scale, childhood trauma questionnaire (CTQ), and PTSD checklist for DSM-5(PCL-5).SPSS 27.0 software and PROCESS 4.1 macro program were used for correlation analysis, regression analysis and Bootstrap-based mediation analysis.Results:The scores of negative emotions subscale of drug relapse risk scale, emotional abuse and emotional neglect subscales of CTQ had no significant gender differences(all P>0.05).There were gender differences in relapse tendency, childhood trauma, and PTSD total scores as well as other dimensions ( t/ Z=2.08-4.67, all P<0.05).There were pairwise positive correlations among the total score of the drug relapse risk scale(31.68±9.79), CTQ(39.90±12.13), and PCL-5(11(3, 24)) for compulsory isolation and rehabilitation personnel ( r=0.28, 0.36, 0.37, P<0.05).After controlling for gender, childhood trauma could significantly and positively predict drug relapse tendency( β=0.34, t=7.24, P<0.01), and PTSD played a mediating role between childhood trauma and drug relapse tendency, with the indirect effect of 0.11(95% CI=0.06-0.16). Conclusion:Childhood trauma can affect drug relapse tendency directly, and indirectly through PTSD.

Objective:To explore the effect of CO2 fractional laser combined with glucocorticoid(GC)on T follicular helper cell(Tfh)and B cell subsets in patients with advanced vitiligo(VL).Methods:Patients with advanced VL(128 cases)who were treated in Affiliated Hospital of Hebei University of Engineering from August 2019 to March 2022 were selected as research objects,and divided into group A(64 cases,CO2 fractional laser combined with GC)and group B(64 cases,CO2 fractional laser)according to different treatment methods,clinical efficacy and safety of the two groups were compared.Another healthy subjects(64 cases)were selected as control group.Collected clinical data of the three groups of subjects for comparative analysis.Randomized walking model was used to evaluate the effect of CO2 fractional laser combined with GC on immune function and inflammatory response in patients with advanced VL.Results:Compared with group B,group A had a higher clinical total effective rate(P<0.05)and a lower probability of adverse reactions(P<0.05).After treatment,compared with control group,proportion of Tfh2 and Tfh17 in group A had no significant difference(P>0.05),while proportion of Tfh2 and Tfh17 in group B still had significant difference(P<0.05);compared with group B,proportion of Tfh2 in group A after treatment was higher(P<0.05),while proportion of Tfh17 type was lower(P<0.05).After treat-ment,compared with control group,proportion of memory transformed B cell in group B was still significantly different(P<0.05).After treatment,compared with control group,levels of IgA,IgE and IgM in group B were still significantly different(P<0.05);compared with group B,level of IgM in group A was higher after treatment(P<0.05).After treatment,compared with control group,levels of IL-21 and IL-1β in group B were still significantly different(P<0.05);compared with group B,level of IL-10 in group A after treatment was higher(P<0.05),while levels of IL-21 and IL-1β were lower(P<0.05).Evaluation results of random walking model showed that the improvement of immune function and inflammatory reaction in group A was better than that in group B.Conclusion:CO2 fractional laser combined with GC can improve the immune function and inflammatory reaction of patients with advanced VL better after treatment,and the probability of adverse reactions is lower.

Objective:To explore the impact of childhood trauma on drug relapse tendency, as well as the mediating role of post-traumatic stress disorder (PTSD).Methods:From March to May 2017, a total of 403 compulsory drug rehabilitation personnel were selected for a cross-sectional study and then were investigated by the general demography scale, drug relapse risk scale, childhood trauma questionnaire (CTQ), and PTSD checklist for DSM-5(PCL-5).SPSS 27.0 software and PROCESS 4.1 macro program were used for correlation analysis, regression analysis and Bootstrap-based mediation analysis.Results:The scores of negative emotions subscale of drug relapse risk scale, emotional abuse and emotional neglect subscales of CTQ had no significant gender differences(all P>0.05).There were gender differences in relapse tendency, childhood trauma, and PTSD total scores as well as other dimensions ( t/ Z=2.08-4.67, all P<0.05).There were pairwise positive correlations among the total score of the drug relapse risk scale(31.68±9.79), CTQ(39.90±12.13), and PCL-5(11(3, 24)) for compulsory isolation and rehabilitation personnel ( r=0.28, 0.36, 0.37, P<0.05).After controlling for gender, childhood trauma could significantly and positively predict drug relapse tendency( β=0.34, t=7.24, P<0.01), and PTSD played a mediating role between childhood trauma and drug relapse tendency, with the indirect effect of 0.11(95% CI=0.06-0.16). Conclusion:Childhood trauma can affect drug relapse tendency directly, and indirectly through PTSD.

Objective:To explore the effect of CO2 fractional laser combined with glucocorticoid(GC)on T follicular helper cell(Tfh)and B cell subsets in patients with advanced vitiligo(VL).Methods:Patients with advanced VL(128 cases)who were treated in Affiliated Hospital of Hebei University of Engineering from August 2019 to March 2022 were selected as research objects,and divided into group A(64 cases,CO2 fractional laser combined with GC)and group B(64 cases,CO2 fractional laser)according to different treatment methods,clinical efficacy and safety of the two groups were compared.Another healthy subjects(64 cases)were selected as control group.Collected clinical data of the three groups of subjects for comparative analysis.Randomized walking model was used to evaluate the effect of CO2 fractional laser combined with GC on immune function and inflammatory response in patients with advanced VL.Results:Compared with group B,group A had a higher clinical total effective rate(P<0.05)and a lower probability of adverse reactions(P<0.05).After treatment,compared with control group,proportion of Tfh2 and Tfh17 in group A had no significant difference(P>0.05),while proportion of Tfh2 and Tfh17 in group B still had significant difference(P<0.05);compared with group B,proportion of Tfh2 in group A after treatment was higher(P<0.05),while proportion of Tfh17 type was lower(P<0.05).After treat-ment,compared with control group,proportion of memory transformed B cell in group B was still significantly different(P<0.05).After treatment,compared with control group,levels of IgA,IgE and IgM in group B were still significantly different(P<0.05);compared with group B,level of IgM in group A was higher after treatment(P<0.05).After treatment,compared with control group,levels of IL-21 and IL-1β in group B were still significantly different(P<0.05);compared with group B,level of IL-10 in group A after treatment was higher(P<0.05),while levels of IL-21 and IL-1β were lower(P<0.05).Evaluation results of random walking model showed that the improvement of immune function and inflammatory reaction in group A was better than that in group B.Conclusion:CO2 fractional laser combined with GC can improve the immune function and inflammatory reaction of patients with advanced VL better after treatment,and the probability of adverse reactions is lower.

Objective:To construct a risk evaluation system for safe operation of medical equipment of the department of pediatric internal medicine on the basis of comprehensive weight,so as to reduce the risk of operating equipment.Methods:The risk evaluation model of managing medical equipment was constructed by using Delphi method,and the evaluation indicators were weighted by analytic hierarchy process(AHP)and entropy weight method,and then,the safety management for equipment was conducted after the relative weights of indicators at each level were determined.A total of 100 used medical equipment in the department of pediatric internal medicine of Yuncheng Central Hospital of Shanxi Province from January 2022 to December 2023 were selected,and they were managed respectively by conventional management mode(50 equipment)and the management mode with risk evaluation system for safe operation of medical equipment(50 equipment).The quality of equipment operation,safety of clinical use and risk control rate of equipment alarm between the two management modes were compared,as well as the recognition scores of the engineers of equipment,doctors,paramedics and managers of relative department,who used and managed equipment,for the two management modes.Results:The average values of maintenance implementation rate,quality inspection qualification rate,disinfection qualification rate and effective response rate of problems of equipment of using the management mode with risk evaluation system were respectively(93.65±3.65)%,(91.45±3.25)%,(93.14±3.69)%and(94.26±3.14)%,which were all higher than these of conventional management mode,and the differences were statistically significant(t=18.599,12.376,11.746,16.006,P＜0.05).The ratios of device-associated infection,stress injury and body fluid extravasation of risk events were respectively 4%(2/50),6%(3/50)and 6%(3/50),which were lower than those of conventional management mode,and the differences were statistically significant(x2=10.714,8.576,9.756,P＜0.05).The recognition scores of the engineers of equipment,doctors,paramedics and managers of relative department for the equipment management of adopting the management mode with risk evaluation system were respectively(92.14±4.01),(93.54±4.63),(93.65±3.36)and(91.57±3.98)points,which were all higher than these of adopting conventional management mode,and the differences were statistically significant(t=15.798,13.331,15.545,13.940,P＜0.05).The average value of qualified rate of threshold value of equipment alarm,and that of operation and maintenance of equipment of adopting the management mode with risk evaluation system were respectively(98.25±3.54)%and(97.36±4.65)%,which were higher than those of the conventional management mode,and the average value of alarm silence rate of the management mode with risk evaluation system was(2.36±1.54)%,which was lower than that of conventional management mode,and the differences were statistically significant(t=11.207,8.813,10.717,P＜0.05).Conclusion:The application of the risk evaluation system for safe operation of medical equipment of the department of pediatrics on the basis of comprehensive weight in the management for equipment can enhance the safety of operating equipment,and reduce the risk of using equipment,and improve the quality of managing equipment.