Objective: To evaluate and compare the accuracy of responses to pediatric preventive dentistry-related questions between the domestic large language model, ChatGLM-6B, and the international large language model, ChatGPT-3.5, in order to provide insights for further research and development of domestic language models in the field of oral medicine. Methods: A total of 100 common pediatric preventive dentistry questions of varying difficulty levels [basic (n = 35), intermediate (n = 35), and advanced (n = 30) ] were provided by pediatric preventive dentistry experts. Two doctors independently registered these questions with ChatGPT-3.5 and ChatGLM-6B and collected the answers. A cohort of 16 dentists assessed responses generated by ChatGLM-6B and ChatGPT-3.5 using a predefined 3-point Likert scale. The average score of the ratings from 16 doctors was taken as the answer score. If the answer score was higher than 2.8, it was accepted as a accurate answer; if the score was lower than 1.4, it was accepted as an inaccurate answer; if the score was between 1.4 and 2.8, it was accepted as a partially accurate answer. Comparative analysis was conducted on the accuracy rates and evaluation outcomes between the two groups. Consistency analysis of the ratings was conducted Results: The answer accuracy rates of ChatGPT-3.5 and ChatGLM-6B for 100 pediatric preventive dentistry questions were comparable: ChatGPT-3.5 demonstrated 68% accurate, 30% partially accurate, and 2% inaccurate responses, while ChatGLM-6B showed 67% accurate, 31% partially accurate, and 2% inaccurate responses, with no statistically significant differences (P>0.05). Both models exhibited equivalent accuracy across questions of varying difficulty levels (basic, intermediate, advanced), showing no statistical differences (P>0.05). The overall average scores for ChatGPT3.5 and ChatGLM-6B in answering all questions were both 2.65, with no statistically significant difference (P>0.05). For questions of different difficulty levels, ChatGPT3.5 had an average score of 2.66 for basic questions while ChatGLM-6B had an average score of 2.70. For intermediate questions, ChatGPT3.5 had an average score of 2.63 and ChatGLM-6B had an average score of 2.64. For advanced questions, ChatGPT3.5 had an average score of 2.68, and ChatGLM-6B had an average score of 2.61. No statistically significant differences were observed across any difficulty category (P>0.05). The consistency of the experts’ grading ranged from fair to moderate. Conclusion This study demonstrates the potential of both ChatGLM-6B and ChatGPT-3.5 in answering pediatric preventive dentistry questions. ChatGLM-6B performed similarly to ChatGPT-3.5 in this field, but the accuracy rates of both models fell short of expectations and are not suitable for clinical use. Future efforts should focus on improving the accuracy and consistency of large language models in providing medical information, as well as developing specialized medical models for the field of oral medicine.

BACKGROUND: Epidermal growth factor receptor (EGFR) sensitive mutation is one of the effective targets of targeted therapy for non-small cell lung cancer (NSCLC). However, due to the difficulty of obtaining some primary tissues and the economic factors in some underdeveloped areas, some patients cannot undergo traditional genetic testing. The aim of this study is to establish a machine learning (ML) model using non-invasive peripheral blood markers to explore the biomarkers closely related to EGFR mutation status in NSCLC and evaluate their potential prognostic value. METHODS: 2642 lung cancer patients who visited Jiangsu Cancer Hospital from November 2016 to May 2023 were retrospectively enrolled and finally 175 NSCLC patients with complete follow-up data were included in the study. The ML model was constructed based on peripheral blood indicators and divided into training set and test set according to the ratio of 8:2. Unsupervised learning algorithms were used for clustering blood features and mutual information method for feature selection, and an ensemble learning algorithm based on Shapley value was designed to calculate the contribution of each feature to the model prediction result. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the model. RESULTS: Through the feature extraction and contribution analysis of the predictive results of the interpretable ML model based on the Shapley value, the top ten indicators with the highest contribution were: pathological type, phosphorus, eosinophils, monocyte count, activated partial thromboplastin time, potassium, total bilirubin, sodium, eosinophil percentage, and total cholesterol. The area under the curve (AUC) of the model was 0.80. In addition, patients with hyponatremia and squamous cell carcinoma group had a poor prognosis (P<0.05). CONCLUSIONS The interpretable model constructed in this study provides a new approach for the prediction of EGFR mutation status in NSCLC patients, which provides a scientific basis for the diagnosis and treatment of patients who cannot undergo genetic testing.
Humans ; Carcinoma, Non-Small-Cell Lung/diagnosis* ; Machine Learning ; Lung Neoplasms/diagnosis* ; Male ; Female ; Mutation ; Middle Aged ; ErbB Receptors/genetics* ; Prognosis ; Aged ; Retrospective Studies ; Adult ; Biomarkers, Tumor/genetics*

OBJECTIVES: To investigate the synergistic mechanism of the traditional Chinese medicine Rosa laevigata Michx. (RLM) for treatment of pulmonary arterial hypertension (PAH). METHODS: Network pharmacological analysis was carried out to screen the active ingredients of RLM and PAH disease targets and construct the "component-target-disease" interaction network, followed by gene enrichment analysis and molecular docking studies. In the cell experiments, primary cultures of rat pulmonary arterial smooth muscle cells were exposed to hypoxia for 24 h and treated with solvent or 100, 200 and 300 mg/mL RLM, and the changes in cell proliferation were detected using Western blotting for PCNA and immunofluorescence staining. In the animal experiment, male SD rats were randomized into 5 control group, monocrotaline (MCT) solvent group, and MCT with RLM (100, 200 and 300 mg/mL) treatment groups. HE staining and immunofluorescence staining were used to observe histopathological changes in the pulmonary blood vessels of the rats. RESULTS: Seven core active ingredients (including β-sitosterol and kaempferol) in RLM and 39 key disease targets were identified, and molecular docking showed that SRC was a high-affinity target. KEGG enrichment analysis showed that the differential genes were significantly enriched in calcium signaling and PI3K-AKT pathways. In rat pulmonary arterial smooth muscle cells, hypoxic exposure significantly up-regulated cellular expression of PCNA and phosphorylation levels of Src and AKT1, which were obviously lowered by RLM treatment. In RLM-treated rat models, the mean pulmonary artery pressure and right ventricular hypertrophy index (Fulton index) were significantly reduced, the tricuspid annular plane systolic excursion (TAPSE) was improved, and pulmonary vascular wall thickening and fibrosis were obviously ameliorated. CONCLUSIONS RLM inhibits pulmonary arterial smooth muscle cell proliferation in rat models of hypertension possibly by regulating the Src-AKT1 axis, suggesting the potential of RLM as a new natural drug for treatment of pulmonary hypertension.
Animals ; Cell Proliferation/drug effects* ; Proto-Oncogene Proteins c-akt/metabolism* ; Rats, Sprague-Dawley ; Pulmonary Artery/cytology* ; Male ; Rats ; Myocytes, Smooth Muscle/cytology* ; Hypertension, Pulmonary/pathology* ; Drugs, Chinese Herbal/pharmacology* ; Signal Transduction/drug effects* ; Muscle, Smooth, Vascular/cytology* ; src-Family Kinases/metabolism* ; Cells, Cultured

Overweight and obesity have emerged as a significant public health concern globally.While factors such as genetics,diet,and physical activity are insufficient to fully account for the rise in overweight and obesity,recent studies have indicated a link between environmental pollutants and the development of obesity.Microplastics,a novel type of environmental pollutant,are pervasive in various environmental media and daily life,entering organisms through multiple pathways including the digestive tract,respiratory tract,skin,among others.Evidence from studies has revealed the presence of microplastics in human tissues,organs,and biological samples,suggesting potential health risks to humans.This review outlines the pathways and distribution of microplastics within the human body while summarizing current research progress in relation to obesity.This article aims to raise awareness within society regarding the detrimental effects of microplastics and provide a theoretical foundation for medical professionals addressing public health issues.

Objective:To analyze the trend, hotspots and frontiers of diabetic retinopathy (DR) therapy by bibliometric method.Methods:Data were taken from the Web of Science website of Science Citation Index. Articles from 2017 to 2021, which were related to the therapy of diabetic retinopathy (DR), were included. The bibliometric analysis softwares, VOSviewer and CiteSpace were used to generate and analyze visual representations of the complex data input, including high-frequency keywords, keywords with the strongest citation bursts and co-occurrence networks of keywords.Results:A total of 3,845 articles were included. The amounts of papers published from 2017 to 2021 is 633, 651, 708, 893, and 960 respectively, increasing over years. Chinese scholars published the most articles, followed by the United States. The number of articles funded by the National Natural Science Foundation of China ranks third. There were 47 high-frequency keywords clustered into DR treatment, pathogenesis of DR, diagnosis of DR, Oxidative stress, diabetic macular edema (DME), type 2 diabetes, optical coherence tomography and deep learning. Those keywords were research hotspots and new keywords were constantly emerging. Among the top 11 burst words, the burst values of "intravitreal bevacizumab", "vascular endothelial growth factor (VEGF)", "choroidal neovascularization", "inhibition", and "receptors" were all over 10. Highly cited references showed a significant clustering tendency, which were treatment of DME, review of DR, clinical research of anti-VEGF drug therapy.Conclusions:The amount of paper related to DR therapy is on the rise; the specific treatment methods for the pathogenesis of DR are constantly research hotspots. In addition, formulating treatment strategies to reduce macular edema and other complications of diabetes, applying optical coherence tomography, deep learning and other technologies to improve the efficiency of DR diagnosis and treatment, improve targeted drug delivery systems, and finding new target points were research frontiers.

Objective:To study the clinicopathological characteristics, treatment and prognosis in lupus nephritis (LN) patients with renal thrombotic microangiopathy (TMA), so as to provide more theoretical basis for clinicians to recognize and treat this disease.Methods:The clinical data of LN patients who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from January 1, 2012 to May 31, 2019 were retrospectively collected and analyzed. According to renal clinicopathological examination, the patients were divided into renal TMA group and non-renal TMA group. The clinical data, laboratory examination, renal pathological examination, therapeutic measures and prognostic between the two groups were compared. Follow-up end points were defined as composite ends, including all-cause death, entry into end-stage renal disease, and estimated glomerular filtration rate decrease>50% of baseline. Kaplan-Meier survival curve and log-rank test were used to compare the difference of survival rate between the two groups, and multivariate Cox regression equation was used to analyze the risk factors of endpoint events in LN patients.Results:A total of 1 133 patients with LN were enrolled in this study. Patients with renal TMA were more likely to have hypertension ( χ2=16.310, P<0.001), higher baseline serum creatinine ( Z=-6.918, P<0.001) and 24-hour urine protein ( Z=-2.232, P=0.026), and higher renal pathology activity index (AI) score ( Z=1.957, P=0.001)and chronic index (CI) score ( Z=1.836, P=0.002). The proportions of hormone shock ( P<0.001) and plasma exchange ( P<0.001) in the renal TMA group were higher than those in non-renal TMA group. After treatment of (12±2) months, patients in the renal TMA group had a lower complete response rate ( χ2=10.455, P=0.001) and a higher non-response rate ( χ2=6.047, P=0.014) than those in non-renal TMA group, and were associated with worse prognosis (Log-rank test χ2=26.490, P<0.001). Renal TMA was an independent risk factor for poor prognosis ( HR=2.347, 95% CI 1.210-4.553, P=0.012). Conclusions:Compared with LN patients without renal TMA, LN patients with renal TMA are more likely to have hypertension, with higher serum creatinine, 24-hour urinary protein, AI and CI, suggesting poorer treatment response and renal prognosis. Moreover, renal TMA is an independent risk factor for poor prognosis in patients with LN.

Patient satisfaction is one of the core indicators to measure the service quality of medical institutions. To this end, a multi-campus public hospital in Shanghai constructed a management system of patient satisfaction evaluation. Since 2021, its call center has conducted a full coverage satisfaction assessment for discharged patients from its three campuses and collected dissatisfaction information feedback. The hospital organized relevant clinical departments and functional departments to fully communicate with the dissatisfied patients according to the feedback information, followed by a joint rectification. The hospital regularly conducts in-depth analysis of all complaints for timely discovery of common problems in different campuses for continuous improvement. This practice can provide reference for multi-campus hospitals to promote homogeneous management, to improve management efficiency, service quality and patient satisfaction.

Objective:To explore the value of apparent diffusion coefficient (ADC) and renal volume in assessing fetal kidney development and disease.Methods:From January 2016 to October 2020, 84 fetuses with congenital anomalies of the kidney and urinary tract (CAKUT) were identified with MRI (CAKUT group), and 97 fetuses with no significant abnormalities on MRI or postnatal follow-up (control group) from the Obstetrics and Gynecology Hospital of Fudan University were enrolled and analyzed retrospectively. ADC value and renal volume were measured to compare the two groups, and the relationship was analyzed between these two parameters in the control group with gestational age, location (left or right kidney), and fetal gender. Two independent or paired sample t-tests, and linear correlation analyses, were adopted for the statistical analysis. Results:(1) There were 84 pregnant women in the CAKUT group, including a twin pregnancy, with an average age of (29±4) years old, ranging from 21 to 39 years old. The gestational age at MRI was (26±4) weeks with a range of 21-34 weeks. Of the 85 fetuses, 52 were male (61.2%), and 33 were female (38.8%). The polycystic dysplastic kidney was found in 32 cases (37.6%), hydronephrosis in 29 cases (34.1%), and an isolated kidney in 24 cases (28.2%). There were 97 singleton pregnancies in the control group, including 45 (46.4%) male and 52 (53.6%) female fetuses. The average maternal age was (30±5) years old, with a range of 19-41 years old, and the gestational week at MRI was (27±4) weeks, with a range of 21-34 weeks. (2) In the control group, the mean ADC value and renal volume were (1.255±0.112)×10 －3 mm2/s and (4 747±2 479) mm 3, which were negatively ( R 2=0.30, P<0.01) and positively correlated ( R 2=0.80, P<0.01) with the gestational age, respectively. There was no significant difference between ADC value and renal volume between different fetal gender in the control group. (3) The ADC value and the renal volume of fetuses with polycystic dysplastic kidney [(1.720±0.200) ×10 －3 mm2/s and (8 154±8 337) mm 3] were higher than those in the control group ( t=－13.11 and－3.08, P<0.001 and P=0.004). Compared with the control group, ADC of fetuses with hydronephrosis [(1.333±0.171) ×10 －3 mm2/s] was higher ( t=－3.90, P<0.001); and the renal volume [(7 201±4 460) mm 3] was larger but without statistical significance. The fetuses with an isolated kidney had an increasing trend in renal volume [(5 239±4 244) mm 3] and a decreasing trend in the ADC value [(1.239±0.125) ×10 －3 mm2/s] when compared with the normal fetuses, but neither difference was significant. Conclusions:In normal fetuses, the ADC value decreases, and the renal volume increases with the gestational age. Fetuses with CAKUT may have a larger kidney than normal.

Objective:To evaluate the pregnancy outcomes of fetal tethered cord (TC) prenatally diagnosed by MRI.Methods:Clinical data of 38 fetuses diagnosed as having TC by MRI, including 36 singletons and two fetuses who were both one of dichorionic diamniotic twins, were retrospectively collected and analyzed in the Obstetrics and Gynecology Hospital of Fudan University from January 2015 to August 2019. According to whether conus medullaris was located above the bladder or reached the lower edge of the bladder, all cases were divided into high or low groups. Pregnancy outcomes were compared between the two groups using Fisher's exact test and Student's t-test. Results:(1) The gestational age at MRI was (25.5±4.7) weeks. Among the 38 cases, 14 (36.8%) were isolated TC, 24 (63.2%) were complicated by other anomalies. The meningocele was responsible for the most (39.5%, n=15). The results of the ultrasound were consistent with those of MRI in 24 cases (63.2%). While in the other 14 cases (36.8%), the ultrasound only showed vertebral body's abnormal morphology, after which further MRI examination revealed a tethered cord. (2) Twenty-nine women (76.3%) chose to terminate the pregnancy. One patient (2.6%) underwent fetal reduction at 23 gestational weeks (one normal twin was delivered prematurely), and one (2.6%) was lost to follow-up. Seven (18.4%) cases continued the pregnancies to delivery. The postnatal follow-up period was 8.1 months (4.0 to 54.9 months). Two infants without comorbidities showed normal growth and development. Another three cases underwent surgeries after birth, and two cases died in the neonatal period. (3) The average width of the medullary cone was (2.5±0.8) cm. There was no significant difference in the spinal cord width between the high [(2.5±0.8) cm, n=34] and low group [(2.7±1.1) cm, n=4]. Six pregnancies (17.6%) in the high group was continued to delivery, and one of the neonates died of severe hydrocephalus. One patient in the low group (1/4) was delivered, while the baby died of neonatal asphyxia. Conclusions:Fetuses with isolated TC are prone to have a good prognosis. Further study should focus on the relation between the high or low position of the conus medullaris and pregnancy outcomes.

Objective:To explore the role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns.Methods:Twenty-seven fluorine chemical enterprises distributed in Zhejiang province, Jiangxi Province, Fujian Province, and Inner Mongolia Autonomous Region and 22 hospitals with burn/plastic department or professional burn treatment group in Zhejiang province, including Zhejiang Quhua Hospital, and 5 hospitals outside Zhejiang province were involved in the first-aid network construction as member units. As the main unit, Zhejiang Quhua Hospital was responsible for the daily maintenance and technical guidance of the first-aid network. Zhejiang Quhua Hospital was assigned as the designated emergency hospital for 20 fluorine chemical enterprises, a near emergency hospital to the other 7 fluorine chemical enterprises was assigned as the designated hospital for them. Medical records of 56 patients (all males) with critically severe hydrofluoric acid burns who admitted to 5 first-aid network hospitals from January 2006 to June 2021, meeting the inclusion criteria, were involved in the retrospective cohort study. Based on whether the enterprise belonging to the first-aid network construction or not, the patients were divided into first-aid network group (27 cases, aged (41±9) years) and non first-aid network group (29 cases, aged (42±10) years). After the patients in the first-aid network group were injured, the enterprises and hospitals linked up immediately. The hospital where the patient was treated mobilize the treatment force, equipment, materials, and drugs in advance by the first-aid network, thereby realizing seamless joint between pre-hospital first-aid and in-hospital treatment. The hospital started the first-aid process and temporarily mobilized the rescue forces, equipment, materials, and drug after patients in non first-aid network group arrived at the department of emergency of the hospital. The time from injury to medical service, the first detection time of serum calcium, the time staying in department of emergency, the duration of hypocalcemia and hypomagnesemia, and the treatment outcome of patients in the two groups were recorded. Data were statistically analyzed with chi-square test, Fisher's exact probability test, independent-sample t test, and Wilcoxon rank-sum test. Results:The time from injury to medical service, the first detection time of serum calcium, and the time staying in department of emergency of patients in first-aid network group were 40.0 (30.0, 55.0), 23.0 (17.5, 37.5), and 42.0 (37.0, 53.0) min, which were significantly shorter than 180.0 (120.0, 240.0), 31.0 (22.5, 47.5), 61.0 (52.0, 65.5) min in non first-aid network group ( Z=-6.17, -1.98, -4.15, P<0.05 or P<0.01). The duration of hypocalcemia and hypo- magnesemia of patients in first-aid network group were 1.2 (1.1, 1.6) and 1.9 (1.7, 2.1) h, which were significantly shorter than 4.6 (3.1, 6.2) and 3.2 (2.5, 4.6) h in non first-aid network group ( Z=-5.80, -4.81, P<0.01). Three patients (11.1%) in first-aid network group died, among whom 2 patients died at 40 min after injury and 1 patient died 9.0 h after injury. Four patients (13.8%) died in non first-aid network group at 3.0, 3.0, 4.5, and 7.0 h after injury, respectively. The mortality rates of patients in the two groups were similar ( P>0.05). Conclusions:Critically severe hydrofluoric acid burn is an extremely urgent situation encountered in clinical practice. The construction of a first-aid network creates condition for on-site treatment of patients and improves the first-aid efficiency, thereby gaining time to save lives.