With the rapid advancement of artificial intelligence technology, chatbots have shown great potential in the healthcare sector. From personalized health advice to chronic disease management and psychological support, chatbots have demonstrated significant advantages in improving the efficiency and quality of healthcare services. As the scope of their applications expands, the relationship between technological complexity and practical application scenarios has become increasingly intertwined, necessitating a more comprehensive evaluation of both aspects. This paper, from the perspective of he althcare applications, systematically reviews the technological pathways and development of chatbots in the medical field, providing an in-depth analysis of their performance across various medical scenarios. It thoroughly examines the advantages and limitations of chatbots, aiming to offer theoretical support for future research and propose feasible recommendations for the broader adoption of chatbot technologies in healthcare.

Objective:To observe the effects of Yiyuan moxibustion on bladder function and antioxidant level of spinal cord tissues in rats with urinary retention after spinal cord injury (SCI); To explore the mechanism of inhibition of ferroptosis in spinal cord neurons after SCI by Yiyuan moxibustion.Methods:Wistar female rats were divided into sham-operation group, model group, and Yiyuan moxibustion group according to random number table method, with 12 rats in each group. The modified Allen′s vertical percussion method was used to construct the model of urinary retention after SCI in T10 segment. The rats in the Yiyuan moxibustion group were moxibued at the Zhongji acupoint, Guanyuan acupoint, and Shenque acupoint for 20 min per day, and the intervention was continued for 2 weeks. Urodynamic test was used to observe the degree of urinary retention in rats; HE staining was used to observe the morphological changes of the injured spinal cord tissues; transmission electron microscopy was used to observe the mitochondrial ultrastructure of the spinal cord tissues; ferric ion kit was used to detect the ferric ion content of the spinal cord tissues; ELISA was used to detect the GSH and MDA contents of the spinal cord tissues of the rats; Western blot was used to measure the relative expressions of glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11) proteins in rat spinal cord tissue.Results:Compared with the model group, the basal and leakage point pressures of the bladder, and bladder compliance were significantly reduced in the Yiyuan moxibustion group ( P<0.05); the spinal cord tissue structure was restored and mitochondrial morphology improved; the levels of iron ions and MDA in spinal cord tissue decreased ( P<0.05), while the level of GSH increased ( P<0.05), and the relative expressions of GPX4 and SLC7A11 proteins increased ( P<0.05). Conclusion:Yiyuan moxibustion can improve bladder function in rats with urinary retention after SCI, and the mechanism may involve the initiation of antioxidant defense and reduction of lipid peroxidation in spinal cord neuronal cells, thus preventing the occurrence of ferroptosis and achieving the protection of neuronal cells.

Objective To explore the value of combined detection of serum mitogen-activated protein kinase 1(MAPK1)and lysyl oxidase-like protein 2(LOXL2)in early diagnosis of cervical cancer.Methods A total of 218 patients with cervical lesions were selected as study group(103 ca-ses in cervical cancer group,115 cases in benign tumor group).Additionally,100 patients with cer-vical intraepithelial neoplasia grade Ⅱ were selected as precancerous lesion group,and 79 healthy in-dividuals undergoing physical examinations during the same period were selected as control group.Se-rum levels of MAPK1 and LOXL2 were measured in each group.Pearson correlation analysis was used to evaluate the correlations of serum MAPK1 and LOXL2 levels in patients with cervical cancer.Logistic regression analysis was performed to screen influencing factors for the occurrence of cervical cancer.Receiver operating characteristic(ROC)curves were plotted to assess the diagnostic efficacy of serum MAPK1 and LOXL2 for cervical cancer.Results Serum MAPK1 and LOXL2 levels in the study group were higher than those in the precancerous lesion group and the control group,and those in the precancerous lesion group were higher than those in the control group,with statistically signif-icant differences(P＜0.05).The proportion of patients with high-risk human papillomavirus(HPV)infection and serum MAPK1 and LOXL2 levels in the cervical cancer group were higher than those in the benign tumor group,with statistically significant differences(P＜0.05).Serum MAPK1 and LOXL2 levels in patients with stage Ⅲ to Ⅳ cervical cancer were higher than those in patients with stage Ⅰ to Ⅱ cervical cancer,with statistically significant differences(P＜0.05).Pearson correlation analysis showed a positive correlation between serum MAPK1 and LOXL2 levels in patients with cervical cancer(r=0.468,P＜0.001).Logistic regression analysis showed that high-risk HPV infection,MAPK1 and LOXL2 were all influencing factors for the occurrence of cervi-cal cancer(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)for com-bined diagnosis of serum MAPK1 and LOXL2 was 0.911,which was significantly greater than the AUCs for individual diagnoses(0.848 and 0.843,respectively).Conclusion Serum MAPK1 and LOXL2 levels in patients with cervical cancer are significantly upregulated,and the two indicators were positively correlated.High-risk HPV infection,serum MAPK1 and LOXL2 levels were influen-cing factors for the occurrence of cervical cancer.Combined detection of MAPK1 and LOXL2 levels is expected to assist in the diagnosis of cervical cancer.

Objective To prepare an ophthalmic solution of dihydromyricetin(DMY)based on dipotassium glycyr-rhizinate(DG)nanomicelle solubilization(DG-DMY)and evaluate its effect on dry eyes of mice.Methods DG-DMY was prepared using the thin-film hydration method,and its micelle size,potential,encapsulation efficiency and storage sta-bility at room temperature were tested.The ocular safety of DG-DMY was tested on mice.Dry eye models were built in mice,which were divided into normal control group(normal mice without intervention),PBS control group(dry eye mouse models,intervened by PBS),HA treatment group[dry eye mouse models,intervened by 1 g·L-1 hyaluronic acid(HA)]and DG-DMY treatment group(dry eye mouse models,intervened by DG-DMY),with 10 mice in each group.The fluorescein sodium staining of corneal epithelium and surface tear secretion were recorded after 10 days of intervention.Morphological changes in corneal epithelium,corneal stroma and endothelial cells were monitored by hematoxylin & eosin staining.The enzyme-linked immunosorbent assay(ELISA)was adopted to measure the expression levels of interleukin-6(IL-6)and interleukin-1β(IL-1β).Results DG-DMY is a light yellow,transparent solution with a nanomicelle size of(208.8±3.9)nm,polydispersity index of 0.277,Zeta potential of-(17.6±1.42)mV,encapsulation efficiency of 76.72％,and drug loading efficiency of 10.21％.It is stable at room temperature(25℃)and storage temperature(4 ℃).The mouse studies showed that DG-DMY displayed good in vivo tolerance in mice eyes.The therapeutic results showed that mice in the PBS treatment group still had extensive corneal staining,mice in the HA treatment group had reduced corneal staining,and mice in the DG-DMY treatment group had almost no corneal staining.The tear secretion of mice in the normal control group,PBS control group,HA treatment group and DG-DMY treatment group was(5.15±0.47)mm,(2.26±0.41)mm,(4.02±0.53)mm,and(4.11±0.54)mm.The histopathological results showed that the corneal epithelium,loose collagen structure and basal layer were damaged in the PBS control group;the corneal histopathological injury of mice in the HA treatment group and DG-DMY treatment group were mitigated,with normal corneal epithelium,corneal stroma and endothelial tissues.ELISA results showed that the expression level of IL-6 in the normal control group,PBS control group,HA treatment group and DG-DMY treatment group was(22.98±0.69)ng·g-1,(108.1±6.06)ng·g-1,(56.79±4.87)ng·g-1 and(44.01±0.99)ng·g-1,respectively,and the expression level of IL-1β was(27.97±2.74)ng·g-1,(115.70±5.16)ng·g-1,(50.36±1.56)ng·g-1 and(42.21±1.46)ng·g-1,respectively.Compared with the HA treatment group,the expression levels of IL-6 and IL-1β in the cornea of mice in the DG-DMY treatment group were lower,and the differences were statistically significant(both P＜0.05).Conclusion DG-DMY nano-preparation successfully prepared in this study is verified to act on benzalkonium chloride-induced dry eye effectively and control the inflammatory response of dry eye mouse models by inhibiting the expressions of IL-6 and IL-1β with high safety.

Objective:To analyze the clinicopathological characteristics, treatment responses and kidney outcomes of patients with atypical membranous nephropathy (MN), and to provide information for the clinical practice.Methods:The clinical data of patients with atypical MN and synchronous primary MN who were diagnosed, treated and followed up in Peking University First Hospital from January 2008 to June 2020 were retrospectively collected and analyzed. Clinicopathological features, treatment responses and kidney prognosis were compared between the two groups. The expression of phospholipase A2 receptor (PLA2R) in kidney tissues was detected by immunofluorescence. Serum anti-PLA2R antibody was detected by enzyme-linked immunosorbent assay. Clinicopathological indexes were compared between PLA2R-related MN group and non-PLA2R-related MN group. Kaplan-Meier (Log-rank test) survival curve and multivariate Cox regression analysis methods were used to analyze the influencing factors of kidney prognosis in patients with atypical MN. The primary endpoint of renal adverse outcome was renal insufficiency, defined as end-stage renal disease or estimated glomerular filtration rate (eGFR) decline>30% baseline and<60 ml·min -1·(1.73 m 2) -1. Results:A total of 65 atypical MN patients were enrolled in this study. Compared with primary MN ( n=324), patients with atypical MN had younger age ( Z=-4.229, P<0.001), higher proportion of hematuria ( χ2=5.555, P=0.018), higher level of urinary protein ( Z=2.228, P=0.026) and lower level of eGFR ( t=-5.108, P<0.001); the proportion of IgG4 deposition in kidneys was lower ( χ2=8.081, P=0.004), and the proportions of IgA ( χ2=16.969, P<0.001) and IgM ( χ2=9.281, P=0.002) deposition were higher. There was no significant difference on gender, serum albumin, positive proportion of anti-PLA2R antibody, anti-PLA2R antibody level and kidney C3/C1q deposition between the two groups (all P>0.05). The proportions of atypical MN patients receiving renin-angiotensin aldosterone system inhibitors (49.3% vs 57.1%), calcineurin inhibitors (27.7% vs 19.1%) and cyclophosphamide (21.5% vs 23.8%) were comparable to those of primary MN patients (all P>0.05). The rates of clinical remission (80.0% vs 77.2%), partial remission (44.6% vs 44.1%), complete remission (35.4% vs 33.1%), spontaneous remission (36.9% vs 42.6%), response to cyclophosphamide (85.7% vs 81.8%), response to calcineurin inhibitor (88.9% vs 79.0%), and relapse (30.8% vs 26.8%) in atypical MN patients were comparable to those in primary MN patients (all P>0.05). During the follow-up 30.0(21.5, 61.5) months, 15 atypical MN patients (23.1%) had eGFR reduction>30%, among whom 7 patients (10.8%) had eGFR reduction>50% and 3 patients (4.6%) had end-stage kidney disease. There was no significant difference on poor kidney prognosis between the two groups (all P>0.05). Kaplan-Meier survival curve showed that patients with age>39 years old ( χ2=10.092, P=0.001), eGFR≤100 ml·min -1·(1.73 m 2) -1( χ2=5.491, P=0.019), tubular interstitial lesion ( χ2=6.999, P=0.008) and no nephropathy remission ( χ2=22.952, P<0.001) had earlier poor renal prognosis. Multivariate Cox regression analysis showed that no nephropathy remission ( HR=12.604, 95% CI 2.691-59.037, P=0.001) was an independent influencing factor for poor renal prognosis in atypical MN patients. Conclusion:No significant difference is found between atypical MN and primary MN on treatment responses and kidney prognosis, which implies that clinical practice of atypical MN can be performed by referring to the guidelines and experience of primary MN.

Objective:To investigate the therapeutic value of modified multipoint drainage for biliary complications after liver transplantation.Methods:A total of 125 patients treated by endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications after liver transplantation in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2018 to May 2020 were enrolled. Patients were divided into endoscopic retrograde biliary drainage (ERBD) group ( n=67, treated with multiple drainage of bile duct stent) and modified multipoint drainage group [ n=58, treated with ERBD combined with endoscopic nasobiliary drainage (ENBD)] by random number table. Modified multipoint drainage group were further randomly divided into two groups, modification group 1, 31 cases, where nasobiliary ducts were cut proximal to duodenal papilla after one week under endoscopy and modification group 2, 27 cases, where they were cut proximal to duodenal papilla after two weeks under endoscopy. The changes of serological indexes in 2 weeks after the operation in three groups were compared, and the incidence of short-term and long-term complications were analyzed. Results:The serological indexes were improved in patients at 1 d, 7 d and 14 d after ERCP, especially in modified multipoint drainage groups. Two weeks after the operation, the improvement of serological indexes in modification group 2 was better than that in modification group 1. Incidence of recent complications including cholangitis, hyperamylasinemia, and pancreatitis in the ERBD group were higher than those in modification group 1 [32.84% (22/67) VS 12.90% (4/31), 46.27% (31/67) VS 19.35% (6/31), 20.90% (14/67) VS 3.23% (1/31), all P<0.05] and modification group 2 [32.84% (22/67) VS 11.11% (3/27), 46.27% (31/67) VS 22.22% (6/27), 20.90% (14/67) VS 3.70% (1/27), all P<0.05]. ERBD group had a higher incidence of long-term complications including recurrent biliary infection and jaundice than modification group 1 [ 58.21% (39/67) VS 35.48% (11/31), P=0.036; 49.25% (33/67) VS 25.81% (8/31), P=0.027] and modification group 2 [58.21% (39/67) VS 11.11% (3/27), P<0.001; 49.25% (33/67) VS 25.93% (7/27), P=0.038]. The incidence of recurrent biliary infection in modification group 1 was higher than that in modification group 2 [35.48% (11/31) VS 11.11% (3/27), P=0.030]. Conclusion:Multiple drainage with indwelling nasal bile duct by ERCP can effectively reduce the short-term and long-term complications and improve the recovery of serological indexes for patients with biliary complications after liver transplantation. It is suggested that the nasobiliary duct should be retained for 2 weeks and then transformed into a built-in tube to continue drainage.

The chin, located in the most prominent part of the lower facial profile, maintains the balance and coordination of the face. The chin size, shape, spatial position and proportion can all give rise to various chin malformations. Chin plasty plays an important role in improving facial appearance. Recent studies indicate that it’s difficult to completely meet the mental aesthetic requirements with a single procedure. The combination of different chin plastic surgery has become a hot spot in plastic surgery. In this paper, the morphological analysis of chin, the surgical progress in Chin plasty, the advantages and adverse effects of these methods, and the synthetic application of various surgeriesis were reviewed.

Objective To construct an professional quality training management system for in-service nurses and to evaluate its effect in clinical practice.Methods From June 2014 to October 2016, a total of 1233 nurses in a classⅢ grade A hospital were selected. Through the establishment and improvement of the organizational structure of the professional quality management of the in-service nurses, the various training content combining theory and practice were adopted, including case study, role playing and simulation scenario training to implement the professional training.Results The average score of nursing professional quality was (91.78±3.82) before training and (94.53±4.33) after training. The difference between before and after training was statistically significant (t=-3.156,P=0.006). The patient satisfaction rate was 90.57％ before training and 97.42％ after training, and the difference was statistically significant (Z=-2.516,P=0.006). The doctor satisfaction rate was 90.57％ before training and 94.88％ after training, and the difference was statistically significant (Z=-2.233,P<0.01).Conclusions The construction of nurses' professional quality training strengthens the importance of nurses' professional quality, improves the evaluation of professional quality, and has guiding significance for the training of in-service nurses' professional quality.

Objective To explore the incidence and prognosis of esophageal adenocarcinoma (EAC),Siewert type Ⅰ adenocarcinoma of esophagogastric junction (AEG) and Barrett esophagus (BE) in Henan province,an area of high incidence of esophageal cancer.Methods From January 2010 to January 2015,the clinical data of 152 patients with EAC,70 patients with Siewert type Ⅰ AEG and 149 patients with BE were collected,and the clinicopathological features and treatment methods of all the patients were retrospectively analyzed.Patients with EAC and Siewert type Ⅰ AEG were followed up by telephone,while the patients with BE were followed up by telephone and endoscopy examination.The follow-up was ended in January 1st 2016 and the total follow-up period was 12 to 72 months.Chi square test,t test and one way analysis of variance were performed for comparison of pathological characteristics among groups;linear regression method was used to detect changing trends in the rates over time and Kaplan-Meier method was for survival analysis.Results The annual detection rates in five years of EAC were 0.7‰,0.9‰,0.8‰,1.1‰ and 1.1‰,respectively,suggesting an increasing trend (F=10.714,P＜0.05).The proportion of EAC to esophageal squamous carcinoma (ESC) were 2.9％,3.2％,3.1％,3.4％ and 3.8％,respectively with an increasing trend (F=17.647,P＜0.05).The one,three-and five-year overall survival rates of EAC were 57.7％,30.6％ and 15.3 ％.Among 152 patients with EAC,51 received operation and 101 patients did not.The median survival time was 14 months,and the median survival time of operation group and non-operation group was 60 months and 10 months,respectively.Survival curve layered by treatment methods indicated that the three-year survival rates of operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and notreatment group were 82.3％,50.0％,11.2％ and 0.The three-year survival rates in operation combined with chemotherapy group,operation group,radiotherapy or chemotherapy group and no-treatment group were significantly different (x2 =1.099,2.236 and 11.431,all P＜0.01).The annual detection rates in five years of Siewert type Ⅰ AEG were 0.2‰,0.3‰,0.4‰,0.4‰,0.7‰,respectively,with an increasing trend (F=19.105,P＜0.05).The one-,three-and five-year overall survival rate of Siewert type Ⅰ AEG was 59.8％,30.5 ％ and 15.3 ％,respectively.Among 70 patients with Siewert type Ⅰ AEG,16 cases received operation,while 54 cases without operation.The median survival time of Siewert type Ⅰ AEG was 16 months,and the median survival time of operation group and non-operation group was 50 months and 13 months.The one-,three-and five-year survival rates of operation group were 87.5％,62.6％ and 43.0％ respectively,and the one-,threeand five-year survival rates of non-operation group were 50.2 ％,19.6 ％ and 0,respectively,and the difference in cumulative survival rate between the two groups was statistically significant (x2 =12.289,P＜ 0.05).The annual detection rates of BE in five years were 0.6‰,0.5‰,0.9‰,0.9‰ and 1.1‰,respectively,with an increasing trend (F=13.364,P＜0.05).Among 149 patients with BE,there were 24 cases with specialized intestinal metaplasia and six cases with dysplasia,but none of them developed into adenocarcinoma during the follow-up period.Conclusions In Henan province,an area with high incidence of esophageal cancer,there is an increasing trend in the annual detection rates in five years of EAC,Siewert type Ⅰ AEG and BE.Although the incidence of EAC and Siewert type Ⅰ AEG is not high,the prognosis is poor with low survival rate.The prognosis of non-operation group is obviously worse than that of operation group.Specialized intestinal metaplasia and dysplasia in patiens with BE are rare and have a low probability of developing into adenocarcinoma.