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

The visual cortex is an essential part of the brain for processing visual information. It exhibits structural and functional plasticity, which is crucial for adapting to complex visual environments. The quintessential manifestation of visual cortical plasticity is ocular dominance plasticity during the critical period, which involves numerous cellular and molecular events. While previous studies have emphasized the role of visual cortical neurons and their associated functional molecules in visual plasticity, recent findings have revealed that structural factors such as the extracellular matrix and glia are also involved. Investigating how these molecules interact to form a complex network that facilitates plasticity in the visual cortex is crucial to our understanding of the development of the visual system and the advancement of therapeutic strategies for visual disorders like amblyopia.
Neuronal Plasticity/physiology* ; Dominance, Ocular/physiology* ; Visual Cortex/physiology* ; Humans ; Animals ; Neurons/physiology*

BACKGROUND:Periprosthetic osteolysis is the most common long-term complication of total joint arthroplasty.Many studies suggest that the inflammasome may play an important role during the osteolysis.Melatonin is a rhythm-regulated hormone secreted by the pineal gland with many functions including anti-inflammatory,anti-oxidation,and antitumor,but its effects on osteolysis and inflammasome have yet to be explored. OBJECTIVE:To explore the effect of melatonin on the osteolysis induced by wear particles and the role of melatonin on the activation of NLRP3 inflammasome. METHODS:(1)In vivo test:Fifteen C57BL/6 mice were randomly divided into sham operation group,osteolysis group and melatonin group by random number table method,with 5 mice in each group.The osteolysis model of the osteolysis group and the melatonin group was established by injecting cobalt-chromium-molybdenum(CoCrMo)particles into the sagittal suture of the skull.After injection,the melatonin group was intraperitoneally injected with 50 mg/(kg·d)of melatonin for 14 consecutive days.After drug intervention,the mouse calvarium was collected for micro-CT analysis to observe the micro-structural changes around the sagittal suture.(2)In vitro test:Mouse bone marrow-derived macrophages and THP-1 cells(which had been induced to differentiate into macrophages)were taken and divided into seven groups:normal group,lipopolysaccharide group,lipopolysaccharide+CoCrMo group and melatonin 0.5,1,1.5,2 mmol/L groups(lipopolysaccharide and CoCrMo were added to the melatonin intervention groups).After the intervention for 6 hours,the expression of related proteins(NLRP3,Caspase-1,interleukin-1β,and gasdermin D,gasdermin D-N terminal)in the inflammasome of cell lysate or cell culture supernatant was detected by western blot assay.Cytotoxicity and cell death were observed through lactate dehydrogenase release and live-dead fluorescence staining. RESULTS AND CONCLUSION:(1)In vivo test:Micro-CT scanning 3D reconstruction images showed that the bone mass around the sagittal suture of the skull of mice in the osteolysis group was significantly reduced,and the bone tissue structure was severely damaged.Compared with the osteolysis group,the bone mass around the sagittal suture of the skull in the melatonin group was significantly increased,and the destruction of tissue structure was reduced.(2)In vitro test:For mouse bone marrow-derived macrophages,lipopolysaccharide significantly up-regulated NLRP3 protein expression in cell lysate,and melatonin intervention could reduce NLRP3 protein expression in a dose-dependent manner.CoCrMo particles significantly up-regulated the protein expressions of the gasdermin D-N terminal in cell lysate and Caspase-1 and interleukin-1β in the supernatant of cell culture,while melatonin intervention could reduce the expression of these proteins in a dose-dependent manner.For THP-1 cells,the protein expressions of Caspase-1 and interleukin-1β in the supernatant of cell culture were significantly up-regulated by CoCrMo particles,and the expression of these proteins was decreased dose-dependent by melatonin intervention.Lactate dehydrogenase release and live-dead fluorescence staining showed that CoCrMo particles significantly increased the release of lactate dehydrogenase and cell death in the supernatant of mouse bone marrow-derived macrophage culture,and melatonin intervention could reduce the release of lactate dehydrogenase and cell death.(3)The results show that melatonin can inhibit particle-induced inflammasome activation and pyroptosis to suppress periprosthetic osteolysis.

Objective:To compare the bile bacterial diversity in patients with different types of common bile duct stones (CBDS).Methods:A total of 45 patients with CBDS diagnosed by abdominal ultrasound, abdominal CT and (or) magnetic resonance cholangiopancreatography (MRCP) and treated by endoscopic retrograde cholangiopancreatography (ERCP) in the First Affiliated Hospital of Air Force Medical University from August 2017 to January 2018 were divided into the non-stone (NS) group, the primary cholesterol stone (PCS) group, the primary pigment stone (PPS) group, and the recurrent stone (RS) group. 16S rRNA sequencing was used to analyze the microbile community structure and diversity in bile which was collected before contrast medium injection.Results:Thirty-three patients were in the non-RS group (8 in the NS group, 8 in the PCS group, and 17 in the PPS group) and 12 were in the RS group. The proportion of patients with intra-diverticular papilla [41.67% (5/12) VS 3.03% (1/33), χ2=8.27, P=0.004], loose stones [91.67% (11/12) VS 36.36% (12/33), χ2=10.77, P=0.001] and pigmental stones [100.00% (12/12) VS 51.52% (17/33), χ2=7.04, P=0.008] were significantly higher in the RS group than those in the non-RS group. There was no significant difference in other baseline data ( P>0.05). At the phylum and genus level, the bacterial abundance was similar in the RS and PPS group. Alpha and Beta diversity analysis showed that the microbial diversity was similar between the RS and PPS group, both of which were lower than those in the NS and PCS group ( P<0.05). MetaStat analysis revealed that Helicobacter pylori was the dominant bacteria in the RS group, and Proteobacteria and Escherichia coli were the dominant bacteria in both RS and PPS groups. Conclusion:Bacterial abundance of bile in the RS group is similar to that of the PPS group, but the diversity of biliary bacteria flora in the RS group and PPS group are significantly lower than those in the PCS group and NS group. Helicobacter pylori is the dominant biliary bacteria in the RS group.

Objective: To investigate the history, risk factors for prognosis of malignant biliary stricture (MBS) patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival (OS). Methods: MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort. Results: Between January 2009 and December 2013, 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort, tumors were mainly originated from bile duct (33.6%), pancreas (23.5%) or ampulla (20.4%). 76.3% (116/152) patients died during the observation period. The median OS for the training population was 5.0 months (3.9-6.2 months). CA19-9≥1 000 U/mL, non-ampulla tumor, metastasis, pre-ERCP total bilirubin≥7 mg/dL and hilar stricture were identified as independent predictive factors of poor OS (all P<0.05). Based on these factors, the COMTH predictive model was developed. The median OS of patients with COMTH>8 in the training and validation cohorts were both 3.0 months, which were significantly shorter than those with COMTH≤8 (10.0 and 6.9 months in the training and validation cohorts respectively, both P<0.001). Conclusion The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH>8 is even more dismal.

BACKGROUNDPalliative chemotherapy has been shown to have a survival benefit for patients with recurrent or metastatic gastric cancer. We conducted a Phase II trial to determine the efficacy and safety of S-1 plus oxaliplatin (SOX regimen) as first-line chemotherapy for patients with unresectable locally advanced or metastatic gastric cancer.

METHODSEligible patients had measurable lesions and no previous history of chemotherapy (except adjuvant chemotherapy). Oxaliplatin was administered intravenously at a dose of 130 mg/m(2) on day 1. S-1 was administered orally in doses of 80, 100, or 120 mg/d according to body surface areas of <1.25 m(2), 1.25-1.5 m(2), or >1.5 m(2) respectively; the total dose was divided into two daily doses on days 1-14. Treatments were repeated every 3 weeks until disease progression or intolerable toxicity occurred.

RESULTSForty-three patients were enrolled in the study. All were assessable for efficacy and adverse events. The objective response and disease control rates were 55.8% and 76.7% respectively. The median follow-up time was 16.5 months. The median progression-free survival time was 7 months (95% CI, 5.8-8.2 months) and the median overall survival time was 16.5 months (95% CI, 9.7-23.3 months). The one-year survival rate was 54.2%. Major adverse reactions were grade 3/4 neutropenia (9.3%) and thrombocytopenia (20.9%).

CONCLUSIONThe SOX regimen with oxaliplatin at a dose of 130 mg/m(2) was found to be effective and safe as a first-line chemotherapy in Chinese patients with advanced gastric cancer.

Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Organoplatinum Compounds ; therapeutic use ; Stomach Neoplasms ; drug therapy ; Treatment Outcome

Objective To investigate the efficacy and complications of therapeutic ERCP for patients over 80 years. Methods Data of 80 patients aging over 80 years, who tnderwent therapeutic ERCP from August 2007 to August 2009 were retrospectively studied. The etiology, complications and therapeutic effects were evaluated. Results A total of 51 patients (63. 8% ) were accompanied by cardiovascular diseases, and 43 patients were diagnosed as having malignant bile duct stricture (53. 8% ). The overail therapeutic efficacy was 96. 3%. The incidence of post-operative complications was 12. 5% (10/80). Occurrence of complications in patients with malignant tumors ( 18. 6% ) was significantly higher than that in patients with bile duct stones (5.6% ,P ＜0. 05). Incidence of complications in those with cardiopulmonary diseases was similar with that in patients without (11.8% vs. 13.8%,P＞0.05). Conclusion Age more than 80should not be considered as contraindication of ERCP. Therapeutic ERCP is effective in senior patients. Patients with advanced ages shows a relatively high incidence of complication after ERCP, which may not be related to other accompanying diseases.