Large language models (LLMs) offer a modern approach to help inherit traditional Chinese medicine (TCM). This article discussed the progress of LLM applications in TCM and proposed future development directions by reviewing the existing research. We have found that LLMs and related technologies have excellent applications and performance in the management of TCM knowledge and data. They are often applied in information extraction, knowledge graph construction, and data standardization processing. However, data quality and security issues need to be given more attention. In clinical diagnosis and treatment, LLMs can imitate the thinking of TCM by disassembling and reconstructing its diagnostic process and can achieve functions such as prescription recommendation and question and answer (Q&A). However, this approach involves LLMs making inferences and predictions based on existing corpora and thus may not flexibly handle complex environments and tasks. Moreover, the current evaluation criteria for TCM LLMs can be summarized into 3 categories: general evaluation metrics, technical framework evaluation, and evaluation criteria for the characteristics of TCM (such as consistency rates of prescriptions and diagnostic suggestions). However, the lack of a unified and standardized evaluation system hinders the clinical application of TCM LLMs. The future progress of TCM LLMs should focus on the 3 aforementioned critical aspects to achieve technological breakthroughs. In addition, we are promoting the research on vertical TCM LLMs and application terminals. We believe this will bring new ideas to the research on TCM LLMs.

Objective:To explore and analyze the system development, application and evaluation of virtual simulation (VS) based clinical thinking system in midwifery education, and to provide reference for the research in this area.Methods:The scoping review guidelines published by the Joanna Briggs Institute was used as the methodological framework. Literature was searched from the domestic and international databases such as CNKI, Wanfang, PubMed, and Web of Science Core Collection, from the date of database construction to September 1, 2023. The literature was screened according to the inclusion and exclusion criteria, and the included literature was statistically and analytically reviewed.Results:A total of 314 articles were retrieved, and 13 articles were finally included. The VS based clinical thinking system is in its infancy in midwifery education at home and abroad. In China, there is a lack of theoretical framework underpinned the system development. The content was limited to the care during labor and delivery and family planning, and virtual woman and multiply operation paths have not been adopted in the system development. Besides, research design of the studies was less rigid and the indicators were not specifically selected for clinical thinking.Conclusions:Current studies have preliminarily proved some positive effects of VS on midwifery clinical thinking. However, it is suggested that development of VS system needs to be underpinned by theoretical framework related to clinical thinking. Types of VS and its operation path need to be adopted according to learning contents and objectives, whilst learning content should be extended to the wider midwifery scope of practice. Improve intervention plans in application and evaluation, select specific high evaluation tools, and further explore the impact of virtual simulation technology on students′ clinical thinking ability in midwifery.

Objective:To explore and analyze the system development, application and evaluation of virtual simulation (VS) based clinical thinking system in midwifery education, and to provide reference for the research in this area.Methods:The scoping review guidelines published by the Joanna Briggs Institute was used as the methodological framework. Literature was searched from the domestic and international databases such as CNKI, Wanfang, PubMed, and Web of Science Core Collection, from the date of database construction to September 1, 2023. The literature was screened according to the inclusion and exclusion criteria, and the included literature was statistically and analytically reviewed.Results:A total of 314 articles were retrieved, and 13 articles were finally included. The VS based clinical thinking system is in its infancy in midwifery education at home and abroad. In China, there is a lack of theoretical framework underpinned the system development. The content was limited to the care during labor and delivery and family planning, and virtual woman and multiply operation paths have not been adopted in the system development. Besides, research design of the studies was less rigid and the indicators were not specifically selected for clinical thinking.Conclusions:Current studies have preliminarily proved some positive effects of VS on midwifery clinical thinking. However, it is suggested that development of VS system needs to be underpinned by theoretical framework related to clinical thinking. Types of VS and its operation path need to be adopted according to learning contents and objectives, whilst learning content should be extended to the wider midwifery scope of practice. Improve intervention plans in application and evaluation, select specific high evaluation tools, and further explore the impact of virtual simulation technology on students′ clinical thinking ability in midwifery.

Age-related ovarian aging is significantly influenced by oxidative stress,which has intricate underlying mechanisms.Studies conducted recently have demonstrated that oxidative stress is a mediator of several pathological processes that lead to ovarian dysfunction in aging.These processes include telomere shortening,chronic inflammation,apoptosis,and mitochondrial dysfunction.Under oxidative stress,antioxidant treatment can assist in enhancing ovarian function.

Objective:To explore the latent classes of fear of childbirth in late pregnancy women and its relationship with sense of coherence, providing reference for precise support interventions in clinical practice.Methods:From January to September 2023, convenience sampling was used to select 304 pregnant women who underwent antenatal examination at the Obstetrics Clinic of Affiliated Hospital of Hangzhou Normal University as participants. The General Information Questionnaire, Childbirth Attitudes Questionnaire, and the Sense of Coherence Scale-13 (SOC-13) were used for questionnaire survey. Latent profile analysis was used to explore the categories of fear of childbirth in late pregnancy women, and analyzed differences of SOC-13 scores among women with different categories of fear of childbirth.Results:Fear of childbirth in 304 late pregnant women was divided into three latent classes, including low-level fear group of (50.0%, 152/304), moderate-level fear group of (35.2%, 107/304), and high-level fear group of (14.8%, 45/304). ANOVA analysis showed that there were statistically significant differences in total score and dimension scores of SOC-13 among late pregnancy women with three different classes of fear of childbirth ( P<0.05) . Conclusions:There are three latent classes of fear of childbirth in late pregnancy women. The sense of coherence among pregnant women affects their fear of childbirth. Nursing staff should address the heterogeneity of fear of childbirth in late pregnancy women, starting from sense of coherence, and take targeted intervention measures to reduce the fear of childbirth in late pregnancy women.

Age-related ovarian aging is significantly influenced by oxidative stress,which has intricate underlying mechanisms.Studies conducted recently have demonstrated that oxidative stress is a mediator of several pathological processes that lead to ovarian dysfunction in aging.These processes include telomere shortening,chronic inflammation,apoptosis,and mitochondrial dysfunction.Under oxidative stress,antioxidant treatment can assist in enhancing ovarian function.

Objective To investigate antigen optimization of Shisa like protein 1 (SHISAL1) for preparing mouse anti-human SHISAL1 polyclonal antibody and to identify the specificity of the prepared antibody. Methods Bioinformatics was employed to predict the antigenic epitope region of SHISAL1 protein, and then a polypeptide composed of amino acid residues from the site of 28 to 97 of SHISAL1, termed SHISAL1-N, was selected as the antigen. The coding region of SHISAL1-N was cloned by molecular cloning technique, and then it was inserted into pET-28a to generate pET28a-SHISAL1-N recombinant plasmid. The two recombinant plasmids pET28a-SHISAL1-N and pET28a-SHISAL1 were transformed into BL21 (DE3) bacteria and induced to express by IPTG. The two proteins were purified and immunized to female Kunming mice, respectively. The specificities and sensitivities of the acquired antibodies were detected by Western blot analysis, immunoprecipitation and immunofluorescent cytochemical staining. Results pET28a-SHISAL1-N recombinant plasmid was successfully constructed, and the two fused proteins, SHISAL1 and SHISAL1-N, were induced to express. Moreover, two types of SHISAL1 mouse polyclonal antibodies, derived from SHISAL1-N and SHISAL1 antigens, were obtained. Western blot results showed that the antibody prepared from SHISAL1 antigen was less specific and sensitive compared with the antibody prepared from SHISAL1-N antigen which could specifically identify different endogenous SHISAL1 protein. Immunoprecipitation results showed that SHISAL1-N antibody could specifically pull down SHIISAL1 protein in hepatocellular carcinoma cells and immunofluorescence results demonstrated that SHISAL1-N antibody could specifically bind to SHISAL1 protein in the cytoplasm. Conclusion We have optimized the SHISAL1 antigen and prepared the mouse anti-human SHISAL1 polyclonal antibodies successfully, which can be used for Western blot analysis, immunoprecipitation and immunofluorescence cytochemical staining.
Animals ; Female ; Humans ; Mice ; Antibodies ; Antibody Specificity ; Blotting, Western ; Cloning, Molecular ; Epitopes/genetics*

Objective:To evaluate the clinical effects of antagonist protocol and progestin-primed ovarian stimulation (PPOS) protocol in patients with low prognosis.Methods:A total of 1560 controlled ovarian stimulation cycles of 1419 patients consistent with POSEIDON low prognosis with antagonist protocol or PPOS protocol in the treatment of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) from January 2016 to December 2018 in the Reproductive Medicine Center of Henan Provincial People's Hospital were collected in a retrospective cohort study. The essential characteristic, clinical characteristics, laboratory index and clinical outcomes of patients in the antagonist protocol group and the PPOS protocol group were compared. Multivariate logistic regression analysis was used to compare cumulative live rate per ovulation cycle after adjusting for confounders of the two controlled ovarian stimulation protocols. Results:The comparison of the general conditions of the patients with the two controlled ovarian stimulation protocols showed that anti-Müllerian hormone (AMH) [1.45(0.68, 3.28) μg/L] and antral follicle count (AFC) [7.00(4.00,11.00) μg/L] in the antagonist protocol group were significantly higher than those in the PPOS protocol group [1.10(0.55, 2.71) μg/L, P=0.002; 6.00(3.00, 9.00) μg/L, P=0.010], and basal follicle-stimulating hormone (FSH) [7.65(6.26, 9.99) U/L] was significantly lower than that in the PPOS protocol group [7.88(6.29, 10.58) U/L, P=0.007]. The results of laboratory and clinical outcomes showed that the estrogen level [726.20(415.30,1 095.00) ng/L] on human chorionic hormone (hCG) injection day in the antagonist protocol group was significantly lower than that in the PPOS protocol group [738.00(412.55, 1 187.75) ng/L, P=0.028], and the endometrial thickness [(9.31±2.67) mm] on hCG injection day, the cumulative pregnancy rate [49.35% (379/768)] and the cumulative live birth rate per ovulation cycle [38.04% (291/765)] were significantly higher than those in the PPOS protocol group [(6.81±2.26) mm, P<0.001; 37.62% (298/792), P<0.001; 26.08% (206/790), P<0.001]. After adjusting for confounder factors, the cumulative pregnancy rate ( OR=1.58, 95% CI=1.24-2.01, P<0.001) and the cumulative live birth rate ( OR=1.68, 95% CI=1.30-2.17, P<0.001) per ovulation cycle in the antagonist protocol group were higher than those in the PPOS protocol group in patients with POSEIDON low prognosis. The results of stratified analysis showed that the cumulative pregnancy rate and the cumulative live birth rate per ovulation cycle of antagonist protocol group per ovulation cycle was higher than that of PPOS protocol group. The cumulative pregnancy rate and the cumulative live birth rate per ovulation cycle in different age ( P<0.001, P<0.001), insemination method ( P<0.001, P<0.001), AMH ( P<0.001, P<0.001) and POSEIDON group 1 ( P=0.001, P<0.001) and POSEIDON group 3 ( P=0.008, P=0.024) were statistically different. Conclusion:In patients with low prognosis of POSEIDON, the antagonist protocol improved the cumulative live birth rate per ovulation cycle compared with the PPOS protocol, especially for patients in POSEIDON group 1 and POSEIDON group 3.

Objective:To investigate the effect of altering trigger timing on clinical outcomes of low prognosis patients with gonadotropin-releasing hormone (GnRH) antagonist.Methods:A retrospective cohort study was conducted on 1613 cycles of low prognosis patients based on POSEIDON criteria undergoing in vitro fertilization-embryo transfer (IVF-ET) with GnRH antagonist protocol between January 2017 to June 2019 in Reproductive Medicine Center, Henan Provincial People's Hospital. Patients were divided into 3 groups depending on different trigger timing criteria (conventional trigger group, n=961; advanced trigger group, n=359; delayed trigger group, n=293). Univariate analysis and multivariate logistic regression analysis were used to analyze the effect of trigger timing on clinical outcomes such as cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) among different groups. Results:The clinical pregnancy rate of fresh cycle in advanced trigger group, conventional trigger group, delayed trigger group were 35.77% (44/123), 39.16% (150/383), 34.01% (50/147), respectively. CPR and CLBR ranked from low to high in order of advanced trigger group, conventional trigger group and delayed trigger group [CPR: 33.18% (72/217) vs. 42.23% (276/652) vs. 45.27% (91/201), P=0.024; CLBR: 22.97% (48/209) vs. 31.96% (201/629) vs. 35.90% (70/159), P=0.012]. The result of multivariate logistics regression analysis showed that there were no significant differences on clinical pregnancy rate, CPR and CLBR among three groups [delayed trigger group: the clinical pregnancy rate in fresh cycle OR(95% CI)=0.69(0.44-1.09), P=0.114; CPR OR(95% CI)=0.77 (0.51-1.16), P=0.214; CLBR OR(95% CI)=0.83(0.54-1.29), P=0.418; advanced trigger group: the clinical pregnancy rate in fresh cycle OR(95% CI)=0.98(0.60-1.60), P=0.934; CPR OR(95% CI)=0.87(0.58-1.30), P=0.513; CLBR OR(95% CI)=0.86(0.54-1.35), P=0.515]. Conclusion:Conventional trigger could obtain the ideal clinical outcomes in low prognosis patients based on P

Objective:To investigate the effect of endometrial thickness (EMT) on the clinical outcome of hormone replacement frozen-thawed embryo transfer (HRT-FET) cycle in different body mass index (BMI) groups, and to analyze the threshold and optimal EMT and EMT interval corresponding to the ideal clinical pregnancy rate.Methods:A retrospective cohort study was conducted on 10 239 HRT-FET cycles in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2013 to December 2017, and they were divided into low weight group (BMI<18.5 kg/m 2), normal weight group (BMI=18.5-24.9 kg/m 2), overweight group (BMI=25.0-29.9 kg/m 2) and obese group (BMI≥30.0 kg/m 2). Four subgroups were divided according to EMT, respectively EMT<8.0 mm, 8.0 mm≤EMT<10.0 mm, 10.0 mm≤EMT<12.0 mm, EMT≥12.0 mm. The clinical characteristics and outcome indicators of different EMT subgroups in different BMI groups were compared. To achieve the ideal clinical pregnancy rate, multiple regression analysis, curve fitting and threshold effect analysis were used to find the best EMT and thickness interval. Results:1) After adjusting for confounding factors, multiple regression analysis showed that, there were no significant differences in clinical pregnancy rate and live birth rate among subgroups with the increase of EMT (all groups P>0.05). The clinical pregnancy rate and the live birth rate increased with the increase of EMT between subgroups of normal body weight group and super-recombinant subgroups (all P<0.001 for normal body weight subgroups, P=0.123, P=0.009, P=0.016 and all P<0.001 for super-recombinant subgroups). In the obesity group, with the increase of EMT, the clinical pregnancy rate did not increase significantly except EMT≥12.0 mm subgroup ( P=0.449, P=0.279, P=0.021), while the live birth rate increased significantly ( P=0.014, P=0.005, P<0.001). 2) Curve fitting showed that in the population of low weight and obese, influence of EMT on clinical pregnancy rate was a straight line, in the population of normal weight and overweight, influence of EMT on clinical pregnancy rate was a curve, as EMT increased the clinical pregnancy rate raised and then decreased, the impact on the live birth rate appeared similar. 3) According to the curve fitting, the threshold effect analysis of the normal weight group showed that the endometrial inflection point of EMT on the clinical pregnancy rate and the live birth rate was 10.0 mm. When EMT was lower than 10.0 mm, the clinical pregnancy rate and the live birth rate increased by 20% and 19% for every 1.0 mm increase in endometrial thickness ( OR=1.20, 95% CI=1.13-1.26; OR=1.13,95% CI=1.13-1.26). In overweight group, the inflection point of EMT on the clinical pregnancy rate and the live birth rate was also 10.0 mm. When EMT was lower than 10.0 mm, the clinical pregnancy rate and the live birth rate increased by 24% and 26% for every 1.0 mm increase in EMT ( OR=1.24, 95% CI=1.13-1.26; OR=1.26, 95% CI=1.14-1.40). When EMT exceeded 10.0 mm, the clinical pregnancy rate and the live birth rate did not increase significantly with the increase of EMT. Conclusion:In HRT-FET cycle, the endometrial thickness has an effect on the clinical pregnancy rate and the live birth rate in the normal weight group and the overweight group. The clinical pregnancy rate and the live birth rate were the best when the EMT was between 10.0-13.5/10.0-12.7 mm and 10.0-14.0/10.0-12.5 mm, respectively. Whether the endometrium was too thin or too thick would affect the clinical pregnancy outcome. The influence of EMT on clinical pregnancy rate and live birth rate was linear between the low weight group and the obese group, but further study is needed.