Objective To explore the application value of three mainstream large language models in the diagnosis, differential diagnosis, and treatment decision support of the primary diseases related to pediatric liver transplantation. Methods Seventy-nine cases of pediatric liver transplantation-related diseases diagnosed through pathological or clinical follow-up data were collected from Renji Hospital, Shanghai Jiao Tong University School of Medicine or published high-quality case reports. These cases covered 25 types of primary diseases such as cholestatic liver disease, metabolic diseases, and tumors. Standardized prompts were used to input the case information into the DeepSeek-R1, ChatGPT-4o and Grok-3 models, and the accuracy of their preliminary diagnosis and differential diagnosis based on basic clinical data was evaluated. The final diagnosis accuracy and the response time after supplementary examination were also assessed, as well as the completeness and rationality of their analysis of disease treatment principles. Results In the initial diagnosis and differential diagnosis stage, the comprehensive accuracy of DeepSeek-R1 was the highest [72.1%, 95% confidence interval (CI) 61.4% - 80.8%], and there was a statistically significant difference in the comprehensive accuracy of the three models for initial diagnosis (P = 0.008). After adding further examination information, the final diagnosis accuracy of the three models increased, with DeepSeek-R1 at 88.6% (95% CI 79.7% - 93.9%), ChatGPT-4o at 87.3% (95% CI 78.2% - 93.0%), and Grok-3 at 78.5% (95% CI 68.2% - 86.1%). There was no statistically significant difference among the three models (P = 0.05). The scores given by experts for the treatment principles showed good consistency (Kappa = 0.769). In addition, the response time of ChatGPT-4o is shorter than that of the other two models [(24 ± 7) s]. Conclusions Large language models demonstrate good efficacy in the diagnosis and treatment decision-making process of various pediatric liver diseases, have a good application prospect for auxiliary diagnosis and decision support, and are expected to help improve the accuracy and efficiency of clinical diagnosis and treatment of pediatric liver transplantation-related primary diseases.

Objective:To evaluate the safety and effectiveness of robot-assisted coronary artery bypass(RACAB).Methods:We retrospectively analyzed the clinical outcomes from 252 consecutive patients who underwent RACAB in our center between April 2021 and August 2023. The internal mammary artery(IMA) was harvested using the skeletonized technique with the assistance of the robotic system. Then, graft-to-target vessel anastomoses were performed via a 4-6 cm left fifth intercostal thoracotomy. Coronary angiography or coronary CTA was routinely performed before discharge.Results:149 patients(59.1%) underwent multi-vessel coronary bypass. 140 patients(55.6%) underwent total arterial bypass grafting, with 131 patients(52.0%) undergoing RACAB with in situ bilateral IMA. IMA harvesting failed in 6 patients(1.6%). One patient(0.4%) was assisted by extracorporeal circulation, and 5 patients(2.0%) underwent re-thoracotomy postoperatively. The patency rate of grafts was 96.6%(449/465). The 12-month and 24-month survival rate were 97.8% and 96.5% respectively; The 12-month and 24-month MACCE-free survival rate were 95.2% and 92.6%, respectively.Conclusion:RACAB is safe and feasible. With the assistance of the robotic system, in situ bilateral IMA can be obtained and bypassed to all target vessels territory. Extended follow-up is warranted.

Objective To investigate the clinical effect of Sansheng Decoction combined with Chinese herbal medicine fumigation on patients with lumbar disc herniation after percutaneous endoscopic lumbar discectomy(PELD).Methods Sixty-six patients with lumbar disc herniation of liver and kidney deficiency complicated with blood-stasis syndrome who were planning to take PELD were randomly divided into control group and treatment group,33 cases in each group.Both groups were treated with PELD.After PELD,the control group was routinely treated with anti-inflammatory,analgesic,neurotrophic and anti-infective treatment.On the basis of treatment for the control group,the treatment group was treated with modified Sansheng Decoction(composed of Eucommiae Cortex,Atractylodis Macrocephalae Rhizoma,Corni Fructus,Notoginseng Radix et Rhizoma,Acanthopanacis Cortex,etc.)orally combined with Chinese herbal medicine fumigation(consists of Achyranthis Bidentatae Radix,Angelicae Sinensis Radix,Spatholobi Caulis,Taxilli Herba,Kadsurae Coccineae Radix,etc.).Before and after treatment,the changes of Visual Analogue Scale(VAS)score of lumbar pain,Japanese Orthopedic Association(JOA)score and Oswestry Disability Index(ODI)score of lumbar function in the two groups were observed.Moreover,the postoperative complications and recurrence in the two groups were compared.Results(1)After 1 month,3 months and 6 months of treatment,except that there was no significant difference between the post-6-month VAS scores and the post-3-month VAS scores in the control group(P＞0.05),the VAS scores of lumbar pain in the two groups were all significantly lowered compared with those at the previous observation time point(P＜0.05),and the decrease in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P＜0.05 or P＜0.01).(2)After 1 month,3 months and 6 months of treatment,except that the JOA scores of lumbar function in the control group after 6 months of treatment did not differ from those after 3 months of treatment(P＞0.05),the JOA scores of the two groups were all significantly increased compared with those at the previous observation time point(P＜0.05),and the increase in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P＜0.01).(3)After 1 month,3 months and 6 months of treatment,the ODI score of lumbar function in the two groups were all significantly decreased compared with those at the previous observation time point(P＜0.05),and the decrease in the treatment group after 1 month,3 months and 6 months of treatment was significantly superior to that in the control group(P＜0.01).(4)In terms of the complications,no injury of nerve root and dura mater or other adverse reactions occurred in the two groups after operation.(5)During the trial,there was one patient lost from each group,and the remaining patients were followed up for 3 years.Within the 3 years,4 patients in the control group relapsed,and one patient in the treatment group relapsed,and all of the relapsed patients did not receive reoperation.Conclusion Sansheng Decoction combined with Chinese herbal medicine fumigation exerts certain effect in the treatment of patients with liver and kidney deficiency complicated with blood-stasis syndrome after PELD for lumbar disc herniation.The therapy can effectively relieve postoperative pain and promote the recovery of postoperative lumbar function.

Objective:To evaluate the safety and effectiveness of robot-assisted coronary artery bypass(RACAB).Methods:We retrospectively analyzed the clinical outcomes from 252 consecutive patients who underwent RACAB in our center between April 2021 and August 2023. The internal mammary artery(IMA) was harvested using the skeletonized technique with the assistance of the robotic system. Then, graft-to-target vessel anastomoses were performed via a 4-6 cm left fifth intercostal thoracotomy. Coronary angiography or coronary CTA was routinely performed before discharge.Results:149 patients(59.1%) underwent multi-vessel coronary bypass. 140 patients(55.6%) underwent total arterial bypass grafting, with 131 patients(52.0%) undergoing RACAB with in situ bilateral IMA. IMA harvesting failed in 6 patients(1.6%). One patient(0.4%) was assisted by extracorporeal circulation, and 5 patients(2.0%) underwent re-thoracotomy postoperatively. The patency rate of grafts was 96.6%(449/465). The 12-month and 24-month survival rate were 97.8% and 96.5% respectively; The 12-month and 24-month MACCE-free survival rate were 95.2% and 92.6%, respectively.Conclusion:RACAB is safe and feasible. With the assistance of the robotic system, in situ bilateral IMA can be obtained and bypassed to all target vessels territory. Extended follow-up is warranted.

RAS, a member of the small GTPase family, functions as a binary switch by shifting between inactive GDP-loaded and active GTP-loaded state. RAS gain-of-function mutations are one of the leading causes in human oncogenesis, accounting for ∼19% of the global cancer burden. As a well-recognized target in malignancy, RAS has been intensively studied in the past decades. Despite the sustained efforts, many failures occurred in the earlier exploration and resulted in an 'undruggable' feature of RAS proteins. Phosphorylation at several residues has been recently determined as regulators for wild-type and mutated RAS proteins. Therefore, the development of RAS inhibitors directly targeting the RAS mutants or towards upstream regulatory kinases supplies a novel direction for tackling the anti-RAS difficulties. A better understanding of RAS phosphorylation can contribute to future therapeutic strategies. In this review, we comprehensively summarized the current advances in RAS phosphorylation and provided mechanistic insights into the signaling transduction of associated pathways. Importantly, the preclinical and clinical success in developing anti-RAS drugs targeting the upstream kinases and potential directions of harnessing allostery to target RAS phosphorylation sites were also discussed.

Objective To summarize the experience and effect of applying 3D printing to repair thoraco-abdominal aortic disease with fenestrated stent-graft or branch stent-graft technique.Methods From Oct 2017 to Sep 2018,22 patients with thoracic and abdominal aortic diseases,including aortic arterial dissection (9 patients) and aortic aneurysm (13 patients) were admitted.There were 19 males and 3 females,with mean age of (60 ± 13) years.Before the surgery 3D printing model guide plate was made according to CT,and then the pre-fenestrated stent-graft technique,branch stent-graft technique and other techniques were adopted in the surgery to perform endovascular repair.Resuits All of the operations were completed in one stage without open surgery.The average operation time was (5.67 ± l.23) hours without renal insufficiency and paraplegia,1 branch artery was lost during operation (1.4％) and 1 patient died (4.5％).Conclusion The application of 3D printing in the treatment of thoraco-abdominal aortic disease involving branches is more accurate than traditional measurement and localization.It had a safe and reliable short-term result.