Objective:To explore the feasibility of using the large-scale language model ChatGPT to focus on research hotspots in the field of clinical medical education management,aiming to accelerate the scientific research process in this field.Methods:First,six key topics in the field were selected,and ChatGPT was guided to automatically generate the five most urgent or important research hotspots in each topic through questioning.Then,six clinical medical education managers were organized to use the five-point Likert scale to evaluate the research hotspots generated by ChatGPT from five dimensions,including pertinence,humanity,dialectics,expansion,and originality.Finally,the evaluation results were analyzed from multiple perspectives based on descriptive statistics,score similarity,and indicator correlation.Results:The research hotspots generated by ChatGPT performed excellently in terms of topic specificity,and were also satisfactory in terms of humanistic,dialectical,and expansive aspects,but performed mediocrely in terms of originality.Conclusion:ChatGPT can serve as an auxiliary tool to focus on research hotspots in clinical medical education management,but more efforts are still needed to enhance the originality of the research hotspots it generates.However,when using ChatGPT to focus on research hotspots,there are a series of ethical risks,including false and abusive data,discrimination and bias in algorithms,as well as academic dishonesty and misconduct.From the technical perspective,researchers can integrate the focused results of multiple large-scale language models,and utilize data and algorithm diversity to avoid ethical risks.From the application perspective,individual identification,group argumentation,and other means can be utilized,and carefully examined with critical thinking to avoid ethical risks.

Objective To explore the current status of posttraumatic growth (PTG) among nurses at psychiatric department and analyze its latent profiles and population characteristics. Methods A total of 357 nurses from psychiatric departments of five tertiary Grade A hospitals were selected as the research subjects using the convenience sampling method. The PTG and professional quality of life were studied using the Posttraumatic Growth Inventory and the Chinese version of the Compassion Fatigue Scale. Results The PTG score of the nurses was (56.6±23.2). The scores of compassion satisfaction, burnout, and secondary traumatic stress among nurses were (32.6±7.2), (26.9±5.9), and (26.0±5.4), respectively. The result of potential profile analysis showed that the nurses could be divided into three latent profiles based on PTG levels: low PTG group (34.4%), moderate PTG group (44.0%), and high PTG group (21.6%). The results of multinomial logistic regression analysis showed that the nurses who slept 7-8 hours per day were at higher risk of being in the high PTG group compared with those who slept more than eight hours per day (P<0.05). Psychiatric nurses who took regular exercise were at higher risk of being in the high PTG group compared with those who took irregular exercise (P<0.05). The nurses who had high job satisfaction scores were at higher risk of being in the high PTG group compared with those who had low job satisfaction scores (P<0.01). The nurses with higher compassion satisfaction scores increased the risk of being in the high PTG group compared with those with lower compassion satisfaction scores (P<0.01). The nurses with higher burnout scores increased the risk of being in the low PTG group compared with those with lower burnout scores (P<0.01). Conclusion The PTG characteristics of the nurses exhibit heterogeneity and can be categorized into three distinct profiles. Sleep duration, regular exercise, job satisfaction, compassion satisfaction, and burnout are influencing factors for the PTG latent profiles of nurses working at psychiatric department.

AIM: To investigate the effect of low-dose aspirin on primary prevention of non-fatal myocardial and cerebral infarction in patients with type 2 diabetes mellitus. METHODS: From January 2015 to December 2016,40-90 years old patients with type 2 diabetes were treated in the Department of Endocrinology of Yijishan Hospital of Wannan Medical College for more than 2 times (the interval of hospitalization was more than 3 months) , we use the hospital's his system to search out-patient and in-patient files, patients were divided into aspirin group and non-aspirin group according to the use of low-dose aspirin within 1 year after the first visit, the basic data of the first visit were collected: name, sex, age, course of diabetes, systolic and diastolic blood pressure, patients were recorded for laboratory markers including fasting blood glucose, glycated hemoglobin, triglyceride, total cholesterol, Low-density lipoprotein, high-density lipoprotein, creatinine, and platelets, complications such as hypertension, coronary heart disease, atrial fibrillation, hyperlipidemia, diabetic nephropathy and arteriosclerosis were recorded. A Chi square test and a Cox proportional hazard model were used to compare baseline data and cerebrovascular disease after the first use of aspirin. RESULTS: Of the 4 176 patients, 2 137 were type 2 diabetes, 417 were eligible for admission, including 198 males, 219 females, 224 aspirin users and 193 non-users. There was no significant difference in the incidence of cerebral infarction between the aspirin group and the non-aspirin group (χ2=0.820, P=0.365). The incidence of non-fatal myocardial infarction was lower than that of the aspirin non-aspirin group (χ2=10.099, P=0.01) , the incidence of massive hemorrhage was significantly higher than that of aspirin-free group χ2=5.425, P=0.020) . In a subgroup analysis of aspirin use, patients younger than 60 years of age had a lower incidence of ischemic stroke (cerebral infarction) and a risk ratio of 0.428 (95%CI: 0.255-0.719, P=0.001) compared with patients older than 60 years of age, the incidence of cerebral infarction was higher in female patients with a risk ratio of 1.574 (95%CI: 1.018-2.434, P=0.041). CONCLUSION: In this study of patients with type 2 diabetes, low-dose aspirin reduced the incidence of nonfatal myocardial infarction but had no significant effect on the incidence of nonfatal ischemic stroke, and significantly increase the incidence of major bleeding events, we should reconsider the use of low-dose aspirin as a potential benefit of nonfatal cerebral infarction in patients with type 2 diabetes.

Objective To investigate the clinical features of adult-onset chronic active Epstein-Barr virus infection (CAEBV). Methods A total of 21 adult patients with CAEBV who were admitted to the department of General Internal Medicine at Peking Union Medical College Hospital from January 2006 to January 2016 were retrospectively analyzed. Demographic data, disease duration, clinical manifestations, laboratory findings, treatments and prognosis were reviewed. Results Eighteen females and 3 males were enrolled with a mean age of 39 years. The most common clinical manifestations included fever in 20 patients, splenomegaly in 20 patients, lymphadenopathy in 18 patients, and hepatomegaly in 10 patients, followed by laryngopharyngeal disorders in 6 patients, pleural effusion and peritoneal effusion each in 5 patients, rash in 4 patients, interstitial lung disease in 3 patients, gastrointestinal hemorrhage in 2 patients, and peripheral neuropathy and pulmonary hypertension each in 1 patient. Six patients were complicated with hemophagocytic lymphohis-tioncytosis(HLH) that developed 5-17 (mean: 9) months following CAEBV onset, all of whom experienced hyperpyrexia, pancytopenia, lymphadenopathy, splenomegaly, and liver dysfunction, 3 with hepatomegaly. Nineteen of the 21 patients had received steroid therapy including 10 combined with immunosuppressive agents, 11 with antiviral therapy, and 8 with intravenous immunoglobulin. Thirteen patients died, including 10 of multiple organ failure, (including 6 of HLH) 2 of severe pulmonary infection, and 1 of lymphoma. Six patients remained on follow-up, yet 2 were missing. Conclusions CAEBV is expected with severe condition and poor prognosis, which is likely to be complicated with HLH. Clinical physicians should pay attention to adult patients with fever, hepatosplenomegaly and lymphadenopathy, which suggests possible CAEBV.

Objective To investigate the impacts on inpatient costs of a hospital in Beijing as incurred by the reform of clinic-pharmacy-separation by means of DRGs. Methods As required by BJ-DRGs, we selected DRGs grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Beijing from January to March in 2017 ( pre-reform group ) and that from May to July in 2017 ( the post-reform group ) . Then we compared the differences of inpatient costs before and after the reform, and the inpatient cost changes of the DRGs groups. Results The median of inpatient costs before the reform was 8751. 21 yuan, and that after the reform was 8522. 07 yuan, a difference without statistical significance (P>0. 05). Of the 104 DRGs studied, cost changes were found in 28 DRGs (P<0. 05), with increases in 19 DRGs and drops in 9 DRGs groups. Conclusions The reform, though without impact on the inpatient costs, changed the makeup of costs on the other hand, especially on HJ13 and BB25 DRGs groups, worthy of attention. A dynamic tuning mechanism is thus suggested for pricing of medical services, and a fine management suggested for the hospitals to curb unreasonable growth of costs.

Objective To explore the predictive capability of different methods for difficult la-ryngoscopy and analyze its optimal cutoff value.Methods Three hundred consecutive patients (aged 18-65 years,weighing 42-88 kg,ASA physical status Ⅰ or Ⅱ)scheduled to undergo general anesthe-sia and surgery were invited to participate.Difficult airway assessments were performed by thyromen-tal height (TMH),thyromental distance (TMD),sternomental distance (SMD),modified Mallam-pati test (MMT)and ratio of height and TMD (RHTMD)before anesthetic induction.Cormack-Le-hane (C-L)grade of laryngoscopy view was assessed after induction.Sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and accuracy of these tests were calculated. Receiver operator characteristic (ROC)curve of TMH was performed to determine the optimal cutoff value of TMH.Results There were 22 patients diagnosed as difficult airway.Sensitivity,specificity, PPV,NPV and accuracy of TMH were higher than those of TMD,SMD and MMT tests.Sensitivity of RHTMD was lower than that of TMH test,and specificity,PPV,NPV and accuracy of RHTMD were similar to that of TMH.The optimal cutoff value of TMH was 4.9 cm through ROC curve. Conclusion The optimal cutoff value of TMH detecting difficult laryngoscopy was 4.9 cm.Similar to RHTMD,TMH appears to be more effective for prediction of difficult laryngoscopy than TMD, SMD and MMT.

Interactive mode of ethical review and quality management in clinical trials consists of several parts, which includesconstructing a scientific platform of interactive information management, interactive achievement in the process of informed consent,and interactive management of following review and quality control. It aims to rem-edy the existing defects in the ethical review of clinical trials and quality management system, to guarantee the quality of clinical trials, and to achieve the full coverage of ethical codes in clinical trials.

After the contents and characteristics of SCI-covered papers list database in Dalian Medical University were described, it was pointed out that databases in academic library should provide more contents and links for the users to browse information and to use related resources by making full use of network technology. Technology and manpower should be well prepared and librarians should be qualified with patience and painstaking if an excellent SCI-covered papers list database is to be developed.

We retrospectively reviewed the clinical records of 12 systemic lupus erythematosus (SLE) patients with thrombotic thrombocytopenic purpura (TTP) admitted into Peking Union Medical College Hospital (PUMCH) during October 2008 to September 2013.TTP occurred in 0.45％ (12/2 693) of patients with SLE.The median age (2 males,10 females) was 23 years.Their SLEDAI scores ranged from 12 to 30.All patients had significant thrombocytopenia and renal abnormalities.Ten of them bad acute renal failure.Cardiac involvement and neurological deficits were observed in 9 and 8 of them respectively.Eight of them had injuries of more than 4 organs.Renal biopsy of 3 patients revealed lupus nephritis (type Ⅳ,n =2 ; type Ⅴ,n =1) and thrombotic microangiopathy.Eleven TTP patients received steroid pulse therapy (1 g/d,3 days) and six of them survived.Six patients were rescued by therapeutic plasma exchange and 4 of them recovered.Among another 6 patients not on plasma exchange therapy,only 3 recovered.Finally 2 died,3 gave up with exacerbated symptoms after therapy and 7 survived.

Objective To investigate the effects of kidney-deficiency on auditory cortex metabolism in the elderly by using the proton magnetic resonance spectroscopy(1H-MRS).Methods 50 volunteers,including 20 young subjects and 30 older subjects matched for gender,were measured by pure tone audiometry、“kidney-deficiency”-related test and were executed 3.0 T multi-voxel 1H-MRS tests,The ratios of N-acetylaspartate (NAA),choline (Cho) and lactate (Lac) to creatine (Cr) were measured and were compared between the two groups.The t-test analysis were used for statistic process.The relationship between auditory cortex metabolism and the symptom of kidney-deficiency was also analyzed.Resnlts The result of kidney-deficiency-related test and pure tone audiometry revealed that there was significant difference between the two groups and the older subjects had the more severity kidney-deficiency and high-frequency hearing loss (t=6.335、19.558,P＜0.05).The NAA/Cho ratio in the auditory cortex in the older group was significantly lower than that in the younger group (t=2.90,P＜0.05).There were no significant differences between two groups for the ratios of NAA/Cr and Cho/Cr (t=1.415、0.927,P＞0.05).Decrease of the ratio of NAA/Cho in the older group is significantly related with kidneT-deficiency(r=- 0.773,P=0.025).Conclusion kidney-deficiency play a very important role in the hearing loss and reduction of the number of neurons in auditory cortex of older healthy subjects.It suggests one possible underlying mechanism for the speech perception difficulties exhibited by aging adults.