As large-scale language models become increasingly mature,generative artificial intelligence(GenAI),represented by ChatGPT/GPT-4,is anticipated to be deeply embedded in clinical decision-making.However,the clinical application of GenAI also has potential issues,such as the Moravec paradox.The Ethics and Governance of Artificial Intelligence for Health:Guidance on Large Multi-Modal Models released by the World Health Organization proposed six principles that should be followed when large models are applied in the medical field.The participation of GenAI in clinical decision-making requires the joint engagement of both doctors and patients.Clinical doctors are involved in the research and development,promotion,and application of GenAI,as well as in controlling the direction of technological development.GenAI empowers patients to participate in decision-making,aligning with actual medical scenario and meeting the value selection preferences of patients.Deepen GenAI's explainability and responsibility allocation system,empower doctor-patient shared decision-making,properly handle the challenges brought by GenAI to traditional information and understanding,and achieve maximum clinical benefits.

Objective To investigate the relationship between the expression of programmed death ligand 1(PD-L1)and hypoxia inducible factor-1α(HIF-1 α)with the clinical pathological characteristics and prognosis of gastric cancer patients.Methods The cancer tissues of 100 gastric cancer patients who underwent radical gastrectomy at the First Hospital of Handan City from July 2019 to July 2020 were selected as the research subjects,and their adjacent tissues(normal tissues ≥ 5 cm from the cancer tissues)were as the control group.Immunohistochemical detection of PD-L1 and HIF-1 α was performed by SP method.Spearman correlation analysis was used to analyze PD-L1 and HIF-1 α in gastric cancer tissues.Kaplan-Meier method was used to analyze the 3-year survival relationship of gastric cancer patients.The influencing factors of prognosis and death in patients with gastric cancer were analyzed by univariate and multivariate Cox regression.Results Among 100 gastric cancer patients,52 were PD-L1 positive and 48 were negative;67 were HIF-1 α positive and 33 were HIF-1 α negative,the positive expression rates of PD-L1 and HIF-1α in gastric cancer tissues were 52.00％and 67.00％,respectively,which were obviously higher than those in adjacent tissues(11.00％、18.00％),the difference was statistically significant(P＜0.05).Spearman correlation analysis showed that the expression of PD-L1 was positively correlated with that of HIF-1α in gastric cancer tissues(r=0.730,P＜0.001).The expressions of PD-L1 and HIF-1α in patients with gastric cancer were correlated with TNM stage,lymph node metastasis and local invasion(P＜0.05).The 3-year overall survival rate of gastric cancer patients was 48.00％after surgery,and the 3-years survival rate of patients with positive expression of PD-L1 and HIF-1α were 28.85％and 31.34％,which were lower than those of patients with negative expression of PD-L1 and HIF-1α(68.75％and 81.82％)(Log rank x2=25.155,P＜0.001.Log rank x2=24.552,P＜0.001).Moreover,positive expression of PD-L1 and HIF-1α,TNM staging of Ⅲ-Ⅳ,lymph node metastasis,and local infiltration were independent risk factors for prognosis and death in gastric cancer patients(P＜0.05).Conclusion Both PD-L1 and HIF-1α are highly expressed in cancer tissues of gastric cancer patients,and they are positively correlated.They are also associated with clinical pathological features such as TNM staging,lymph node metastasis,and poor prognosis.

Nanomaterial-based drug sustainable release systems have been tentatively applied to bone regeneration. They, however, still face disadvantages of high toxicity, low biocompatibility, and low drug-load capacity. In view of the low toxicity and high biocompatibility of polymer nanomaterials and the excellent load capacity of hollow nanomaterials with high specific surface area, we evaluated the hollow polydopamine nanoparticles (HPDA NPs), in order to find an optimal system to effectively deliver the osteogenic drugs to improve treatment of bone defect. Data demonstrated that the HPDA NPs synthesized herein could efficiently load four types of osteogenic drugs and the drugs can effectively release from the HPDA NPs for a relatively longer time in vitro and in vivo with low toxicity and high biocompatibility. Results of qRT-PCR, ALP, and alizarin red S staining showed that drugs released from the HPDA NPs could promote osteogenic differentiation and proliferation of rat bone marrow mesenchymal stem cells (rBMSCs) in vitro. Image data from micro-CT and H&E staining showed that all four osteogenic drugs released from the HPDA NPs effectively promoted bone regeneration in the defect of tooth extraction fossa in vivo, especially tacrolimus. These results suggest that the HPDA NPs, the biodegradable hollow polymer nanoparticles with high drug load rate and sustainable release ability, have good prospect to treat the bone defect in future clinical practice.
Animals ; Bone Regeneration ; Indoles ; Nanoparticles ; Osteogenesis ; Pharmaceutical Preparations ; Polymers ; Rats

Objective:To explore the selection of surgical methods for different sites of symptomatic Rathke's cleft cyst (RCC) and the clinical efficacies of these patients.Methods:Forty-seven patients with symptomatic RCC, admitted to our hospital from January 2016 to December 2019, were chosen in our study; 21 patients with intrasellar symptomatic RCC accepted surgery via unilateral nasal approach at the right side, 19 patients with intra-suprasellar symptomatic RCC accepted surgery via bilateral nasal approach, 3 patients with suprasellar symptomatic RCC accepted endonasal transsphenoidal surgery under endoscope, and 4 patients with suprasellar symptomatic RCC accepted craniotomy via pterion approach. The clinical efficacies and complications of patients accepted different surgical methods were compared. All patients were followed up for 3-36 months to observe the recurrence.Results:The postoperative symptoms of the patients were effectively improved, including headache relief ratio of 27/31, vision loss improvement ratio of 5/5, high prolactin relief ratio of 11/13, pituitary function improvement ratio of 9/18. Complications occurred in 6 patients, presenting as diabetes insipidus. Four patients recurred during follow-up.Conclusion:Intrasellar and intra-suprasellar symptomatic RCC accepted surgery via endoscopic transnasal transsphenoidal approach are safe and effective; selection of surgical methods for suprasellar symptomatic RCC should be determined according to the sizes and growth directions of cysts.

As a new technology in the field of computer science, virtual reality has been widely used in the field of medicine. Because of its great developmental potential and application value, virtual reality has attracted wide attention in the field of plastic surgery. By summarizing the pros and cons of this technology, such as the development of this technology, the study of craniofacial anatomy, plastic surgery training, preoperative design, doctor-patient communication, etc., the purpose of this article is to promote the application of virtual reality in the realm of plastic surgery so that more and more patients and physicians could benefit from this technology.

As a new technology in the field of computer science, virtual reality has been widely used in the field of medicine. Because of its great developmental potential and application value, virtual reality has attracted wide attention in the field of plastic surgery. By summarizing the pros and cons of this technology, such as the development of this technology, the study of craniofacial anatomy, plastic surgery training, preoperative design, doctor-patient communication, etc., the purpose of this article is to promote the application of virtual reality in the realm of plastic surgery so that more and more patients and physicians could benefit from this technology.

OBJECTIVE:To provide reference for pharmacists to participate in the management of chronic disease. METHODS:A total of 259 patients with chronic airway disease [included asthma and chronic obstructive pulmonary disease (COPD)] met the inclusion criteria were selected from our hospital and 5 community health care centers of medical consortium. These patients received medication safety assessment management,which was led by clinical pharmacists of our hospital with the participation of community pharmacists,including medication safety comprehensive evaluation and risk classification management, follow-up and medication guidance, integrated prescriptions checking, establishment of shared database. 1 years after the implementation,the effectiveness were evaluated by score the relatived indicators in related groups. RESULTS:After a year of the management mode practice,compared with before intervention,the patients'safety medication cognitive ability score in high-risk and low-risk group increased from(4.49±1.26)and(7.31±1.01)to(5.40±1.56)and(7.44±0.91);medication adherence score increased from(4.96±1.21)and(7.08±1.24)to(6.66±1.08)and(7.38±0.98);ACT score from asthma patients increased from (16.15±2.58)and(21.15±1.03)to(16.80±2.57)and(21.64±1.55);CAT score from COPD patients decreased from(25.51± 4.07) and (14.90 ± 3.95) to (24.20 ± 3.96) and (13.80 ± 4.08);the rate of irrational prescription effective identification and intervention by pharmacists increased from 3.6％ and 1.4％ to 9.4％ and 7.6％,respectively. All the differences above were statistically significant (P<0.05). CONCLUSIONS:The participation of pharmacists in long-term medication safety assessment management for chronic airway disease patients can improve patients'safety medication cognitive ability,medication adherence, disease control and the pharmacists'ability of irrational drug use identification and intervention.

Objective To study the prevalence and the related risk factors of diabetic peripheral neuropathy(DPN) after good blood glucose well controlled among in middle-aged and old-aged population with type 2 diabetes mellitus in a community of Beijing.Methods DPN was screened by Michigan neuropathy screening instrument (MNSI),and common blood biochemical parameters were tested,among over 45 years of age registered population patients with type 2 diabetes mellitus in Shuangjing community of Chaoyang District of Beijing.Results The blood glucose control rate was 90.36％ (253/280),and the prevalence of DPN was 25.36％ (71/280) with male of 24.47 ％ (23/94) and female of 25.81％ (48/186).Univariate analysis showed that both age and HbA1c in DPN group were higher than that of non-DPN group,and the differences were statistically significant(P =0.000,0.008).The level of plasma low density lipoprotein cholesterol(LDL-C) of the DPN group was lower than that of the non-DPN group,and the difference was statistically significant (P=0.017).The hypertension prevalence rate of the DPN group was 87.32％(62/71),higher than that of the nonDPN group(75.6％ (158/209)),and the difference was statistically significant (P =0.037).The multivariate logistic regression analysis showed that the estimate of parameter for age was 0.143 (P =0.0001),OR was 1.153,95％CI was from 1.029 to 1.219,for HbA1c was 0.529(P=0.03),OR was 1.698,95％CI was from 1.053 to 2.738,and for LDL-C was-O.919 (P =0.018),OR was 0.399,95％ CI was from 0.186 to 0.854.Conclusion The prevalence of DPN is still above 25％ among middle-aged and old-aged in a community,even though the well controlled rate of blood glucose control rate is above 90％.It is possible that old age and HbA1c are related to DPN,apart from blood glucose.

Objective To investigate the surgical safety and clinical efficacy of resection of deep brain lesions by using awake anesthesia and multiple positioning technology.Methods A retrospective analysis of clinical data and surgical treatments of 77 patients with deep brain lesions,admitted to our hospital from September 2013 and September 2014,was performed.Craniotomy was performed under general anesthesia,and then,awaking up of patient during surgery was achieved.Under awake state,the boundary of the lesions was mapped by neuroimage navigation technology,and language and movement functional areas were located using direct cortex evoked potential or cortical electrical stimulation.The deep brain lesions were removed according to anatomic-functional boundaries.Patients were followed up for 3 months.Results Intra-operative awaking up was successful in 74 patients.Language areas were identified in 8 patients,and movement functional areas were detected in 38 patients.Total resection was achieved in 51 patients,sub-total resection in 24 and 2 partial removals.Postoperative temporary movement barriers were noted in 10 patients and language barriers in 2 patients.Conclusion The deep brain lesions can be maximally removed by combined neuroimage navigation with cortical electrical stimulate under awake anesthesia,which can significantly protect the important brain functions and improve the quality of patients life after surgery.

Objective To explore the expression of heme oxygenase-1 (HO-1) in gastric mucosa of patient with portal hypertensive gastropathy (PHG),and its role in the pathogenesis of PHG.Methods The specimens were obtained from the gastric mucosa of 22 healthy subjects,20 portal hypertension (PHT) without PHG,and 22 PHG patients.Histological changes of the gastric mucosa were detected,and portal venous flow (PVF) was measured.The expression of HO-1 protein in gastric mucosal specimens was assessed by immunohistochemistry and Western blot analysis,respectively.The relationship between HO-1 expression and PHG severity score,HO-1 expression and PVF,PHG severity score and clinical parameters were investigated.Results HO-1 protein expression in gastric mucosa of PHG and PHT was significantly higher than that of the control (P ＜ 0.05),while there was no significant difference in this variable between PHG and PHT (P ＞ 0.05).The positive correlation was detected between HO-1 expression and PHG severity score in PHG patients (r =0.459,P ＜0.05),however,PHG severity score was irrelevant to severity of esophageal varice (r =0.059,P ＞ 0.05) or to Child-Pugh classification (r =-0.001,P ＞ 0.05).Of all the patients with PHT and PHG,no significant correlation was found between HO-1 expression and PVF (r =0.071,P ＞ 0.05).Conclusion HO-1 protein is up-regulated in gastric mucosa of PHG patients,which may contribute to gastric circulation disorder of PHG.