AIM: To evaluate the performance of three distinct large language models(LLM), including GPT-3.5, GPT-4, and PaLM2, in responding to queries within the field of ophthalmology, and to compare their performance with three different levels of medical professionals: medical undergraduates, master of medicine, and attending physicians.METHODS: A total of 100 ophthalmic multiple-choice tests, which covered ophthalmic basic knowledge, clinical knowledge, ophthalmic examination and diagnostic methods, and treatment for ocular disease, were conducted on three different kinds of LLM and three different levels of medical professionals(9 undergraduates, 6 postgraduates and 3 attending physicians), respectively. The performance of LLM was comprehensively evaluated from the aspects of mean scores, consistency and confidence of response, and it was compared with human.RESULTS: Notably, each LLM surpassed the average performance of undergraduate medical students(GPT-4:56, GPT-3.5:42, PaLM2:47, undergraduate students:40). Specifically, performance of GPT-3.5 and PaLM2 was slightly lower than those of master's students(51), while GPT-4 exhibited a performance comparable to attending physicians(62). Furthermore, GPT-4 showed significantly higher response consistency and self-confidence compared with GPT-3.5 and PaLM2.CONCLUSION: LLM represented by GPT-4 performs well in the field of ophthalmology, and the LLM model can provide clinical decision-making and teaching aids for clinicians and medical education.

OBJECTIVE To study the inhibitory effect and mechanism of curcumin and its derivatives A and B on TGF-β induced LX-2 cell fibrosis. METHODS Established the liver fibrosis model of LX-2 cells induced by TGF-β(10 ng·mL−1).The effects on cell proliferation were detected by CCK-8. The effects on cell apoptosis was detected by flow cytometry. The effects on fibrosis related factors(Collagen I, Collagen Ⅳ, Fibronectin, Vimentin, α-SMA, PDGFRβ, TGFβR1, TGFβR2, MMP2, MMP9, TIMP1 and TIMP2) protein expression and gene transcription levels were detected by Western blotting and q-PCR. RESULTS The curcumin and its derivative A and B had the inhibition effects on normal LX-2 cells, and the IC25 values were 15.7, 2.6, 10.2 μmol·L−1, respectively. Compared to the model group, the curcumin(15.7 μmol·L−1) and its derivative A(2.6 μmol·L−1) and B(10.2 μmol·L−1) had the significant inhibition effects on cell proliferation of the TGF-β induced LX-2 cells(P<0.05). The cell apoptosis rate of curcumin derivative B group was higher than the model group(P<0.05). Collagen I, Fibronectin, Vimentin, α-SMA, TGFβR1 and TIMP-1 protein expression levels in curcumin group were lower, while the protein expression level of MMP-9 was higher(P<0.05). The protein expression levels of Collagen I, Collagen IV, Fibronectin, Vimentin, α-SMA, TIMP-1 and TIMP-2 in curcumin derivative A group were lower, while the protein expression level of MMP-2 was higher(P<0.05). The protein expression levels of Collagen I, Collagen IV, Fibronectin, Vimentin, α-SMA, PDGFRβ, TGFβR1, TGFβR2, TIMP-1 and TIMP-2 in curcumin derivative B group were lower, while the protein expression level of MMP-2 was higher(P<0.05). The gene transcription levels of Collagen I, Fibronectin, α-SMA and TIMP-1 in curcumin group were lower(P<0.05). The gene transcription levels of Collagen I, Fibronectin and α-SMA in curcumin derivative A and B groups were lower(P<0.05). CONCLUSION Curcumin and its derivatives A and B inhibit the abnormal activation and proliferation of TGF-β-induced LX-2 cells, inhibit the excessive secretion and accumulation of its extracellular matrix components, and promote its degradation, thus playing an anti-fibrotic effect in vitro, especially the curcumin derivative B.

Mild traumatic brain injury(mTBI)is a common brain injury,which is usually associated with traffic acci-dents,sports activities or explosions in military conflicts.Although the symptoms of mTBI may not be as obvious as those of moderate or severe TBI,it may lead to short-term or long-term neurological dysfunction,including visual problems,which may affect the daily life of patients.In clinical practice,there are many therapies for visual impairment in patients with mTBI,such as visual rehabilitation therapy,eye movement training,double nose occlusion,as well as prism and filter application.However,the scientific basis for these treatments is often insufficient,and there is a lack of control studies to verify their effectiveness,leading to questions about these treatments.In 2022,a group of experts proposed the"Consensus on Visual Rehabilitation of Patients with Mild Traumatic Brain Injury"to unify the definition of mTBI,evaluate existing di-agnosis and treatment methods and propose suggestions for future research,promoting more scientific and rigorous re-search.This paper interprets the consensus combined with the latest literature.

The myopia in children is on the rise and has become a major threat to public health,attracting extensive at-tention worldwide.Premyopia is an indication for the accurate prediction of myopia.Children that have premyopia are ex-tremely likely to develop myopia,and these children make up a substantial portion.Hence,it is imperative that we devote our efforts to the premyopia population.In the premyopia eyes,there is a decline in the accommodation force,which is comparable to mild myopia.Timely detection and efficient preventative interventions on premyopia may mitigate the inci-dence of myopia,postpone the development of myopia,safeguard children's eyesight,and further improve their quality of life.Some treatments for preventing and controlling premyopia involve encouraging outdoor activities,using repeated low-level red-light therapy,applying low-dose atropine treatment,and utilizing orthokeratology.Furthermore,it encompasses several innovative technologies,such as flat-light defocusing lenses and traditional Chinese medicine treatment.We must grasp the critical period of premyopia and actively investigate cutting-edge methods for myopia prevention and control.Fur-thermore,we should carefully employ these new technologies with the goal of improving the well-being of patients.

Purpose/Significance To introduce the knowledge graph technology in the field of electronic information into the study of traditional Chinese medicine(TCM)terminology,and to demonstrate the dialectical relationship between the therapeutic effects of TCM and its nature,flavor,meridians and TCM diseases in a vivid way.Method/Process The top-down ontology construction method is adopted to build the top-level structure of TCM ontology on the Protégé platform.Taking the 2020 edition of the Chinese Pharmacopoeia as the data source,the TCM information in the pharmacopoeia is split and extracted,and the information of each axis is sorted,disambiguated and nor-malized.With the help of the Protégé platform,entities and relationships are created,and the TCM triple data is output in RDF data for-mat.Finally,the Neo4j graph database is used to store and display the RDF data to form a systematic TCM knowledge graph.Result/Con-clusion It mainly realizes the construction of the knowledge graph of TCM in the pharmacopoeia,and fully reveals the complex knowledge system structure in the field of TCM through data statistical analysis,knowledge measurement and drawing of visual graphics.

Objective:To detect the pathogen and clinically diagnose for a suspected case of Neisseria meningitidis with positive blood culture result, and assess the risk of disease transmission among the community. Methods:Blood sample was collected for Neisseria meningitidis isolation and culture. Pathogen identification and serogroup typing were conducted by colony morphology, Gram staining, biochemical tests, latex agglutination test, slide agglutination test, and nucleic acid testing. The susceptibility to 12 antibiotics was also tested. Epidemiological investigation was conducted on the case, and epidemic control measures were also implemented. Results:Through various detection, the suspected case was diagnosed as Neisseria meningitidis invasive infection. The isolated strain belonged to group Y serotype, type 767 (multilocus sequence typing), and the ST167 clonal complex. The strain was sensitive to nine antibiotics, including penicillin, ampicillin, and meropenem. It exhibited intermediate sensitivity to ciprofloxacin and levofloxacin, and resistance to methicillin/sulfamethoxazole. Close contacts of the case and environmental testing results were negative. Conclusions:The case is confirmed to be an invasive infection caused by group Y Neisseria meningitidis, the ST167 clonal complex. Epidemiological investigation shows a relatively low risk of epidemic transmission. Continuous monitoring and surveillance are necessary for further assessment.

Abstract OBJECTIVE To study the mechanism of NLRP3 gene’s regulation on inflammatory response in non-alcoholic fatty liver disease(NAFLD) mice induced by high-fat and high-fructose diet using NLRP3 gene knockout mice. METHODS Use male homozygous(NLRP3-/-) mice, and the high-fat and high-fructose diet was used to establish NAFLD model in NLRP3 knockout(KO) mice and wild-type(WT) mice, divided into KO high-fat and high-fructose diet(KO-HFD) group and WT high-fat and high-fructose diet(WT-HFD) group, while the WT and KO groups were also established. The body weight of mice in each group were observed. The changes of ALT, AST, TG, TC, MDA, SOD, lipidosis, apoptosis rate, IL-1β, IL-18, TNF-α, NF-κB, NLRP3, Caspase-1 and ASC in serum and tissue samples were tested to study the mechanism of the NLRP3 gene regulating the inflammatory response in NAFLD mice. RESULTS As time goes on, the mice weight of each group increased gradually, but the KO-HFD group increased less than the WT-HFD group. Each group’s level of ALT, AST, TG, TC in serum increased gradually, but the KO-HFD group increased less than the WT-HFD group. The level of MDA in liver tissues of each group was gradually increased and the level of SOD was gradually decreased, but the change range of KO-HFD group was smaller than that of WT-HFD group. The results of oil red O staining and Tunel section showed that the degree of lipid deposition and apoptosis in hepatocytes increased gradually in all groups, but the changes in KO-HFD group were less than that in WT-HFD group. The levels of serum and liver inflammatory factors IL-1β, IL-18, TNF-α and NF-κB increased in all groups, but the changes of KO-HFD group 20 weeks were less than those of WT-HFD group 20 weeks, and the difference was statistically significant. The expression levels of NLRP3 inflammasomes and related inflammatory cytokines NLRP3, Caspase-1, ASC, IL-1β and IL-18 in liver tissues of WT-HFD group were higher than those of KO-HFD group. The mRNA transcription levels of NLRP3, ASC, Caspase-1, IL-1β and IL-18 in WT-HFD group were gradually increased, while there was no change in KO-HFD group. CONCLUSION The NLRP3 gene may be activated in NAFLD mice model, resulting in increased expression of NLRP3 inflammasome-associated protein, promoting the synthesis and secretion of downstream inflammatory factors, resulting in significant inflammatory response and liver damage, and promoting the progression of NAFLD disease.

Treatment of advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation with EGFR-tyrosine kinase inhibitors (EGFR-TKIs) can achieve good disease control, but it will inevitably produce drug resistance. About 3%-10% of the resistance mechanism is small cell transformation. Two cases of stage IV lung adenocarcinoma with EGFR mutation were reported and the disease was controlled after EGFR-TKIs treatment. In case 1, progression-free survival (PFS) before small cell carcinoma transformation was 16 months, and in case 2, PFS before small cell carcinoma transformation was 24 months. Subsequent biopsy after disease progression indicated a shift to small cell lung cancer. Case 1 PFS after small cell carcinoma transformation was 6 months, and case 2 PFS after small cell carcinoma transformation was 8 months, and overall survival (OS) was 36 months, which significantly prolonged the patient's survival. At the same time, the literature of such drug resistance mutations was reviewed. For patients with advanced NSCLC with sensitive mutations, it is necessary to conduct secondary histopathological tests after TKIs treatment resistance, and select subsequent treatment according to different resistance mechanisms for the whole course of disease management.
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Humans ; Carcinoma, Small Cell ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Adenocarcinoma/genetics* ; Small Cell Lung Carcinoma/genetics* ; ErbB Receptors/genetics*

Objective:To explore the application of PDCA cycle combined with project management method in the assessment and management of special skills training in clinical skills center.Methods:From January to December in 2018, the PDCA cycle combined with project management method was used to manage the special skills training project team. The utilization rate of special skills simulation equipment before and after management was compared. A questionnaire survey was conducted to investigate the satisfaction with the management model among the students involved in the special skills training in 2018.The data was analyzed by SPSS 13.0.Results:The utilization rate of special skills simulation equipment was significantly improved, and the students were highly satisfied with the management model.Conclusion:Using PDCA cycle combined with project management method, this paper explores a management model of special skills training and assessment in clinical skills center, which improves the quality of special skills training and assessment management in clinical skills center, and is worthy of further exploration and practice.

Objective To compare the safety and efficacy of different methods for nasal jejunum tube placement in patients with mechanical ventilation.Methods From March 1,2015 to August 31,2017,patients with mechanical ventilation needed nasal jejunum tube placement were randomly divided into three groups,and three groups were provided with supine position(Group A),head forward flexion (Group B) and head back position(Group C),and nasal jejunum tubes were inserted by the same person.Time of reaching stomach,time of stomach to jejunum,and number of successful cases were recorded.Results In Group C,time of reaching stomach was significantly shorter than that in Group A and Group B(P＜0.01),time of stomach to jejunum in Group B was significantly shorter than that in Group A and Group C(P＜0.01).There were no statistically significant differences among three groups in number of successful cases in stomach and in jejunum(P＞O.05).Conclusion The method of head elevation and head back position is easy for nasal jejunum tube to pass through the throat with spiral movement;right lateral position together with uniform continuous advancing of nasal jejunum tube can have higher successful rate,which is conducive to the establishment of early enteral nutrition in patients with mechanical ventilation.