OBJECTIVE:To enhance the understanding of identifying personalized pharmacotherapy options in Traditional Chinese Medicine(TCM),and further support the registration of new TCM drugs.METHODS:Generalized Boosted Models ...OBJECTIVE:To enhance the understanding of identifying personalized pharmacotherapy options in Traditional Chinese Medicine(TCM),and further support the registration of new TCM drugs.METHODS:Generalized Boosted Models and XGBoost were employed to construct a classification model to identify the bad prognosis factors in resistant hypertension(RH)patients.Furthermore,we used association analysis to explore the rules of"symptomsyndrome"and"symptom-herb"for the major influencing factors,in order to summarize prescription pattern and applicable patients of TCM.RESULTS:Patients with major adverse cardiac events mostly have complex symptoms of phlegm,stasis,deficiency and fire intermingled with each other,and finally summarized the human experience of using Chinese herbal medicine to precisely intervene in some symptoms of RH patients on the basis of conventional Western medical treatment.CONCLUSIONS:Machine learning algorithms can make full use of human use experience and evidence to save clinical trial resources and accelerate the development of TCM varieties.展开更多
This critical review provides an in-depth analysis of Large Language Models(LLMs),encompassing their foundational principles,diverse applications,and advanced training methodologies.We critically examine the evolution...This critical review provides an in-depth analysis of Large Language Models(LLMs),encompassing their foundational principles,diverse applications,and advanced training methodologies.We critically examine the evolution from Recurrent Neural Networks(RNNs)to Transformer models,highlighting the significant advancements and innovations in LLM architectures.The review explores state-of-the-art techniques such as in-context learning and various fine-tuning approaches,with an emphasis on optimizing parameter efficiency.We also discuss methods for aligning LLMs with human preferences,including reinforcement learning frameworks and human feedback mechanisms.The emerging technique of retrieval-augmented generation,which integrates external knowledge into LLMs,is also evaluated.Additionally,we address the ethical considerations of deploying LLMs,stressing the importance of responsible and mindful application.By identifying current gaps and suggesting future research directions,this review provides a comprehensive and critical overview of the present state and potential advancements in LLMs.This work serves as an insightful guide for researchers and practitioners in artificial intelligence,offering a unified perspective on the strengths,limitations,and future prospects of LLMs.展开更多
BACKGROUND Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis(AIS),affecting individuals across both sex and age groups.AIM To explore the network structu...BACKGROUND Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis(AIS),affecting individuals across both sex and age groups.AIM To explore the network structure of depression and anxiety symptoms,with a focus on identifying differences at the symptom level between sex and age subgroups.METHODS A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale(PHO-9)and the Generalized Anxiety Disorder Scale(GAD-7),and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized toconstruct and compare the depression-anxiety symptoms networks among sex and age subgroups.RESULTSThe results revealed GAD3 “Excessive worry” and PHQ2 “Sad mood” were the most significant central symptomsin all subgroups, while “Sad mood” had higher strength than “Excessive worry” in the lower age group. In thenetwork comparisons, the female network exhibited tighter connectivity, especially on GAD6 “Irritability” andGAD2 “Uncontrollable worry”, while only PHQ3 “Sleep” and PHQ9 “Suicidal ideation” had differences at thelocal level in the lower age group.CONCLUSIONSeveral interventions targeting excessive worry and sad mood could reduce the risk of depression and anxietysymptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbancesand suicidal ideation in the lower age group, should be addressed at an early stage to prevent significantdisruptions in mental health trajectories.展开更多
Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical expe...Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.展开更多
Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance D...Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance Dataset,which covers 2.37 billion person-years.Age-standardized mortality rates(ASMRs)were calculated using Segi’s world standard population and the trends were evaluated via Joinpoint regression.Bayesian age-period-cohort models were used for mortality projections.Contributions of demographic changes(population size and age structure)and risk factors to the mortality burden were quantified using the decomposition analysis.Results:The combined ASMRs for all cancers decreased annually by 2.3%,driven by significant declines in esophageal(4.8%),stomach(4.5%),and liver cancers(2.7%).In contrast,the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually,respectively.Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers[average annual percent change(AAPC)=-3.0% in urban areas vs.-2.0% in rural areas],highlighting persistent disparities.Population aging contributed 20%-50% to death increases between 2013 and 2021.The combined ASMRs for all cancers,like the findings of temporal trend analyses,will continue to decrease and the regional(urban and rural)difference is projected to simulate that of the temporal trend through 2030.In fact,cancer deaths are projected to reach 2.4 million by 2030.Conclusions:The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities.It is necessary to prioritize rural screening,control risk factors,such as smoking and diet,and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.展开更多
BACKGROUND Childhood maltreatment has a potentially lasting influence on subthreshold depressive symptoms(SDS)and major depressive disorder(MDD).This study aimed to explore the association of childhood maltreatment wi...BACKGROUND Childhood maltreatment has a potentially lasting influence on subthreshold depressive symptoms(SDS)and major depressive disorder(MDD).This study aimed to explore the association of childhood maltreatment with MDD and SDS,focusing on the differences between young and middle-aged adults.AIMTo examine the associations among childhood maltreatment, SDS, and MDD in young and middle-aged adults.METHODSA total of 3209 adults were recruited from 34 primary healthcare settings. The Childhood Trauma Questionnaire-28item Short Form was used to assess childhood maltreatment. The Patient Health Questionnaire-9 was used toassess SDS and the Mini-International Neuropsychiatric Interview depression module was used to assess MDD.RESULTSChildhood maltreatment was significantly associated with higher odds of developing SDS and MDD than in thenon-depressed control group (P < 0.05). Childhood maltreatment significantly increased the risk of developing SDSin young adults but was not significantly associated with SDS in middle-aged adults (P = 0.055). Conversely,childhood maltreatment was significantly associated with MDD in both young (P < 0.001) and middle-aged adults(P < 0.05). In young adults, various types of childhood maltreatment were associated with MDD;however, onlyemotional abuse and neglect were significantly associated with MDD in middle-aged adults.CONCLUSIONOur study revealed a strong association among childhood maltreatment, SDS, and MDD across age groups,highlighting the impact of emotional abuse and need for trauma-informed depression care.展开更多
BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection ...BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.展开更多
BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints.Evidence shows that a foot-related exercise program,combined w...BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints.Evidence shows that a foot-related exercise program,combined with a health-promoting program,can improve the signs and symptoms of diabetic polyneuropathy,enhance gait,res-tore mobility in the foot and ankle joints,redistribute pressure while walking,and increase foot strength and function.As a result,these exercise programs can help mitigate the risk factors for diabetic foot ulceration.AIM To determine the effect of supervised stretching,strengthening,functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.METHODS This was a randomized controlled trial conducted in a tertiary hospital.The study included 82 participants allocated into the intervention group(alpha-lipoic acid and exercise on 15 consecutive therapeutic days,n=42)and control group(alpha lipoic acid only,n=40).Muscle strength included dorsal and plantar flexors dynamometry and strength score,while range of motion included ankle,subtalar and first metatarsophalangeal joint goniometry.RESULTS Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15(9.9±7.2 vs 0.1±3.3;P=0.006)and month 6(2.8±7.3 vs-0.9±4.1;P<0.001),subtalar joint on day 15(7.5±5.1 vs-0.25±2.25;P<0.001)and month 6(3.9±6.4 vs-0.13±3.49;P<0.001).Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15(2.62±1.69 vs 0.10±1.35;P<0.001)and month 6(0.66±2.38 vs-0.75±1.94;P=0.004)as well as plantar flexors on day 15(3.3±1.6 vs 0.3±1.5;P<0.001)and month 6(1.8±2.2 vs-0.9±2.1;P<0.001).Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15(-1.45±1.42 vs-0.03±0.16;P<0.001)and month 6(-1.17±1.53 vs 0.20±0.56;P<0.001).CONCLUSION Exercise in combination with alpha-lipoic acid can improve joint mobility,as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.展开更多
Our study describes the reported rate of the Institutional Review Board(IRB)approval,declaration of Helsinki(DoH),and informed consent in the case reports and case series and investigates factors associated with the e...Our study describes the reported rate of the Institutional Review Board(IRB)approval,declaration of Helsinki(DoH),and informed consent in the case reports and case series and investigates factors associated with the ethical approval report.We searched PubMed for case reports and case series from 2006 to 2017.Annually,we obtained the first 20 articles of a case report cluster from 20 distinct publications.This analysis initially contained at least 2400 papers,with 100 papers each study design and year.Only 26(5.4%)of 480 included studies reported IRB approval,DoH approval,and participant informed consent;58(12.1%)reported two out of three ethical statements(DoH,informed consent,IRB);and 151(31.5%)reported only one,leading to nearly 245 studies(51.0%)did not report any ethical approval item.Both clusters mentioned the DoH the least.Only years,ages,ethical item types,and cluster types were associated with ethical reporting practices.This study found the serious under‐reporting of ethical practices in both case reports and case series.展开更多
Background:Although transradial access(TRA)has become the main vascular access for coronary intervention,its high radial artery occlusion rate limits its application in some patients.Studies have shown that compared w...Background:Although transradial access(TRA)has become the main vascular access for coronary intervention,its high radial artery occlusion rate limits its application in some patients.Studies have shown that compared with TRA,distal transradial access(dTRA)with the snuffbox area or the Hegu acupoint area as the puncture point significantly decreases the incidence of radial artery occlusion.However,no randomized controlled study has confirmed the safety and efficacy of coronary artery intervention via dTRA in China.Methods and analyses:This single-center,prospective,randomized controlled,superiority open-label study will enroll 428 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention as the study population.After preoperative evaluation,the participants will be randomly divided into a study group(dTRA)and control group(TRA)in a 1:1 ratio.The primary endpoint(radial artery occlusion at 24 hours after operation)and secondary endpoint events will be evaluated and recorded.Study registration:This study has been registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2300073902).展开更多
Objective Since HFMD was designated as a class C communicable disease in May 2008,18 months surveillance data have been accumulated to December 2009.This article was to describe the distribution of HFMD for age,sex,ar...Objective Since HFMD was designated as a class C communicable disease in May 2008,18 months surveillance data have been accumulated to December 2009.This article was to describe the distribution of HFMD for age,sex,area,and time between 2008 and 2009,to reveal the characteristics of the epidemic.Methods We analyzed weekly reported cases of HFMD from May 2008 to December 2009,and presented data on the distribution of age,sex,area and time.A discrete Poisson model was used to detect spatial-temporal clusters of HFMD.Results More than 1 065 000 cases of HFMD were reported in China's Mainland from May 2008 to December 2009 （total incidence：12.47 per 10 000）.Male incidence was higher than female for all ages and 91.9% of patients were 5 years old.The incidence was highest in Beijing,Shanghai,Zhejiang and Hainan.The highest peak of HFMD cases was in April and the number of cases remained high from April to August.The spatial-temporal distribution detected four clusters.Conclusion Children 5 years old were susceptible to HFMD and we should be aware of their vulnerability.The incidence was higher in urban than rural areas,and an annual pandemic usually starts in April.展开更多
AIM： To investigate the effectiveness of low-volume plus ascorbic acid [polyethylene glycol plus ascorbic acid （PEG ＋ Asc）] and high-volume plus simethicone [polyethylene glycol plus simethicone （PEG ＋ Sim）] bo...AIM： To investigate the effectiveness of low-volume plus ascorbic acid [polyethylene glycol plus ascorbic acid （PEG ＋ Asc）] and high-volume plus simethicone [polyethylene glycol plus simethicone （PEG ＋ Sim）] bowel preparations. METHODS： A total of one hundred and forty-four outpatients （76 males）, aged from 20 to 84 years （median age 59.5 years）, who attended our Department, were divided into two groups, age and sex matched, and underwent colonoscopy. Two questionnaires, one for patients reporting acceptability and the other for endoscopists evaluating bowel cleansing effectiveness according to validated scales, were completed. Indications, timing of examination and endoscopical findings were recorded. Biopsy forceps were used as a measuring tool in order to determine polyp endoscopic sizeestimation. Difficulty in completing the preparation was rated in a 5-point Likert scale （1 = easy to 5 = unable）. Adverse experiences （fullness, cramps, nausea, vomiting, abdominal pain, headache and insomnia）, number of evacuations and types of activities performed during preparation （walking or resting in bed） were also investigated. RESULTS： Seventy-two patients were selected for each group. The two groups were age and sex matched as well as being comparable in terms of medical history and drug therapies taken. Fourteen patients dropped out from the trial because they did not complete the preparation procedure. Ratings of global bowel cleansing examinations were considered to be adequate in 91% of PEG ＋ Asc and 88% of PEG ＋ Sim patients. Residual Stool Score indicated similar levels of amount and consistency of residual stool; there was a significant difference in the percentage of bowel wall visualization in favour of PEG ＋ Sim patients. In the PEG ＋ Sire group, 12 adenomas≤ 10 mm diameter （5/left colon ＋ 7/right colon） vs 9 （8/left colon ＋ 1/right colon） in the PEG ＋ Asc group were diagnosed. Visualization of small lesions seems to be one of the primary advantages of the PEG ＋ Sim preparation. CONCLUSION： PEG ＋ Asc is a good alternative solution as a bowel preparation but more improvements are necessary in order to achieve the target of a perfect preparation.展开更多
AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric can...AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric cancer.METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate.Univariate and multivariate analyses were performed to identify risk factors for overall survival(OS). Propensity score analysis was performed to adjust variables to control for selection bias.RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring(hazard ratio, 1.668; 95% confidence interval:1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ-Ⅲ disease(P = 0.019, P < 0.001), T3-T4 tumors(P <0.001), or lymph node metastasis(P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS(P = 0.022, P = 0.030, P < 0.001, and P = 0.024,respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.展开更多
Objective To identify patterns of hand, foot and mouth disease （HFMD） incidence in China during declining incidence periods of 2008, 2009, and 2010. Methods Reported HFMD cases over a period of 25 months were extrac...Objective To identify patterns of hand, foot and mouth disease （HFMD） incidence in China during declining incidence periods of 2008, 2009, and 2010. Methods Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System （NDRS） and analyzed. An interrupted time series （ITS） technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Results Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level （P〈0.0001） when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 （all P〈O.O05）, but not 2009 to 2008. Conclusion Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.展开更多
AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi...AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi-urban primary health care centers. Of the 2400 registered with diagnosed diabetes, 1980 agreed and gave their consent to take part in this study, thus giving a response rate of 82.5%. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. DM was defined according to the World Health Organization expert group. A trained nurse performedphysical examinations and measurements. RESULTS: Of the study population, 72.9% reported a family history of DM. Family history of DM was significantly higher in females (54.2%; P = 0.04) and in the age group below 30 years (24%; P < 0.001). The prevalence of diabetes was higher among patients with a diabetic mother (25.4% vs 22.1%) and maternal aunts/uncles (31.2% vs 22.2%) compared to patients with a diabetic father and paternal aunts/ uncles. Family history of DM was higher in patients of consanguineous parents (38.5%) than those of non-consanguineous parents (30.2%). The development of type 2 diabetes mellitus (T2DM) complications was higher in patients with either a paternal or maternal history of DM than in those without. No significant difference was observed in the metabolic characteristics of patients with/without family history of DM except for hypertension. Complications were higher in diabetic patients with a family history of DM. CONCLUSION: The present study found a significant maternal effect in transmission of T2DM. Family history is associated with the increased incidence of diabetes.展开更多
基金the China Academy of Chinese Medical Sciences,Independent Topic Project:Application Research on Named Entity Recognition and Relationship Extraction of Case Records of Renowned Traditional Chinese Medicine Practitioners(No.Z0643).China Academy of Chinese Medical Sciences,Independent Topic Project:Analysis of Research Directions and Scope in the Discipline of Traditional Chinese Medicine Statistics(No.Z0723)China Academy of Chinese Medical Sciences,Science and Technology Innovation Project:Real-world Effectiveness Evaluation of Traditional Chinese Medicine and Translational Application Research on Causal Inference(No.CI2021A04706).China Academy of Chinese Medical Sciences,Science and Technology Innovation Project:Research on Causal Inference Methodology for Real-world Clinical Evaluation in Traditional Chinese Medicine(No.CI2021B003)National Key Research and Development Program of China:Integrated Evaluation Model and Key Technologies of"Syndrome-Disease-Prescription"for Traditional Chinese Medicine in the Prevention and Treatment of Coronary Heart Disease—Statistical Data Analysis and Data Mining(No.2017YFC1700406-2)。
文摘OBJECTIVE:To enhance the understanding of identifying personalized pharmacotherapy options in Traditional Chinese Medicine(TCM),and further support the registration of new TCM drugs.METHODS:Generalized Boosted Models and XGBoost were employed to construct a classification model to identify the bad prognosis factors in resistant hypertension(RH)patients.Furthermore,we used association analysis to explore the rules of"symptomsyndrome"and"symptom-herb"for the major influencing factors,in order to summarize prescription pattern and applicable patients of TCM.RESULTS:Patients with major adverse cardiac events mostly have complex symptoms of phlegm,stasis,deficiency and fire intermingled with each other,and finally summarized the human experience of using Chinese herbal medicine to precisely intervene in some symptoms of RH patients on the basis of conventional Western medical treatment.CONCLUSIONS:Machine learning algorithms can make full use of human use experience and evidence to save clinical trial resources and accelerate the development of TCM varieties.
文摘This critical review provides an in-depth analysis of Large Language Models(LLMs),encompassing their foundational principles,diverse applications,and advanced training methodologies.We critically examine the evolution from Recurrent Neural Networks(RNNs)to Transformer models,highlighting the significant advancements and innovations in LLM architectures.The review explores state-of-the-art techniques such as in-context learning and various fine-tuning approaches,with an emphasis on optimizing parameter efficiency.We also discuss methods for aligning LLMs with human preferences,including reinforcement learning frameworks and human feedback mechanisms.The emerging technique of retrieval-augmented generation,which integrates external knowledge into LLMs,is also evaluated.Additionally,we address the ethical considerations of deploying LLMs,stressing the importance of responsible and mindful application.By identifying current gaps and suggesting future research directions,this review provides a comprehensive and critical overview of the present state and potential advancements in LLMs.This work serves as an insightful guide for researchers and practitioners in artificial intelligence,offering a unified perspective on the strengths,limitations,and future prospects of LLMs.
基金Supported by The Sanming Project of Medicine in Shenzhen,No.SZSM202211003Shenzhen-Hong Kong Jointly Funded Project,Shenzhen Science and Technology Program,No.SGDX20230116093645007+1 种基金Shenzhen Second People's Hospital Clinical Project,No.20243357003Shenzhen Medical Research Fund,No.B2303005.
文摘BACKGROUND Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis(AIS),affecting individuals across both sex and age groups.AIM To explore the network structure of depression and anxiety symptoms,with a focus on identifying differences at the symptom level between sex and age subgroups.METHODS A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale(PHO-9)and the Generalized Anxiety Disorder Scale(GAD-7),and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized toconstruct and compare the depression-anxiety symptoms networks among sex and age subgroups.RESULTSThe results revealed GAD3 “Excessive worry” and PHQ2 “Sad mood” were the most significant central symptomsin all subgroups, while “Sad mood” had higher strength than “Excessive worry” in the lower age group. In thenetwork comparisons, the female network exhibited tighter connectivity, especially on GAD6 “Irritability” andGAD2 “Uncontrollable worry”, while only PHQ3 “Sleep” and PHQ9 “Suicidal ideation” had differences at thelocal level in the lower age group.CONCLUSIONSeveral interventions targeting excessive worry and sad mood could reduce the risk of depression and anxietysymptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbancesand suicidal ideation in the lower age group, should be addressed at an early stage to prevent significantdisruptions in mental health trajectories.
文摘Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.
基金supported by the CAMS Innovation Fund for Medical Sciences(Grant No.2021-I2M-1-011)the Capital’s Funds for Health Improvement and Research(Grant No.CFH2024-2G-40214).
文摘Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance Dataset,which covers 2.37 billion person-years.Age-standardized mortality rates(ASMRs)were calculated using Segi’s world standard population and the trends were evaluated via Joinpoint regression.Bayesian age-period-cohort models were used for mortality projections.Contributions of demographic changes(population size and age structure)and risk factors to the mortality burden were quantified using the decomposition analysis.Results:The combined ASMRs for all cancers decreased annually by 2.3%,driven by significant declines in esophageal(4.8%),stomach(4.5%),and liver cancers(2.7%).In contrast,the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually,respectively.Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers[average annual percent change(AAPC)=-3.0% in urban areas vs.-2.0% in rural areas],highlighting persistent disparities.Population aging contributed 20%-50% to death increases between 2013 and 2021.The combined ASMRs for all cancers,like the findings of temporal trend analyses,will continue to decrease and the regional(urban and rural)difference is projected to simulate that of the temporal trend through 2030.In fact,cancer deaths are projected to reach 2.4 million by 2030.Conclusions:The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities.It is necessary to prioritize rural screening,control risk factors,such as smoking and diet,and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.
基金Supported by National Natural Science Foundation of China,No.82373660 and No.81761128030Sanming Project of Medicine in Shenzhen Nanshan,No.11the China Scholarship Council。
文摘BACKGROUND Childhood maltreatment has a potentially lasting influence on subthreshold depressive symptoms(SDS)and major depressive disorder(MDD).This study aimed to explore the association of childhood maltreatment with MDD and SDS,focusing on the differences between young and middle-aged adults.AIMTo examine the associations among childhood maltreatment, SDS, and MDD in young and middle-aged adults.METHODSA total of 3209 adults were recruited from 34 primary healthcare settings. The Childhood Trauma Questionnaire-28item Short Form was used to assess childhood maltreatment. The Patient Health Questionnaire-9 was used toassess SDS and the Mini-International Neuropsychiatric Interview depression module was used to assess MDD.RESULTSChildhood maltreatment was significantly associated with higher odds of developing SDS and MDD than in thenon-depressed control group (P < 0.05). Childhood maltreatment significantly increased the risk of developing SDSin young adults but was not significantly associated with SDS in middle-aged adults (P = 0.055). Conversely,childhood maltreatment was significantly associated with MDD in both young (P < 0.001) and middle-aged adults(P < 0.05). In young adults, various types of childhood maltreatment were associated with MDD;however, onlyemotional abuse and neglect were significantly associated with MDD in middle-aged adults.CONCLUSIONOur study revealed a strong association among childhood maltreatment, SDS, and MDD across age groups,highlighting the impact of emotional abuse and need for trauma-informed depression care.
文摘BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.
文摘BACKGROUND Limited joint mobility is the proven risk factor for diabetic foot ulceration when present in the subtalar and first metatarsophalangeal joints.Evidence shows that a foot-related exercise program,combined with a health-promoting program,can improve the signs and symptoms of diabetic polyneuropathy,enhance gait,res-tore mobility in the foot and ankle joints,redistribute pressure while walking,and increase foot strength and function.As a result,these exercise programs can help mitigate the risk factors for diabetic foot ulceration.AIM To determine the effect of supervised stretching,strengthening,functional and walking exercises on joint mobility and muscle strength in patients with diabetic polyneuropathy.METHODS This was a randomized controlled trial conducted in a tertiary hospital.The study included 82 participants allocated into the intervention group(alpha-lipoic acid and exercise on 15 consecutive therapeutic days,n=42)and control group(alpha lipoic acid only,n=40).Muscle strength included dorsal and plantar flexors dynamometry and strength score,while range of motion included ankle,subtalar and first metatarsophalangeal joint goniometry.RESULTS Change of motion range was significantly higher in the intervention group compared to the control group regarding ankle joint on day 15(9.9±7.2 vs 0.1±3.3;P=0.006)and month 6(2.8±7.3 vs-0.9±4.1;P<0.001),subtalar joint on day 15(7.5±5.1 vs-0.25±2.25;P<0.001)and month 6(3.9±6.4 vs-0.13±3.49;P<0.001).Change in dorsal flexors was significantly higher in the intervention group compared to the control group on day 15(2.62±1.69 vs 0.10±1.35;P<0.001)and month 6(0.66±2.38 vs-0.75±1.94;P=0.004)as well as plantar flexors on day 15(3.3±1.6 vs 0.3±1.5;P<0.001)and month 6(1.8±2.2 vs-0.9±2.1;P<0.001).Muscle strength score change was significantly lower in the intervention group compared to the control group on day 15(-1.45±1.42 vs-0.03±0.16;P<0.001)and month 6(-1.17±1.53 vs 0.20±0.56;P<0.001).CONCLUSION Exercise in combination with alpha-lipoic acid can improve joint mobility,as well as strength of the foot and lower leg muscles in patients with diabetic polyneuropathy.
文摘Our study describes the reported rate of the Institutional Review Board(IRB)approval,declaration of Helsinki(DoH),and informed consent in the case reports and case series and investigates factors associated with the ethical approval report.We searched PubMed for case reports and case series from 2006 to 2017.Annually,we obtained the first 20 articles of a case report cluster from 20 distinct publications.This analysis initially contained at least 2400 papers,with 100 papers each study design and year.Only 26(5.4%)of 480 included studies reported IRB approval,DoH approval,and participant informed consent;58(12.1%)reported two out of three ethical statements(DoH,informed consent,IRB);and 151(31.5%)reported only one,leading to nearly 245 studies(51.0%)did not report any ethical approval item.Both clusters mentioned the DoH the least.Only years,ages,ethical item types,and cluster types were associated with ethical reporting practices.This study found the serious under‐reporting of ethical practices in both case reports and case series.
基金funded by the CAMS Innovation Fund for Medical Sciences(CIFMS,No.2022-I2M-C&T-B-048).
文摘Background:Although transradial access(TRA)has become the main vascular access for coronary intervention,its high radial artery occlusion rate limits its application in some patients.Studies have shown that compared with TRA,distal transradial access(dTRA)with the snuffbox area or the Hegu acupoint area as the puncture point significantly decreases the incidence of radial artery occlusion.However,no randomized controlled study has confirmed the safety and efficacy of coronary artery intervention via dTRA in China.Methods and analyses:This single-center,prospective,randomized controlled,superiority open-label study will enroll 428 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention as the study population.After preoperative evaluation,the participants will be randomly divided into a study group(dTRA)and control group(TRA)in a 1:1 ratio.The primary endpoint(radial artery occlusion at 24 hours after operation)and secondary endpoint events will be evaluated and recorded.Study registration:This study has been registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2300073902).
文摘Objective Since HFMD was designated as a class C communicable disease in May 2008,18 months surveillance data have been accumulated to December 2009.This article was to describe the distribution of HFMD for age,sex,area,and time between 2008 and 2009,to reveal the characteristics of the epidemic.Methods We analyzed weekly reported cases of HFMD from May 2008 to December 2009,and presented data on the distribution of age,sex,area and time.A discrete Poisson model was used to detect spatial-temporal clusters of HFMD.Results More than 1 065 000 cases of HFMD were reported in China's Mainland from May 2008 to December 2009 （total incidence：12.47 per 10 000）.Male incidence was higher than female for all ages and 91.9% of patients were 5 years old.The incidence was highest in Beijing,Shanghai,Zhejiang and Hainan.The highest peak of HFMD cases was in April and the number of cases remained high from April to August.The spatial-temporal distribution detected four clusters.Conclusion Children 5 years old were susceptible to HFMD and we should be aware of their vulnerability.The incidence was higher in urban than rural areas,and an annual pandemic usually starts in April.
文摘AIM： To investigate the effectiveness of low-volume plus ascorbic acid [polyethylene glycol plus ascorbic acid （PEG ＋ Asc）] and high-volume plus simethicone [polyethylene glycol plus simethicone （PEG ＋ Sim）] bowel preparations. METHODS： A total of one hundred and forty-four outpatients （76 males）, aged from 20 to 84 years （median age 59.5 years）, who attended our Department, were divided into two groups, age and sex matched, and underwent colonoscopy. Two questionnaires, one for patients reporting acceptability and the other for endoscopists evaluating bowel cleansing effectiveness according to validated scales, were completed. Indications, timing of examination and endoscopical findings were recorded. Biopsy forceps were used as a measuring tool in order to determine polyp endoscopic sizeestimation. Difficulty in completing the preparation was rated in a 5-point Likert scale （1 = easy to 5 = unable）. Adverse experiences （fullness, cramps, nausea, vomiting, abdominal pain, headache and insomnia）, number of evacuations and types of activities performed during preparation （walking or resting in bed） were also investigated. RESULTS： Seventy-two patients were selected for each group. The two groups were age and sex matched as well as being comparable in terms of medical history and drug therapies taken. Fourteen patients dropped out from the trial because they did not complete the preparation procedure. Ratings of global bowel cleansing examinations were considered to be adequate in 91% of PEG ＋ Asc and 88% of PEG ＋ Sim patients. Residual Stool Score indicated similar levels of amount and consistency of residual stool; there was a significant difference in the percentage of bowel wall visualization in favour of PEG ＋ Sim patients. In the PEG ＋ Sire group, 12 adenomas≤ 10 mm diameter （5/left colon ＋ 7/right colon） vs 9 （8/left colon ＋ 1/right colon） in the PEG ＋ Asc group were diagnosed. Visualization of small lesions seems to be one of the primary advantages of the PEG ＋ Sim preparation. CONCLUSION： PEG ＋ Asc is a good alternative solution as a bowel preparation but more improvements are necessary in order to achieve the target of a perfect preparation.
基金Supported by National Natural Science Foundation of China,Nos.81101865 and 81272637Doctoral Fund of the Ministry of Education of China,No.20110171120064+1 种基金Natural Science Foundation of Guangdong Province,No.S2013020012724Clinical Medicine Research Project 5010 of Sun Yat-sen University,No.2010006
文摘AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric cancer.METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate.Univariate and multivariate analyses were performed to identify risk factors for overall survival(OS). Propensity score analysis was performed to adjust variables to control for selection bias.RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring(hazard ratio, 1.668; 95% confidence interval:1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ-Ⅲ disease(P = 0.019, P < 0.001), T3-T4 tumors(P <0.001), or lymph node metastasis(P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS(P = 0.022, P = 0.030, P < 0.001, and P = 0.024,respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.
文摘Objective To identify patterns of hand, foot and mouth disease （HFMD） incidence in China during declining incidence periods of 2008, 2009, and 2010. Methods Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System （NDRS） and analyzed. An interrupted time series （ITS） technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Results Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level （P〈0.0001） when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 （all P〈O.O05）, but not 2009 to 2008. Conclusion Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.
基金Supported by Qatar Diabetic Association and Qatar National Research Fund, QNRF UREP 07-099-3-023
文摘AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi-urban primary health care centers. Of the 2400 registered with diagnosed diabetes, 1980 agreed and gave their consent to take part in this study, thus giving a response rate of 82.5%. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. DM was defined according to the World Health Organization expert group. A trained nurse performedphysical examinations and measurements. RESULTS: Of the study population, 72.9% reported a family history of DM. Family history of DM was significantly higher in females (54.2%; P = 0.04) and in the age group below 30 years (24%; P < 0.001). The prevalence of diabetes was higher among patients with a diabetic mother (25.4% vs 22.1%) and maternal aunts/uncles (31.2% vs 22.2%) compared to patients with a diabetic father and paternal aunts/ uncles. Family history of DM was higher in patients of consanguineous parents (38.5%) than those of non-consanguineous parents (30.2%). The development of type 2 diabetes mellitus (T2DM) complications was higher in patients with either a paternal or maternal history of DM than in those without. No significant difference was observed in the metabolic characteristics of patients with/without family history of DM except for hypertension. Complications were higher in diabetic patients with a family history of DM. CONCLUSION: The present study found a significant maternal effect in transmission of T2DM. Family history is associated with the increased incidence of diabetes.
