Outpatient reception via collaboration between nurses and a large language model: a randomized controlled trial.

Reception is an essential process for patients seeking medical care and a critical component influencing the healthcare experience. However, current communication systems rely mainly on human efforts, which are both labor and knowledge intensive. A promising alternative is to leverage the capabilities of large language models (LLMs) to assist the communication in medical center reception sites. Here we curated a unique dataset comprising 35,418 cases of real-world conversation audio corpus between outpatients and receptionist nurses from 10 reception sites across two medical centers, to develop a site-specific prompt engineering chatbot (SSPEC). The SSPEC efficiently resolved patient queries, with a higher proportion of queries addressed in fewer rounds of queries and responses (Q&Rs; 68.0% ≤2 rounds) compared with nurse-led sessions (50.5% ≤2 rounds) (P = 0.009) across administrative, triaging and primary care concerns. We then established a nurse-SSPEC collaboration model, overseeing the uncertainties encountered during the real-world deployment. In a single-center randomized controlled trial involving 2,164 participants, the primary endpoint indicated that the nurse-SSPEC collaboration model received higher satisfaction feedback from patients (3.91 ± 0.90 versus 3.39 ± 1.15 in the nurse group, P < 0.001). Key secondary outcomes indicated reduced rate of repeated Q&R (3.2% versus 14.4% in the nurse group, P < 0.001) and reduced negative emotions during visits (2.4% versus 7.8% in the nurse group, P < 0.001) and enhanced response quality in terms of integrity (4.37 ± 0.95 versus 3.42 ± 1.22 in the nurse group, P < 0.001), empathy (4.14 ± 0.98 versus 3.27 ± 1.22 in the nurse group, P < 0.001) and readability (3.86 ± 0.95 versus 3.71 ± 1.07 in the nurse group, P = 0.006). Overall, our study supports the feasibility of integrating LLMs into the daily hospital workflow and introduces a paradigm for improving communication that benefits both patients and nurses. Chinese Clinical Trial Registry identifier: ChiCTR2300077245 .

Water use sources and its influencing factors of Pinus massoniana and Quercus acutissima community in hilly region of Southern China.

The process of plant water use is complex and changeable, which is affected by various factors. Exploring the sources and influencing factors of plant water use can provide reference for clarifying the mechanisms of forest water adaptation under climate change. We chosen the typical forest communities in the hilly region of Sou-thern China, Pinus massoniana and Quercus acutissima mixed forest as the research object. By analyzing water sources of plants in different seasons, the factors affecting the changes of water sources were explored in combination with soil water, precipitation, and plant roots. The results showed that water use characteristics of P. massoniana and Q. acutissima were similar and both mainly utilized 0-40 cm soil water during the dry season, with proportions of 60.0% and 66.6%. During the rainy season, as soil water content of deep layers increased, the main water sources of both gradually shifted towards deep soil. The similarity proportion indices of P. massoniana and Q. acutissima were above 60%, indicating that there was an obvious water competition between them. Root system of Q. acutissima had plasticity in water absorption, and played a dominant role in absorbing shallow water during the dry season. Water was the main driving factor for water source transformation of Q. acutissima and P. massoniana during the rainy season. Compared with P. massoniana, Q. acutissima was more sensitive to the changes of water sources. Under the background of future warming and drying, the competition between the two species for shallow water sources might be intensified. Those two species should be sparsely planted or thinned to optimize forest structure to cope with water stress.

Therapeutic assessment of crystalloid fluid resuscitation in experimental military injury.

BACKGROUND: A significant part of blast injury is accompanied by hemorrhagic shock (BS), while research on its fluid resuscitation strategies have not been reported. Although blood products are usually recommended in most resuscitation cases, they are less available in certain conditions. To this end, here, we focused on a widely used and more accessible fluid type- crystalloid fluid, in BS treatment. METHODS: We conducted studies in rats comparing the therapeutic effects of 3 different crystalloid solutions at different time points after BS, and explored the underlying mechanisms. Generally, the survival rates gradually dropped along with the time when fluid resuscitation was given. RESULTS: Among different types of solution, the hypertonic saline (HS) group showed the highest survival rates. The lactated Ringer's solution (LR) only displayed lifesaving effect at 0.5h resuscitation time point. Moreover, it is worth noting that the survival rates of the normal saline (NS) group at all the time points were lower than the non-treatment control. Mechanism study in rats indicated that the therapeutic differences may be caused by varied degrees of pulmonary edema and inflammatory responses under different crystalloid fluid resuscitation. CONCLUSIONS: In conclusion, we assessed the effects and investigated the mechanisms of different crystalloid fluid resuscitation strategies for BS for the first time, which potentially contributes to the establishment of guidance for crystalloid fluid resuscitation of BS patients.

Risk factors for postoperative portal vein thrombosis in patients with hepatitis B liver cancer and its impact on mortality-a retrospective study.

Background: The treatment of portal thrombosis is very difficult, which can seriously affect the prognosis of the patients, and thus, preventing postoperative portal thrombosis in patients with hepatitis B liver cancer is crucial. Identifying the risk factors in these patients is key to preventing postoperative portal vein thrombosis. However, relevant research is currently lacking. The present study was to study the risk factors for postoperative portal vein thrombosis in patients with hepatitis B liver cancer and its impact on mortality. Methods: We retrospectively included 663 patients with hepatitis B liver cancer admitted to the Second Affiliated Hospital of Anhui Medical University and Shenzhen University General Hospital from January 2017 to December 2021. The patients were divided into a portal thrombosis group (n=54) and a control group (n=609) according to whether they had portal thrombosis after surgery. The clinical characteristics including alcoholism, D-dimer, surgery method and tumor diameter of the two groups were compared, and the treatment and mortality of the patients in the portal thrombosis group were analyzed. Results: The incidence of portal vein thrombosis in patients with hepatitis B liver cancer was 8.14% (54/663). The area under the Receiver operator characteristics curve for the diagnostic value of D-dimer for postoperative portal vein thrombosis in patients with hepatitis B liver cancer was 0.716 (95% CI: 0.650-0.781, P=0.000). Alcoholism, D-dimer >8.74 mg/L, open surgery, and a maximum tumor diameter >5 cm were identified as risk factors for portal vein thrombosis after surgery in patients with hepatitis B hepatitis cancer [odds ratio: 2.991 (95% CI: 1.234-7.249), P=0.015; odds ratio: 3.269 (95% CI: 1.683-6.349), P=0.000; odds ratio: 6.726 (95% CI: 3.419-13.232), P=0.000; odds ratio: 2.443 (95% CI: 1.344-4.442), P=0.003]. Patients with Grade I or II grade Yerdel (96.30%) were cured after treatment, while two patients with III grade (3.70%) died after surgery. Conclusions: The incidence of portal vein thrombosis after surgery in patients with hepatitis B liver cancer is high. Intervention against risk factors may be beneficial to improve the prognosis of patients with hepatitis B liver cancer.

CDC6 is a prognostic biomarker and correlated with immune infiltrates in glioma.

BACKGROUND: Cell division cycle 6 (CDC6) has been proven to be associated with the initiation and progression of human multiple tumors. However, it's role in glioma, which is ranked as one of the common primary malignant tumor in the central nervous system and is associated with high morbidity and mortality, is unclear. METHODS: In this study, we explored CDC6 gene expression level in pan-cancer. Furthermore, we focused on the relationships between CDC6 expression, its prognostic value, potential biological functions, and immune infiltrates in glioma patients. We also performed vitro experiments to assess the effect of CDC6 expression on proliferative, apoptotic, migrant and invasive abilities of glioma cells. RESULTS: As a result, CDC6 expression was upregulated in multiple types of cancer, including glioma. Moreover, high expression of CDC6 was significantly associated with age, IDH status, 1p/19q codeletion status, WHO grade and histological type in glioma (all p < 0.05). Meanwhile, high CDC6 expression was associated with poor overall survival (OS) in glioma patients, especially in different clinical subgroups. Furthermore, a univariate Cox analysis showed that high CDC6 expression was correlated with poor OS in glioma patients. Functional enrichment analysis indicated that CDC6 was mainly involved in pathways related to DNA transcription and cytokine activity, and Gene Set Enrichment Analysis (GSEA) revealed that MAPK pathway, P53 pathway and NF-κB pathway in cancer were differentially enriched in glioma patients with high CDC6 expression. Single-sample gene set enrichment analysis (ssGSEA) showed CDC6 expression in glioma was positively correlated with Th2 cells, Macrophages and Eosinophils, and negative correlations with plasmacytoid dendritic cells, CD8 T cells and NK CD56bright cells, suggesting its role in regulating tumor immunity. Finally, CCK8 assay, flow cytometry and transwell assays showed that silencing CDC6 could significantly inhibit proliferation, migration, invasion, and promoted apoptosis of U87 cells and U251 cells (p < 0.05). CONCLUSION: In conclusion, high CDC6 expression may serve as a promising biomarker for prognosis and correlated with immune infiltrates, presenting to be a potential immune therapy target in glioma.

Simultaneous determination of 12 index components and compatibility changes in Longchai decoction by liquid chromatography-mass spectrometry.

The aim of this study was to explore the traditional decoction theory of Chinese medicine compound prescriptions. To control the quality of Longchai decoction and to analyze the changes of chemical components before and after compatibility, the determination method of 12 index components including salidroside, wogonoside, liquiritin, isoliquiritin, liquiritigenin, quercetin, isoliquiritigenin, isorhamnetin, wogonin, saikosaponin A, saikosaponin D and ursolic acid by liquid chromatography-mass spectrometry (LC-MS) was established. The 12 index components were detected by LC-MS with the Agilent Zorbax SB C18 (3.1 × 100 mm, 3.6 µm) column, the mobile phase consisted of acetonitrile-0.1% methanoic acid with gradient elution at the flow rate of 0.25 mL min(-1) and the column temperature was maintained at 30°C. All the samples were isolated to baseline. All calibration curves showed good linear regression (r(2) > 0.9978). The average recoveries were between 99.16 and 103.25% of relative standard deviation <2.82% (n = 5). Obtained results indicated that the content of index components was increased in traditional decoction, compared with mixed individual decoctions. This method with good resolution and high precision could be used for the quality control of Longchai decoction.

[Study on MEKC-DAD fingerprint of Scutellariae radix].

OBJECTIVE: To establish the analytical method for the fingerprint of Scutellariae Radix by MEKC-DAD and compare the fingerprints of Scutellariae Radix, Scutellariae Radix Stir-baked and Scutellariae Radix Green. METHODS: Based on the mode of micellar electrokinetic chromatography, 40 mmol/L sodium hydrogen phosphate, 15 mmol/L sodium borate, 40 mmol/L SDS, 15% acetonitrile, 7.5% propyl alcohol were selected for the running buffer (pH 8.4). The separation voltage was 20 kV and the detection wavelength was set at 280 nm. Baicalin was used as reference standard, the chromatographic fingerprint was established. RESULTS: MEKC-DAD fingerprint with 9 main peaks was established preliminarily. Regarding to the fingerprints of Scutellariae Radix and its processed products, the samples before and after storage moisture, there were obvious differences in the relative areas of common peaks. CONCLUSION: The method is reliable, accurate and can be used for quality control of Scutellariae Radix.

[Study on HPCE-DAD fingerprint of Salviae Miltiorrhizae Radix et Rhizoma].

OBJECTIVE: To establish the analytical method for the fingerprint of Salviae Miltiorrhizae Radix et Rhizoma by HPCE-DAD and estimate its quality. METHODS: Salviae Miltiorrhizae Radix et Rhizoma were analyzed and the chromatographic fingerprint were determined by HPCE-DAD. The data were analysed by fuzzy cluster and fingerprint similarity evaluation software was used to compare the similarity of samples. RESULTS: HPCE-DAD fingerprint of 10 main common peaks was established preliminarily. It was discovered that a small number of samples were different from the others. CONCLUSION: The method is reliable, accurate and can be used for the quality control of Salviae Miltiorrhizae Radix et Rhizoma

[Preliminary analysis of quality of Antrodia camphorata powder].

OBJECTIVE: To proceed a preliminary analysis of the quality of Antrodia camphorata powder. METHODS: The contents of water-soluble extract were detected according to the standards stated in Chinese Pharmacopoeia. UV-VIS was used to analyze total polysaccharide and triterpenoid. HPLC method was applied for the analysis of adenosine in Antrodia. camphorata. Besides, volatile compounds were analyzed by HSGC-MS. RESULTS: The contents of water-soluble extract (37.26% - 40.98%), total polysaccharide (5.45% - 8.08%), total triterpenoid (2.44% - 2.87%) and adenosine (0.0470% - 0.0604%) were obtained respectively. 49 volatile compounds were identified in Antrodia camphorata powder. CONCLUSION: The established method can be used for the quality control of Antrodia camphorata powder.

[Location and relative quantity of flavonoids in the leaf of Apocynum venetum].

In this study, laser scanning confocal microscopy (LSCM) was used to determine the location and relative quantity of flavonoids in the leaves of Apocynum venetum L. from the top, middle and basal parts of the branch. The leaves of the plants of one, two and three years old, separately, were collected in July. ANOVA and LSD test were employed in the statistical analysis. The results indicated that flavonoids located mainly in xylem conduit of vein, collenchyma, epidermic cells and cuticle. The data of flavonoids contents under statistical analysis showed that difference existed in the leaves of different parts and different ages. This study provided the reliable scientific material about the analysis of the ecological and the exploitation of the leaves of Apocynum venetom L.

[Study on water-soluble iron, heavy metals and harmful elements of Magnetitum].

OBJECTIVE: To measure the contents of the water-soluble iron, five heavy metals and harmful elements in Magnetiturn and provide a basis for the quality control and safety evaluation of Magnetitum. METHOD: Iron (Fe), lead (Pb), cadmium (Cd) and copper (Cu) were determined by atomic absorption spectrometry (AAS); arsenic (As) and mercury (Hg) were determined by atomic fluorescence spectrometry (AFS). RESULT: The mean content of element iron is 764.30 mg x kg(-1). The contents of five water-soluble heavy metals and harmful elements in Magnetitum were within the safety range. The recovery of the standard addition was in the range of 93.7% - 110.6%, and the RSD was less than 5.0%. CONCLUSION: Analyzing the water-soluble iron, heavy metals and harmful elements in Magnetitum is effective to the quality control and the safety evaluation of magnetitum.

[The effects of extracts from Arenaria kansuensis on the levels of HBsAG and HBeAg in HepG2.2.15 cells].

OBJECTIVE: To investigate the anti-HBV effects of the extracts with alcohol and water from Arenaria kansuensis in vitro. METHODS: HepG2.2.15 cells were used to estimate the effects of the extracts with alcohol and water from Arenaria kansuensis on the levels of HBsAg and HBeAg in medium by ELISA. RESULTS: Incubation of HepG2.2.15 cells with both the extracts with alcohol and water from Arenaria kansuensis (50-400 mg/L) for 72 and 96h significantly inhibited the levels of HBsAg and HBeAg. The maximum inhibiting rate of HBeAg from the Arenaria kansuensis extracts with alcohol was 63.2% and 90. 8% at 72h and 96h, respectively. Meanwhile, the Arenaria kansuensis extracts with water had obvious inhibitory effects on the levels of HBsAg and HBeAg in HepG2.2.15 cells at 96 h, compared with that of the control group (P < 0.01). The maximum inhibiting rates were 52.5% and 72.8%, respectively. CONCLUSION: The extracts with water from Arenaria kansuensis has obvious anti-HBV effects in vitro.