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UNSTRUCTURED: This viewpoint article first explores the ethical challenges associated with the future application of large language models (LLMs) in the context of medical education. These challenges include not only ethical concerns related to the development of LLMs, such as artificial intelligence (AI) hallucinations, information bias, privacy and data risks, and deficiencies in terms of transparency and interpretability but also issues concerning the application of LLMs, including deficiencies in emotional intelligence, educational inequities, problems with academic integrity, and questions of responsibility and copyright ownership. This paper then analyzes existing AI-related legal and ethical frameworks and highlights their limitations with regard to the application of LLMs in the context of medical education. To ensure that LLMs are integrated in a responsible and safe manner, the authors recommend the development of a unified ethical framework that is specifically tailored for LLMs in this field. This framework should be based on eight fundamental principles: quality control and supervision mechanisms; privacy and data protection; transparency and interpretability; fairness and equal treatment; academic integrity and moral norms; accountability and traceability; protection and respect for intellectual property; and the promotion of educational research and innovation. The authors further discuss specific measures that can be taken to implement these principles, thereby laying a solid foundation for the development of a comprehensive and actionable ethical framework. Such a unified ethical framework based on these eight fundamental principles can provide clear guidance and support for the application of LLMs in the context of medical education. This approach can help establish a balance between technological advancement and ethical safeguards, thereby ensuring that medical education can progress without compromising the principles of fairness, justice, or patient safety and establishing a more equitable, safer, and more efficient environment for medical education.
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Objective To observe the evaluation value of serum high mobility group protein B1(HMGB-1) and APACHE Ⅱ score in severity degree and prognosis of the patients with acute pancreatitis(AP).Methods Sixty patients with AP were collected,including 20 cases in the mild AP group(MAP),20 cases in moderate AP group(MSAP) and 20 cases in the severe AP group (SAP).The HMGB-1 level in each group was dynamically monitored on 1,3,7 d after admission and its relationship with AP severity and APACHE Ⅱ score was analyzed.According to clinical outcomes,these cases were divided into the survival group(48 cases) and death group(12 cases),and the value of serum HMGB-1 level and APACHE-Ⅱ scores for evaluating the prognosis was analyzed.Results The HMGB-1 values on 1,3,7 d in the MAP group were(2.16±0.35),(4.34±0.96),(1.21±0.33)μg/L respectively,which in the MSAP group were(7.78 ±1.32),(10.45 ± 2.36),(6.92 ± 1.55) μg/L respectively,and which in the SAP group were(14.12±2.64),(27.53±8.19),(11.34± 2.57)μg/L respectively.The HMGB-1 levels in the SAP group were significantly higher than those in the MAP group and MSAP group,the differences were statistically significant (P＜ 0.01,P＜ 0.05);the HMGB-1 level had statistical difference between the MSAP group and MAP group(P＜0.05);the HMGB1l score on 3 d in the SAP group was increased with△3-1 HMGB1 increas(difference value of HMGB1 on 1,3 d),the both showed the positive correlation(r=0.725,P＜0.05).But the APACHE-Ⅱ score in the MSAP and MAP groups had no obvious change with the HMGB-1 level increase,the difference was not statistically significant(r=0.127,0.114,P＞0.05).Serum HMGB1 level and APACHE-lⅡ score in the death group were significantly higher than those in the survival group(P＜0.05).Conclusion The serum HMGB1 level has good correlation with APACHE-Ⅱ score in AP;their combination can serve the sensitive indicator for predicting disease condition severity and prognosis of AP.
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Objective To observe the effect of rhubarb enema on serum level of high mobility group protein B1 (HMGB1) in patients with severe acute pancreatitis (SAP).Methods A total of 60 cases of patients with SAP in our hospital were collected from October 2014 to October 2016,and were randomly divided into the observation group and control group (30 cases in each group).Serum levels of HMGB1 were dynamically detected on the 1st,3rd and 5th day after admission.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was conducted.The recovery time of gastrointestinal function and time for continuous renal replacement therapy (CRRT) were observed.Results On the 1st day after admission,no statistically significant difference was found in serum level of HMGB1 between the two groups (P＞0.05).The serum level of HMGB1 in the observation group was obviously decreased on the 5th day after admission,which was lower than that in the control group,there was statistically significant difference(P＜0.05).In the observation group,the value of difference between serum level of HMGB1 on the 1st day after admission and that on the 3rd day after admission was significantly negatively related with the APACHE Ⅱ score on the 3rd day after admission(r=-0.604,P＜0.05).In the observation group,the remission time of abdominal pain and abdominal distension,first time of exhaust and defecation and time for CRRT were significantly shorter than those in the control group,there were statistically significant differences (P＜0.05).Conclusion Rhubarb could improvesymptoms and prognosis of patients with SAP through effectively inhibit the expression of HMGB1.
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Objective To explore the prevention and treatment of complications of vascular injury after inguinal hernia repair.Methods The retrospective cross-sectional and descriptive study was adopted.The clinical data of 22 patients with vascular injury after inguinal hernia repair who were admitted to the First Affiliated Hospital of Chongqing Medical University between June 2005 and March 2016 were collected.Observation indicators included:(1) the vascular complications after inguinal hernia repair:vascular injury,peritoneal interstitial hemorrhage or hematoma formation,thrombosis and vascular embolization,(2) treatment,(3) follow-up.Patients were followed up by telephone interview at 15 days after discharge up to April 2016,and conditions of patients,recovery of symptoms and subsequent pharmacotherapy were detected.Results (1) The vascular complications after inguinal hernia repair:of 22 patients,peritoneal interstitial hemorrhage or hematoma formation was detected in 8 patients (vascular injury of corona mortis in 2 patients,inferior epigastric artery injury in 3 patients and unexplained peritoneal interstitial hemorrhage in 3 patients),femoral vein injury in 3 patients,femoral artery injury in 1 patient,deep vein thrombosis of the double lower limbs in 8 patients (including 2 with pulmonary embolism) and femoral and popliteal artery embolism in 2 patients.(2) Treatments:20 of 22 patients had good therapeutic effect,1 patient with arterial embolism received timely treatment avoiding the necrosis of limbs,1 ischemic necrosis of partial toes and the other patients had good effect through vascular repair or construction.One patient with inferior epigastric artery injury and 1 with femoral vein injury died of hemorrhagic shock.(3) Follow-up:20 of 22 patients were followed up for 2 weeks,with good conditions.Patients' hemorrhage had been improved.The symptoms of patients with deep vein thrombosis and arterial embolism of lower limbs didn't become obviously aggravated,and they took the medicine as medical advice.Conclusion The different treatments are conducted according to the occuring characteristics of vascular complications,with better outcomes.
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Objective To evaluate TriVex based transilluminated powered phlebectomy (TIPP)three-stage management for lower limb venous ulcers.Methods This retrospective study included 86 patients with 103 diseased limbs treated in our hospital from October 2005 to July 2013.All received TriVex TIPP three-stage management.Results After therapy there was no acute cellulitis,skin necrosis nor lower limb deep venous thrombosis.There were 2 cases of subcutaneous ecchymosis,1 case of subcutaneous hematoma,1 case of skin abnormal sensation and 1 case of subcutaneous induration.Ulcers healed within one month postoperation in all cases,while skin abnomalities were alleviated with no ulcer recurrence during the follow-up ranging from 4 to 48 months.Conclusions TriVex TIPP centered threestage management is a good option for lower limb venous ulcer,with shortened healing time,low recurrence rate.
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Objective To evaluate the clinical efficacy of oral Sarpogrelate hydrochloride in the treatment of chronic arterial ischemia of the lower extremities.Methods In this study 892 patients,who suffered from arteriosclerosis (ASO) or thromboangiitis obliterans ( TAO ) or diabetic foot ( DF ),with symptoms of intermittent claudication, sensation of cold, pain, ulcer, and without a history of vasotransplantation or bypass grafting or interventional therapy, were treated by taking Sarpogrelate hydrochloride tablets 100 mg tid for consecutive 8 weeks.The improvement rate of concomitant symptoms and the total effective rate of ASO, TAO, DF were evaluated.Drug adverse reaction were recorded.Results The improvement rate of intermittent claudication,sensation of cold,pain and ulcer were 96.9％,97.1％,89.0％ and 86.9％ respectively.The total effective rate for ASO,TAO,DF was 83.5％.A total of 81 cases (9.1％) reported mild side effects,including 7 patients with mild rash after 2- 5 days' medication,21 patients with mild nausea and 53 patients with stomach discomfort after 1 - 2 days' medication.Symptoms were managed conservatively without discontinuing taking sarpogrelate hydrochloride.Conclusions Sarpogrelate hydrochloride oral is a safe and effective therapy for chronic arterial ischemia diseases of the lower extremities.
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Objective To set up a determination method of warfarin,coumatertralyl,bromadiolone and brodifacoum.Methods HPLC-ESI-MS/MS was used to detect warfarin,coumatertralyl,bromadiolone and brodifacoum using ZORBAX sb-aq(1 50mm×2.1 mm×3.5 μm)as chromatographic column at constant temperature 30℃ while methanol of 0.1%formic acid and water as mobile phase in the grads program.The flow rate was 0.4 mL/min;Detection was performed on an electrospray ionization(ESI)in the negative model and the MRM condition.Results The limit of qualitation was found to be less than 40 pg for four raticides at one time and 10pg for every raticide in the MRM condition;The four raticides linear range were suitable and r were more than 0.999.Matrix affection Was also determined.Conclusion This method is simple,sensitive and accurate for the determination of warfarin,coumatertralyl,bromadiolonc and brodifacoum in the biological tissue.
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Objective To investigate the effects of VEGF-induced expression of Survivin by colon cancer cells (LOVO, HCT116) and human umbilical vein endothelial cells (HUVECs). Methods VEGF was used to stimu-late the LOVO, HCT116, HUVECs. We used RT-PCR and Western blot to estimate the expression of Survivin in different cells, and immunocytochemistry to investigate the expression level and site of Survivin protein. Results Survivin was expressed highly in the cytoplasm and was upregulated with the induction of VEGF. In HUVECs, Sur-vivin expression was not obvious but significantly upregulated with the inductioin of VEGF in the cytoplasm and nu-cleus. Conclusion The expression of Survivin mRNA and protein are upregulated by VEGF stimulation. The level and distribution of Survivin are different in tumor cell lines and non-tumorgenicity cells.
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Objective To investigate the effects of VEGF-induced expression of Survivin by colon cancer cells(LOVO,HCT116) and human umbilical vein endothelial cells(HUVECs).Methods VEGF was used to stimulate the LOVO,HCT116,HUVECs.We used RT-PCR and Western blot to estimate the expression of Survivin in different cells,and immunocytochemistry to investigate the expression level and site of Survivin protein.ResultsSurvivin was expressed highly in the cytoplasm and was upregulated with the induction of VEGF.In HUVECs,Survivin expression was not obvious but significantly upregulated with the inductioin of VEGF in the cytoplasm and nucleus.Conclusion The expression of Survivin mRNA and protein are upregulated by VEGF stimulation.The level and distribution of Survivin are different in tumor cell lines and non-tumorgenicity cells.
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Objective To observe the ultrastructure of theca interna of the de-endothelium allogenetic blood vessels in dogs by transmission and scanning electron microscope at different phases. Methods The endothelium of the allogenetic blood vessels were first removed and cryodensiccated, and were then end to end anastomosed to canine femoral artery. Samples were collected and observed with scanning and transmission electron microscope on the first, second, fourth, eighth, twelfth, sixteenth, and twentieth week after transplantation, respectively. Results A layer of cellulose membrane was formed on the surface of allogenetic blood vessels one week after transplantation; Fusiform cells were observed at the anastomotic stoma of the allogenetic blood vessels two weeks after transplantation, and theca interna, which was covered by fusiform cells and elliptical erythrocytes, was formed twelve weeks later; Slightly hyperplastic smooth muscle cells and collagenous fibers were observed under the endothelium twelve to twenty weeks after transplantation. Conclusion The endothelium cells could cover the surface of the allogenetic blood vessels without remarkable hyperplasia of intima during a short period of time, which may suggest the satisfactory histocompatibility of canine allogenetic blood vessels.
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Objective To observe the intimal changes of inferior caval vein(ICV) wall after combined thrombolysis and anticoagulation therapy for acute thrombosis in rats.Methods The inferior caval venous thrombosis model was established in 105 rats and they were randomly diride into 3 treated groups:heparin(A) treatment group(n=35),urokinase(B) treatment group(n=35),and combination of urokinase and heparin(C) treatment group(n=35),and also eslablished a sham(D) group(n=30).The thrombosed caval veins were taken 1,4,7,14,and 28 d after thrombosis.Changes of thrombus structure and orgainization and intimal hyperplasia were observed by light microscope.The expression areas of collagen fiber were measured by histochemistry.Scanning electron microscopy was used to observe the damage of endothelial cells.Results The intimal hyperplasia in A group was the most severe.The expression area of collagen fiber in group C was less than that of A and B groups(P
