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Background The advent of pre-trained generative transformers, exemplified by ChatGPT, has significantly impacted medical education, catalysing a wealth of research focused on enhancing educational methodologies. Despite this, the application of ChatGPT in the specific area of career planning for medical students remains relatively unexplored. This study seeks to rigorously evaluate the potential of ChatGPT-4o in facilitating the career planning of medical students, comparing its effectiveness with that of traditional human educators. It also aims to identify optimal strategies for integrating ChatGPT-4o with human educators to maximise support in career planning for medical students.Methods Adopting a mixed-methods approach, this research combines qualitative insights from interviews with quantitative data from questionnaires. The research is bifurcated into two primary segments: first, evaluating the proficiency of ChatGPT-4o in aiding medical students’ career planning, and second, identifying effective collaborative practices between ChatGPT-4o and human educators.Discussion The study focuses on assessing ChatGPT-4o’s utility in career planning for medical students and determining how it can be best used within medical education by both educators and students. The aim is to augment the career planning consultation process, thereby enhancing the efficiency and quality of human educators’ contributions. This includes exploring how ChatGPT-4o can supplement traditional teaching methods, providing a more robust and comprehensive support system for career planning in medical education.

Summary: Background: Over 500,000 new cases are diagnosed with papillary thyroid cancer (PTC) globally per year, of whom the vast majority are in the low-risk stratification. Although thyroid-stimulating hormone (TSH) suppression is traditionally recommended for all postoperative PTCs in current guidelines, its necessity remains highly controversial in low-risk patients. Since relevant recommendations in current guidelines are still empirical, we aim to provide a direct, large-scale, real-world evidence. Methods: This large-scale real-world retrospective study included 11,140 low-risk PTC patients from two Chinese large-volume centers (Fudan University Shanghai Cancer Center [FUSCC] and Cancer Hospital of Chinese Academy of Medical Sciences [CH-CAMS]) treated from January 1, 2000 to June 30, 2022. The mean TSH level was calculated based on postoperative serum TSH values during follow-up. The primary outcome was the association between postoperative TSH level and structural recurrence assessed by Kaplan–Meier, log-rank, multivariate Cox regression analyses and equivalence testing by Two One-Sided Tests (TOST) procedure. Propensity score matching (PSM) was used to adjust for confounders among groups. Findings: A total of 11,140 patients with low-risk PTC were included with a median follow-up of 70 months. Based on the mean TSH level, we classified these patients into ≤0.5 (n = 1,504, 13.5%), (0.5–1] (n = 4,336, 38.9%), (1–2] (n = 4,285, 38.5%), (2–3] (n = 704, 6.3%) and >3 (n = 311, 2.8%) mU/L groups. After PSM adjusting for age, sex, T and N stage, 8991 patients were included in further analysis, for whom the log-rank analyses showed no significant differences between any two groups (all P > 0.05) in recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS), and suppressed TSH was not associated with tumor recurrence in the multivariate Cox analysis (TSH > 2 group vs TSH ≤ 2 group: HR = 1.30, 95% CI = 0.85–2.01, P = 0.23). Furthermore, the TOST equivalence tests showed that tumor recurrence status of any two TSH groups were statistically comparable (all Bonferroni-corrected P values

BackgroundClinical observations have recently shown that Abelmoschus manihot (L.) in the form of Huangkui capsule (HKC) and in combination with irbesartan (EB) is an effective therapy for diabetic nephropathy (DN) in patients with type 2 diabetes (T2D). The present study aims to explore the mechanisms underlying the therapeutic efficacies of HKC and its combination with EB in DN via the gut-kidney axis.MethodsHKC, EB, and their combination or vehicle were administered in db/db mice, which is an animal model for the study of T2D and DN. Comparative analyses of the gut microbiota, serum metabolites, and kidney transcriptomics before and after drug administration were performed.ResultsAfter treatment with HKC, EB, and their combination for 4 weeks, the urinary albumin-to-creatinine ratios decreased significantly in the db/db mice with DN. In terms of the gut microbiota, the abundances of Faecalitalea, Blautia, and Streptococcus increased but those of Bacteroidetes, Firmicutes, Enterobacteriaceae, and Desulfovibrio decreased. Parallelly, serum metabolites, mainly including quercetin 3′-glucuronide and L-dopa, were elevated while cortisol and cytochalasin B were reduced. Furthermore, the S100a8, S100a9, Trem1, and Mmp7 genes in the kidneys were downregulated. These altered elements were associated with proteinuria/albuminuria reduction. However, EB had no effects on the changes in blood pressure and specific differentially expressed genes in the kidneys.ConclusionThe present study provides experimental evidence that HKC regulates the gut microbiota, circulating metabolites, and renal gene activities, which are useful for better understanding of the action mechanisms of A. manihot in the treatment of DN through the gut-kidney axis.

Abstract Background and Aims Various inflammatory and immune cytokines play key roles in the progression of hepatitis B virus (HBV)‐related liver cirrhosis (LC). This study explored the relationship between single nucleotide polymorphisms (SNPs) in cytokines with the combined effect of polymorphisms and gender‐polymorphisms interaction and LC risk. Methods In this study, a case–control design was used, samples were selected from 45 patients with hepatitis B‐related cirrhosis and 45 age‐gender‐matched chronic HBV‐infected patients without cirrhosis attending the tumor hospital of Wuwei Academy of Medical Sciences. Fifteen SNPs were examined using a real‐time polymerase chain reaction allelic discrimination system. Logistic regression was utilized to assess cytokine‐associated SNPs and the association between SNPs and LC progression in HBV‐infected patients. Results The multivariate‐adjusted logistic model revealed that the GG/AG dominant model (OR, 16.38; 95% CI, 1.13–236.70) and G allele (OR, 5.93; 95% CI, 0.98–36.01) of rs1800896 were associated with an increased risk of cirrhosis in CHB patients. Instead, rs2227306 CT presented a reduced cirrhosis risk (OR, 0.22; 95% CI, 0.04–1.38). Rs2055979 AA/AC was negatively associated with the risk of cirrhosis, potentially reversed in males (p = 0.021). Rs1799964 CC/CT was positively related to the risk of cirrhosis but reduced the risk of cirrhosis in males (OR, 0.13; 95% CI, 0.022–0.808; p = 0.028). Both rs1799964 TT and rs1799724 CT/TT genotype showed a synergistic effect in reducing the risk of cirrhosis with rs1800896 AA (OR, 0.08; 95% CI, 0.01–1.43 and OR, 0.12; 95% CI, 0.01–2.21). Conclusion Polymorphisms rs1800896 and rs2227306 are potentially associated with the risk of cirrhosis. For the first time, the study highlights that the rs2055979 AA/AC and rs1799964 CC/CT polymorphism interact with gender and its potential reversal of cirrhosis risk in males. Furthermore, rs1800896 AA showed a synergistic effect with rs1799964 TT and rs1799724 CT/TT to prevent the progression of HBV infection to cirrhosis.

Abstract Introduction Exercise enhances one's health and competitiveness. A strong physical fitness status can pave the way for a promising future. This study presents the time-based trends in physical fitness indicators—including height, weight, BMI, lung capacity, dash, long-distance running, and standing long jump—among medical undergraduates during their university years. Additionally, we analyzed the impact of students' physical fitness on their career paths. Method We conducted a retrospective database study by collecting physical fitness test data and career paths information for 634 medical students from a university in southwestern China. These students graduated in 2022. The career paths included pursuits in further studies, employment, and unemployment. To detect differences in these aspects, we used the t-test and Chi-square test. Results Our study indicates a significant declining trend in the physical fitness of medical students during their university years. The changes observed between the first and fourth tests are as follows: Weight (kg): 58.52 ± 10.48 to 60.73 ± 12.07, P

BackgroundThe presence of lymph node metastasis (LNM) is frequently observed in papillary thyroid carcinoma (PTC), and most clinical guidelines recommend total thyroidectomy. However, the impact of LNM on specific types of locoregional recurrence remains uncertain, particularly for stage T1 PTC.MethodsThe present retrospective cohort study enrolled patients diagnosed with stage T1 PTC between 2008 and 2015. Propensity score matching was performed in patients with lobectomy accompanied by varying degrees of LNM. Logistic regression analysis was performed to compare the effect of LNM on relapse types, and Kaplan-Meier method was utilized to calculate recurrence-free survival.ResultsThe study cohort comprised 2,785 patients who were followed up for an average duration of 69 months. After controlling follow-up time and potential prognostic factors, we include a total of 362 patients in each group. Recurrence rates in the N0, N1a, and N1b groups were found to be 2.5%, 9.7%, and 10.2% respectively. Notably, group N1a versus group N0 (P=0.803), N1b group versus N0 group (P=0.465), and group N1b versus group N1a (P=0.344) had no difference in residual thyroid recurrence. However, when considering lymph node recurrence, both N1a(P=0.003) and N1b(P=0.009) groups showed a higher risk than N0 group. In addition, there was no difference in lymph node recurrence between N1b group and N1a group (P=0.364), but positive lymph node (PLN) and lymph node positive rate (LNPR) demonstrated a strong discriminatory effect (P

Objectives This study aimed to investigate the associations between critical thinking (CT) disposition and personal characteristics and tutors’ guidance among medical graduate students, which may provide a theoretical basis for cultivating CT.Design A cross-sectional study was conducted.Setting This study was conducted in Sichuan and Chongqing from November to December 2021.Participants A total of 1488 graduate students from clinical medical schools were included in this study.Data analysis The distribution of the study participants’ underlying characteristics and CT was described and tested. The Spearman rank correlation coefficient was used to evaluate the correlation between each factor and the CT score. The independent risk factors for CT were assessed using a logistic regression model.Results The average total CT score was 81.79±11.42 points, and the proportion of CT (score ≥72 points) was 78.9% (1174/1488). Female sex (OR 1.405, 95% CI 1.042 to 1.895), curiosity (OR 1.847, 95% CI 1.459 to 2.338), completion of scientific research design with reference (OR 1.779, 95% CI 1.460 to 2.167), asking ‘why’ (OR 1.942, 95% CI 1.508 to 2.501) and team members’ logical thinking ability (OR 1.373, 95% CI 1.122 to 1.681) were positively associated with CT while exhaustion and burn-out (OR 0.721, 95% CI 0.526 to 0.989), inattention (OR 0.572, 95% CI 0.431 to 0.759), Following others’ opinions in decision-making (OR 0.425, 95% CI 0.337 to 0.534) and no allow of doubt to tutors (OR 0.674, 95% CI 0.561 to 0.809) had negative associations with the formation of CT disposition in the fully adjusted model.Conclusions Factors associated with motivation and internal drive are more important in the educational practice of cultivating CT. Educators should change the reward mechanism from result-oriented to motivation-maintaining to cultivate students’ CT awareness.

Septic encephalopathy (SE) represents a severe inflammatory syndrome linked to elevated septic mortality rates, lacking specific therapeutic interventions, and often resulting in enduring neurological sequelae. The present investigation endeavors to elucidate the involvement of C-X-C Motif Chemokine Receptor 2 (CXCR2) in the pathogenesis of SE and to explore the potential of CXCR2 modulation as a therapeutic avenue for SE. Employing a murine SE model induced by lipopolysaccharide (LPS) administration, CXCR2 knockout mice and the CXCR2 inhibitor SB225002 were utilized to assess neutrophil recruitment, endothelial integrity, and transendothelial migration. Our findings substantiate that either CXCR2 deficiency or its inhibition curtails neutrophil recruitment without impacting their adhesion to cerebral endothelial cells. This phenomenon is contingent upon endothelial CXCR2 expression rather than CXCR2’s presence on neutrophils. Furthermore, the CXCR2 blockade preserves the integrity of tight junction protein ZO-1 and mitigates F-actin stress fiber formation in cerebral endothelial cells following septic challenge. Mechanistically, CXCL1-mediated CXCR2 activation triggers cerebral endothelial actin contraction via Rho signaling, thereby facilitating neutrophil transmigration in SE. These observations advocate for the potential therapeutic efficacy of CXCR2 inhibition in managing SE.

Introduction: Huangkui capsule (HKC) is made from the ethanol extract of Abelmoschus manihot (L.) Medik [Malvaceae; abelmoschi corolla] and received approval from the China Food and Drug Administration (Z19990040) in 1999. Currently, HKC is used for treatment of the patients with diabetic nephropathy (DN) in China. The bioactive chemical constituents in HKC are total flavonoids of A. manihot (L.) Medik (TFA). The present study aims to identify the primary flavonoid metabolites in HKC and TFA and their metabolism fates in db/db mice, the animal model for the study of type 2 diabetes and DN.Methods: HKC (0.84 g/kg/d) and TFA (0.076 g/kg/d) or vehicle were respectively administered daily via oral gavage in db/db mice for 4 weeks. The metabolism fate of the main metabolites of HKC in serum, liver, kidney, heart, jejunum, colon, jejunal contents, colonic contents, and urine of db/db mice were analyzed with a comprehensive metabolite identification strategy.Results and Discussion: In db/db mice administered with HKC and TFA, 7 flavonoid prototypes and 38 metabolites were identified. The related metabolic pathways at Phases I and II reactions included dehydroxylation, deglycosylation, hydrogenation, methylation, glucuronidation, sulphation, and corresponding recombined reactions. Quercetin, isorhamnetin, quercetin sulphate, quercetin monoglucuronide, and isorhamnetin monoglucuronide presented a high exposure in the serum and kidney of db/db mice. Thereby, the present study provides a pharmacodynamic substance basis for better understanding the mechanism of A. manihot (L.) Medik for medication of DN.

Abstract Huangkui capsule (HKC), a traditional Chinese medicine, has been used for medication of kidney diseases, including diabetic nephropathy (DN). The current study aimed to evaluate the effects of HKC in the modulation of gut microbiota and the amelioration of metabolite levels by using non‐obese diabetes (NOD) mice with DN. The microbiota from three parts of intestines (duodenum, ileum and colon) in NOD mice with and without HKC treatment were analysed using 16S rDNA sequencing techniques. Untargeted metabolomics in plasma of NOD mice were analysed with liquid mass spectrometry. Results showed that HKC administration ameliorated DN in NOD mice and the flora in duodenum were more sensitive to HKC intervention, while the flora in colon had more effects on metabolism. The bacterial genera such as Faecalitalea and Muribaculum significantly increased and negatively correlated with most of the altered metabolites after HKC treatment, while Phyllobacterium, Weissella and Akkermansia showed an opposite trend. The plasma metabolites, mainly including amino acids and fatty acids such as methionine sulfoxide, BCAAs and cis‐7‐Hexadecenoic acid, exhibited a distinct return to normal after HKC treatment. The current study thereby provides experimental evidence suggesting that HKC may modulate gut microbiota and subsequently ameliorate the metabolite levels in DN.

The simultaneous binding/dissociation of multiple bonds in a one-pot manner by multicomponent reactions provide an important approach for developing novel and sustainable pathway in the drug discovery process. Herein we develop an electrocatalytic three-component reaction to construct multifunctional and valuable isothiourea compounds, which uses thiols, isocyanides and amines as substrates. Compared with the previous work, the organic electrosynthesis technique can avoid the requirement of heavy metal catalysts and stoichiometric oxidants. In addition, using thiol as a substrate to participate in the three-component reaction broadens the source of sulfur, which can also construct more abundant isothiourea derivatives.

Introduction: As a traditional Chinese medicine, Abelmoschus manihot (L.) in the form of Huangkui (HK) capsule has been used as a medication for kidney diseases, including diabetic nephropathy (DN), in China. The most significant effect of HK capsule treatment in kidney diseases is the reduction of albuminuria and proteinuria. To evaluate the efficacy of HK capsule in the regression of DN, in the current study, we analyzed the biomarkers in the glomerulus and proximal and distal convoluted tubules in the kidneys of db/db mice, the animal model for type 2 diabetes and DN.Methods: Huangkui capsules (0.84 g/kg/d) or vehicle were administered daily via oral gavage for 4 weeks in db/db mice. Urinary albumin-to-creatinine ratio and blood glucose levels were measured during the whole experimental period. Five biomarkers in the glomerulus and proximal and distal convoluted tubules in the kidneys were selected, namely, col4a3, slc5a2, slc34a1, slc12a3, and slc4a1, and their activities at mRNA and protein levels before and after HK capsule treatment were analyzed by real-time RT–PCR and immunohistochemistry.Result and discussion: After HK capsule treatment for 4 weeks, the urinary albumin-to-creatinine ratio in db/db mice was found to be significantly decreased. The activities of col4a3, slc5a2, slc34a1, slc12a3, and slc4a1 in the kidneys were upregulated in db/db mice prior to the treatment but downregulated after HK capsule treatment. Further analyses of the fields of whole kidney tissue sections demonstrated that the number of nephrons in the kidneys of db/db mice with HK capsule treatment was higher than that in the kidneys of db/db mice without HK capsule treatment. Thereby, the current study provides experimental evidence confirming the medical efficacy of A. manihot in the reduction of albuminuria and proteinuria, suggesting that A. manihot may have pharmacological efficacy in the regression of the development of type 2 diabetes-DN.

Aiming at the problem of how to reduce the complexity of trajectory optimization of redundant or super-redundant manipulators， a constrained energy consumption optimal manipulator trajectory planning method is proposed. The dynamics of the redundant manipulator are modeled based on lagrange dynamics， and the motion trajectory is constructed using the uniform quintic B-spline function. In order to improve the computational efficiency of trajectory optimization， a new penalty algorithm is designed through dealing with the kinematic and dynamic constraints in the cost function calculation， so as to avoid running the inverse dynamic model when all the constraints are not met. Before running the inverse dynamic model for trajectory optimization， a new virtual link concept is introduced to replace all redundant links to eliminate the physically impossible configuration. The proposed method is verified by experiments on a three-degree-of-freedom redundant manipulator at the same time. The research results show that the simulation and the actual measurement obtain the same expected optimal trajectory tracking performance， and the energy consumption after trajectory optimization is significantly reduced by about 56.32%， which verifies the effectiveness of the proposed trajectory planning optimization method.

Functionalised mesoporous poly(ionic liquid)s are valuable carbon dioxide capture and conversion materials. Here, an imidazole poly(ionic liquid) PIL-s1-HCO3 with a mesoporous structure was formed by the copolymerisation of vinyl-modified ionic liquids and crosslinking agents. The material has excellent adsorption properties for carbon dioxide. Using it as the catalyst, the formylation of carbon dioxide with various amides was realised at room temperature and pressure without metal participation. In addition, the material is stable in performance, easily separated, and has good reusability. In this work, relying on the new PIL as a multi-functional platform, carbon dioxide capture and the transformation to high-value-added chemicals were completed simultaneously.

BackgroundHepatitis B surface antigen (HBsAg) loss is considered a functional cure for chronic hepatitis B (CHB), however, several factors influence HBsAg loss.Methods29 CHB patients who had achieved HBsAg loss, were selected and 58 CHB patients with persistent HBsAg were matched, according to gender and age (+/- 3 years). Logistic regression and restricted cubic spline (RCS) modelling were performed.ResultsMultivariate-adjusted logistic regression, based on stepwise selection, showed that baseline HBsAg levels negatively correlated with HBsAg loss (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.98-0.99). Interferon treatment positively related with HBsAg loss (OR = 7.99, 95%CI = 1.62-44.88). After adjusting for age, HBsAg level, ALT level, HBeAg status and interferon treatment, MMP-1 (OR = 0.66, 95%CI = 0.44-0.97), CXCL9 (OR = 0.96, 95%CI = 0.93-0.99) and TNF-R1 (OR = 0.97, 95%CI = 0.94-0.99) baseline levels all negatively correlated with HBsAg loss. Our multivariate-adjusted RCS model showed that baseline CXCL10 was associated with HBsAg loss although the relationship was “U-shaped”.ConclusionsCytokines such as MMP-1, CXCL9, CXCL10 and TNF-R1 are important factors which influence HBsAg loss. It may be possible to develop a nomogram which intercalates these factors; however, further research should consider immune processes involved in HBsAg loss.

The impact of the land use landscape pattern on river hydrochemistry has significant scale effects. It is the premise and foundation of landscape optimization and the conservation of water resources to accurately identify the core scale of the landscape pattern impacting on river hydrochemistry. Taking Binggou River Basin in the source region of Shiyang River Basin as the study area, this paper selected the three spatial scales of catchment area, buffer zone, and riparian zone, and the relationships between land use types and landscape indices and river hydrochemical characteristics were analyzed at different spatio-temporal scales using redundancy analysis. The results showed that the hydrochemistry characteristics of Binggou River Basin had strong temporal variability, and the rainy season was the key period when the land use landscape pattern affected the river hydrochemistry. The sub-watershed and riparian scales were the core scales of influence of the landscape pattern on river hydrochemistry in Binggou River Basin. In particular, the landscape pattern index contributed the most to the river hydrochemistry at the sub-watershed scale on the whole, which was the core scale affecting river hydrochemistry. The “source” or “sink” functions of the same land use type also changed as the scale changed. Forest land showed weak “source” effect at the sub-watered scale, but a strong interception effect on the soil erosion process at the riparian scale, which is a typical “sink” landscape.

Background and aimChronic hepatitis B (CHB) can be divided into immune tolerance (IT), immune clearance (IC), hepatitis B e antigen (HBeAg)-negative inactive/quiescent carrier (ENQ), and HBeAg-negative hepatitis (ENH) phases. The conventional biomarkers used to distinguish these phases have limitations. We examined the clinical significance of hepatitis B virus (HBV) RNA and hepatitis B core-related antigen (HBcrAg) as novel biomarkers.MethodsOne hundred eighty-nine patients without treatment currently were categorized by CHB phase (IT = 46, IC = 45, ENQ = 49, ENH = 49). The associations of HBV RNA and HBcrAg with HBV DNA and alanine transaminase (ALT) were analyzed. The decision tree model was used to distinguish the four phases in the natural course of CHB.ResultsThe concentrations of HBV RNA and HBcrAg were highest in the IT and IC phases (P < 0.01). Serum HBV RNA was similar to HBcrAg in treatment-naïve patients. HBV RNA and HBcrAg correlated with HBV DNA in the HBeAg+ and HBeAg− status (HBV RNA: e+ r = 0.51, e− r = 0.62; HBcrAg: e+ r = 0.51, e− r = 0.71), but their association with HBV DNA differed among phases. The accuracy, sensitivity, and specificity of HBcrAg with ALT in distinguishing the CHB phases were 95.65%, 95.83%, and 95.55%, respectively.ConclusionSerum HBV RNA and HBcrAg may be useful to monitor CHB progression.

Robust speech recognition in real world situations is still an important problem, especially when it is affected by environmental interference factors and conversational multi-speaker interactions. Supplementing audio information with other modalities, such as audio–visual speech recognition (AVSR), is a promising direction for improving speech recognition. The end-to-end (E2E) framework can learn information between multiple modalities well; however, the model is not easy to train, especially when the amount of data is relatively small. In this paper, we focus on building an encoder–decoder-based end-to-end audio–visual speech recognition system for use under realistic scenarios. First, we discuss different pre-training methods which provide various kinds of initialization for the AVSR framework. Second, we explore different model architectures and audio–visual fusion methods. Finally, we evaluate the performance on the corpus from the first Multi-modal Information based Speech Processing (MISP) challenge, which is recorded in a real home television (TV) room. By system fusion, our final system achieves a 23.98% character error rate (CER), which is better than the champion system of the first MISP challenge (CER = 25.07%).

As an important data analysis method in the field of machine learning and data mining, feature learning has a wide range of applications in various industries. The traditional multidimensional scaling (MDS) maintains the topology of data points in the low-dimensional embeddings obtained during feature learning, but ignores the discriminative nature between classes of low-dimensional embedded data. Thus, the discriminative multidimensional scaling based on pairwise constraints for feature learning (pcDMDS) model is proposed in this paper. The model enhances the discriminativeness from two aspects. The first aspect is to increase the compactness of the new data representation in the same cluster through fuzzy k-means. The second aspect is to obtain more extended pairwise constraint information between samples. In the whole feature learning process, the model considers both the topology of samples in the original space and the cluster structure in the new space. It also incorporates the extended pairwise constraint information in the samples, which further improves the model’s ability to obtain discriminative features. Finally, the experimental results on twelve datasets show that pcDMDS performs 10.31% and 8.31% higher than PMDS model in terms of accuracy and purity.