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Issues related to the impact of ChatGPT-like artificial intelligence generated content (AIGC) and artificial general intelligence (AGI) technologies on medicine and medicare have been presented and discussed. We believe that advances in medical foundation models, scenarios engineering, and medical operations with operating systems would lead to parallel doctors in parallel hospitals, i.e., digital, robotic, and human doctors working in parallel within cyber-physical-social spaces under three modes: autonomous, parallel, and expert/emergency operations. Under decentralized/distributed autonomous organizations/operations (DAO) and DeSci, as well as DeMed and DeHospitals, the vision for individual patients with her/his personalized digital hospital could be a reality in the future.

Chronic diseases have become a major problem affecting the health of residents in China and globally. The improvement of the quality of general practice is of great significance to improving the management of chronic diseases in primary care. It is an important way to achieve continuous quality improvement by evaluating the quality of chronic disease management in general practice to identify the current problems. According to the review of current status of domestic and international research, some countries have established relatively complete quality evaluation systems for the management of chronic diseases in general practice. Compared with foreign countries, the practice of quality evaluation and improvement of chronic disease management in general practice in China is still in the exploratory stage, although some progress has been made, there are also some challenges: firstly, the quality evaluation of chronic disease management is mainly focused on hypertension and diabetes, insufficient attention has been paid to the clinical quality of other chronic diseases, and the degree of refinement of clinical indicators still needs to be further strengthened compared with foreign countries. Secondly, there are limitations in evaluating the practice process of chronic disease management in general practice, most of the researches were mainly limited to the performance indicators within the framework of services specification. It is possible to refine the evidence-based quality evaluation and quality improvement systems and specify monitoring indicators. Thirdly, there is still a big gap in the construction of information system in general practice, the "fragmentation" and lack of information have seriously hindered the effective evaluation of the quality of chronic disease management, the information system construction should be improved as soon as possible. Fourthly, quality evaluation results focus on feedback within the administrative system and health service providers lack awareness of their own service quality, more equitable and effective evaluation and feedback mechanisms should be explored to promote continuous improvement in the quality of chronic disease management.

This paper proposes the concept of digital doctors and their roles in parallel healthcare for the digital transformation of medical services based on atificial intelligence and intelligent technology. By integrating complexity medicine, transdisciplinary medicine, and systematized intelligent medicine, we outline an ACP-based parallel healthcare and federated hospitals for preventive, proactive, precise, and personalized medical services.

BackgroundSince the 1990s, porous materials have been widely used in the fields of gas adsorption, electrochemistry, drug delivery, catalyst and catalyst carrier because of their excellent physical and chemical properties such as high specific surface area, high permeability, adsorption and assemblability. The application of porous materials largely depends on their macroscopic properties, especially the diversity of pore structure and the adjustability of pore size, especially, the thermal stability of SBA-15 is very important for its large-scale practical application.PurposeThis study aims to observe the thermal stability of SBA-15 by positron annihilation spectroscopy (PAS).MethodsFirst of all, ordered mesoporous silica SBA-15 were synthesized by using TEOS (tetraethyl orthosilicate) as the silicon source and P123 as the structure-directing agent. Part of the obtained SBA-15 was further calcined at 550 ℃. Then, the above two kinds of SBA-15 were heated at 100~1 000 ℃ to check the thermal stability of their pore structure. Small angle X-ray scattering (SAXS), scanning electron microscopy (SEM),high-resolution transmission electron microscopy (HRTEM), N2 adsorption/desorption and positron annihilation spectroscopy (PAS) measurements were used to study the ordered pore structure of SBA-15.ResultsPositron lifetime measurements reveal that four life components exist in both SBA-15 whilst the two longer lifetimes τ3 and τ4 correspond to the annihilation of o-Ps in the micropores and large pores of the material, respectively. With the increase of heat treatment temperature, the longest lifetime τ4 of these two kinds of synthesized silica decrease gradually, as well as the corresponding intensity I4. However, the longer life and intensity of calcined SBA-15 decrease obviously after 600 ℃. Meanwhile, the S parameter of calcined SBA-15 is in good agreement with the results of o-Ps lifetime, and the S-W curve also shows that the pore types of calcined SBA-15 nearly are unchanged during in the heat treatment process at the temperature range of 100~900 ℃.ConclusionsAll the results indicate that the synthesized SBA-15 calcined at 550 ℃ exhibits relatively better thermal stability, and positronium (Ps) is a very sensitive probe to study pore structure.

Abstract Background A community in northern Italy was previously reported to have an excess incidence of amyotrophic lateral sclerosis among residents exposed to high levels of inorganic selenium in their drinking water. Methods To assess the extent to which such association persisted in the decade following its initial observation, we conducted a population-based case-control study encompassing forty-one newly-diagnosed cases of amyotrophic lateral sclerosis and eighty-two age- and sex-matched controls. We measured long-term intake of inorganic selenium along with other potentially neurotoxic trace elements. Results We found that consumption of drinking water containing ≥ 1 μg/l of inorganic selenium was associated with a relative risk for amyotrophic lateral sclerosis of 5.4 (95% confidence interval 1.1-26) after adjustment for confounding factors. Greater amounts of cumulative inorganic selenium intake were associated with progressively increasing effects, with a relative risk of 2.1 (95% confidence interval 0.5-9.1) for intermediate levels of cumulative intake and 6.4 (95% confidence interval 1.3-31) for high intake. Conclusion Based on these results, coupled with other epidemiologic data and with findings from animal studies that show specific toxicity of the trace element on motor neurons, we hypothesize that dietary intake of inorganic selenium through drinking water increases the risk for amyotrophic lateral sclerosis.