Evaluating large language models as patient education tools for inflammatory bowel disease:A comparative study

BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.

Main focus of parents of children with attention deficit hyperactivity disorder and the effectiveness of early clinical screening

BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a common mental and behavioral disorder among children.AIM To explore the focus of attention deficit hyperactivity disorder parents and the effectiveness of early clinical screening METHODS This study found that the main directions of parents seeking medical help were short attention time for children under 7 years old(16.6%)and poor academic performance for children over 7 years old(12.1%).We employed a two-stage experiment to diagnose ADHD.Among the 5683 children evaluated from 2018 to 2021,360 met the DSM-5 criteria.Those diagnosed with ADHD underwent assessments for letter,number,and figure attention.Following the exclusion of ADHD-H diagnoses,the detection rate rose to 96.0%,with 310 out of 323 cases identified.RESULTS This study yielded insights into the primary concerns of parents regarding their children's symptoms and validated the efficacy of a straightforward diagnostic test,offering valuable guidance for directing ADHD treatment,facilitating early detection,and enabling timely intervention.Our research delved into the predominant worries of parents across various age groups.Furthermore,we showcased the precision of the simple exclusion experiment in discerning between ADHD-I and ADHD-C in children.CONCLUSION Our study will help diagnose and guide future treatment directions for ADHD.

Back-n white neutron source at CSNS and its applications

Back-streaming neutrons from the spallation target of the China Spallation Neutron Source(CSNS)that emit through the incoming proton channel were exploited to build a white neutron beam facility(the so-called Back-n white neutron source),which was completed in March 2018.The Back-n neutron beam is very intense,at approximately 29107 n/cm2/s at 55 m from the target,and has a nominal proton beam with a power of 100 kW in the CSNS-I phase and a kinetic energy of 1.6 GeV and a thick tungsten target in multiple slices with modest moderation from the cooling water through the slices.In addition,the excellent energy spectrum spanning from 0.5 eV to 200 MeV,and a good time resolution related tothe time-of-flight measurements make it a typical white neutron source for nuclear data measurements;its overall performance is among that of the best white neutron sources in the world.Equipped with advanced spectrometers,detectors,and application utilities,the Back-n facility can serve wide applications,with a focus on neutron-induced cross-sectional measurements.This article presents an overview of the neutron beam characteristics,the experimental setups,and the ongoing applications at Backn.

Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction

AIM： TO evaluate the effectiveness and safety of capsule endoscopy （CE） in patients with recurrent subacute small bowel obstruction.METHODS： The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through.RESULTS： CE made a definitive diagnosis in 12 （38.7%） of 31 cases： four Crohn＇s disease （CD）, two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine,one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three （9.7%） of 31 patients, and was caused by CD （2） or tumor （1）. Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 too. No case had an acute small bowel obstruction caused by performance of CE.CONCLUSION： CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.

Measurement of the ^(232)Th(n,f)cross section in the 1-200 MeV range at the CSNS Back-n

The ^(232)Th(n,f)cross section is very important in basic nuclear physics and applications based on the Th/U fuel cycle.Using the time-of-flight method and a multi-cell fast-fission ionization chamber,a novel measurement of the^(232)Th(n,f)cross sec-tion relative to^(235)U in the 1–200 MeV range was performed at the China Spallation Neutron Source Back-n white neutron source(Back-n).The fission event-neutron energy spectra of^(232)Th and^(235)U fission cells were measured in the single-bunch mode.Corrected 232Th/235U fission cross-sectional ratios were obtained,and the measurement uncertainties were 2.5–3.7%for energies in the 2–20 MeV range and 3.6–6.2%for energies in the 20–200 MeV range.The^(232)Th(n,f)cross section was obtained by introducing the standard cross section of^(235)U(n,f).The results were compared with those of previous theoreti-cal calculations,measurements,and evaluations.The measured 232Th fission cross section agreed with the main evaluation results in terms of the experimental uncertainty,and 232Th fission resonances were observed in the 1–3 MeV range.The present results provide^(232)Th(n,f)cross-sectional data for the evaluation and design of Th/U cycle nuclear systems.

Endoscopic mucosal resection-precutting vs conventional endoscopic mucosal resection for sessile colorectal polyps sized 10-20 mm

BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.

Knowledge,attitude,and practice of monitoring early gastric cancer after endoscopic submucosal dissection

BACKGROUND Early gastric cancer(EGC)is typically treated with endoscopic submucosal dissection(ESD).However,recurrence may occur after ESD,requiring surveillance.AIM To examine the knowledge,attitude,and practice(KAP)of EGC survivors following ESD regarding gastric cancer recurrence.METHODS This cross-sectional study was conducted between June 1,2022 and October 1,2022 in Zhejiang,China.A total of 400 EGC survivors who underwent ESD at the Affiliated Jinhua Hospital,Zhejiang University School of Medicine participated in this study.A self-administered questionnaire was developed to assess KAP monitoring gastric cancer after ESD.RESULTS The average scores for KAP were 3.34,23.76,and 5.75 out of 5,30,and 11,respectively.Pearson correlation analysis revealed positive and significant correlations between knowledge and attitude,knowledge and practice,and attitude and practice(r=0.405,0.511,and 0.458,respectively;all P<0.001).Multivariate logistic regression analysis showed that knowledge,attitude,13-24 mo since the last ESD(vs≤12 mo since the last ESD),and≥25 mo since the last ESD(vs≤12 mo since the last ESD)were independent predictors of proactive practice(odds ratio=1.916,1.253,3.296,and 5.768,respectively,all P<0.0001).CONCLUSION EGC survivors showed inadequate knowledge,positive attitude,and poor practices in monitoring recurrences after ESD.Adequate knowledge,positive attitude,and a longer time since the last ESD were associated with practice.

Mesenteric phlebosclerosis with amyloidosis in association with the long-term use of medicinal liquor: A case report

BACKGROUND Mesenteric phlebosclerosis(MP)is a rare disease of the colon.The clinical manifestations of this disease are nonspecific and it may easily be misdiagnosed.We report a case of MP with amyloidosis in the colonic vessel walls in a patient with hypertension who had been consuming Chinese medicinal liquor for 10 years.We also review the relevant literature and summarize the characteristics of MP in patients in China's Mainland.CASE SUMMARY A 64-year-old man was referred to our department from his primary hospital because of abdominal pain,diarrhea,and fever for almost 10 d.Computed tomography showed colon wall thickening,with threadlike calcifications in the mesenteric vein in the transverse colon.Colonoscopy revealed purple-blue mucosa with multiple ulcers in the ascending and transverse colon.Biopsy showed thickening and calcification of the vein walls,perivascular and mucosal collagen degeneration,and amyloidosis.The patient had been consuming Chinese medicinal liquor,mainly that made from gardenia fruit,for 10 years.Based on these results,a diagnosis of MP with amyloidosis was made.After conservative treatment,the patient’s discomfort subsided and he was followed closely.The use of Chinese herbal medicine was suspected to play a role in the pathogenesis of MP.CONCLUSION The clinical manifestations of MP are nonspecific.Recognition of its typical imaging findings,including multiple calcifications on computed tomography and purple-blue mucosal discoloration on colonoscopy,is vital.

CLAG-M chemotherapy followed by umbilical cord blood stem cell transplantation for primary refractory acute myeloid leukaemia in a child:A case report

BACKGROUND The prognosis of paediatric primary refractory/relapsed acute myeloid leukaemia(R/R AML)remains poor.Intensive therapy is typically used as salvage treatment for those with R/R AML.No data are currently available about the use of the CLAG-M protocol as salvage therapy in paediatric patients with R/R AML.CASE SUMMARY An 8-year-old patient was diagnosed with acute myeloid leukaemia by bone marrow morphology and immunophenotype.The patient showed poor response to two cycles of induction therapy with 60%blast cells in the bone marrow after the second induction cycle.The patient achieved complete remission after being treated with the CLAG-M protocol as salvage therapy before undergoing umbilical cord blood stem cell transplantation.Morphological complete remission with haematological recovery has hitherto been maintained over 4 mo.Abnormal gene mutations detected at diagnosis were undetectable after haematopoietic stem cell transplantation.CONCLUSION Here we present a paediatric patient with primary refractory acute myeloid leukaemia who was successfully treated with the CLAG-M protocol.Given the positive results of the presented patient,large-scale clinical studies are required to assess the role of the CLAG-M protocol in the salvage treatment of refractory or relapsed AML in childhood.

Diffuse xanthoma in early esophageal cancer: A case report

BACKGROUND Gastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus.To date,there have been no reports of esophageal xanthoma combined with esophageal cancer.Herein,we present the first case in the literature of a diffuse xanthoma complicated with early esophageal cancer.Moreover,this combination makes the endoscopic diagnosis difficult if it is not in mind.CASE SUMMARY A 68-year-old man visited our department with a 2-mo history of epigastric discomfort.He underwent surgery for gastric cancer 6 years ago.Esophagogastroduodenoscopy showed a semi-circumferential irregular yellowish-colored and granular lesion in the esophagus(30-35 cm from the incisors).Using magnifying endoscopy with narrow band imaging,aggregated minute and yellowish-colored spots with tortuous microvessels on the surface were observed,and background coloration was clearly seen in the lesion.As endoscopic biopsy suggested a histologically high-grade dysplasia;the lesion was completely resected en bloc by endoscopic submucosal dissection(ESD).The resected specimen was confirmed to be a squamous cell carcinoma in situ with extensive foamy cells in the superficial mucosal layer.Immunohistochemically,the observed foamy cells were strongly positive for CD68,which is characteristic of xanthoma.The clinical course was favorable,and no recurrence was observed 2 years and 7 mo after ESD.CONCLUSIONDiffuse xanthoma concurrent with early esophageal cancer is extremely rare.The characteristic endoscopic features may assist endoscopists in diagnosing similar lesions.

An Almost Sure Central Limit Theorem for Self-normalized Weighted Sums

Let X, X1, X2, be a sequence of nondegenerate i.i.d, random variables with zero means, which is in the domain of attraction of the normal law. Let （ani, 1 ≤ i ≤n,n ≥1} be an array of real numbers with some suitable conditions. In this paper, we show that a central limit theorem for self-normalized weighted sums holds. We also deduce a version of ASCLT for self-normalized weighted sums.

Effects of neuro-immuno-modulation on healing of wound combined with local radiation injury in rats

Purpose： To investigate effects of neuro-immuno-modulation on wound healing by observing changes of cytokines and hypothalamic-pituitary-adrenal （HPA） axis hormones in acute stress reaction in rats with wound and combined local radiation injury. Methods： Sixty female Wistar rats （weighting 200 ± 20 g） were randomly divided into normal control group, wound group and combined wound-local radiation （CWR） group （25 Gy local radiation post wound）, 20 rats in each group. Contents of IL-1β, IL-6 and IFN-γ and IL-4 in serum were measured and changes of adrenocorticotropic hormone （ACTH） and glucocorticoid （GC） in serum were analyzed by using enzyme-linked immunosorbent assay and radioimmunologic assay, respectively at different time points post wound and radiation. Results： （1） The level of IFN-γ, one of the Thl cell cytokines increased significantly at 14 d post CWIL which was markedly higher than that in control group and wound group. However, the level of IL-4, IL-1β and IL-6, one of the Th2 cell cytokines, did not show obvious change. （2） Ratio of Thl/Th2 （IFN-γ/IL-4） in wound group and CWR group increased significantly at 7 d after wound and radiation, which suggested that Thl/Th2 balance drifted to Thl immune response. The ratio of Thl/Th2 in wound group returned to the normal level up to 14 d after the wound and radiation, while the Thl/Th2 ratio in CWR group increased persistently and was much higher than that in control and wound groups. （3） Level of serous ACTH and CC in CWR group increased at 3 d post wound and radiation, and among them, level of CC showed statistically significant increase, which was much higher than that in control and wound groups. Conclusion： Level of serous neurohormone CC in rats increased significantly immediately after wound and radiation; while the level of IFN-γ showed significant increase only up to 14 d after wound and radiation, and the Th1/Th2 imbalance sustained till 28 d post wound and radiation. In order to reduce acute damage caused by CWR, organic immune system and nerve system showed up a marked regulate effects simultaneously and mutually. Nonetheless, the excessive stress induced by CWR causes distur- bance of immunoregulation, which is one of the key reasons for delayed wound healing in CWR.