Evaluating the accuracy and reproducibility of ChatGPT-4 in answering patient questions related to small intestinal bacterial overgrowth

BACKGROUND Small intestinal bacterial overgrowth(SIBO)poses diagnostic and treatment challenges due to its complex management and evolving guidelines.Patients often seek online information related to their health,prompting interest in large language models,like GPT-4,as potential sources of patient education.AIM To investigate ChatGPT-4's accuracy and reproducibility in responding to patient questions related to SIBO.METHODS A total of 27 patient questions related to SIBO were curated from professional societies,Facebook groups,and Reddit threads.Each question was entered into GPT-4 twice on separate days to examine reproducibility of accuracy on separate occasions.GPT-4 generated responses were independently evaluated for accuracy and reproducibility by two motility fellowship-trained gastroenterologists.A third senior fellowship-trained gastroenterologist resolved disagreements.Accuracy of responses were graded using the scale:(1)Comprehensive;(2)Correct but inadequate;(3)Some correct and some incorrect;or(4)Completely incorrect.Two responses were generated for every question to evaluate reproducibility in accuracy.RESULTS In evaluating GPT-4's effectiveness at answering SIBO-related questions,it provided responses with correct information to 18/27(66.7%)of questions,with 16/27(59.3%)of responses graded as comprehensive and 2/27(7.4%)responses graded as correct but inadequate.The model provided responses with incorrect information to 9/27(33.3%)of questions,with 4/27(14.8%)of responses graded as completely incorrect and 5/27(18.5%)of responses graded as mixed correct and incorrect data.Accuracy varied by question category,with questions related to“basic knowledge”achieving the highest proportion of comprehensive responses(90%)and no incorrect responses.On the other hand,the“treatment”related questions yielded the lowest proportion of comprehensive responses(33.3%)and highest percent of completely incorrect responses(33.3%).A total of 77.8%of questions yielded reproducible responses.CONCLUSION Though GPT-4 shows promise as a supplementary tool for SIBO-related patient education,the model requires further refinement and validation in subsequent iterations prior to its integration into patient care.

Morphological Difference and DNA Diversity Between Flower-colour Sport and Original Cultivar of Chrysanthemum with Small Flowers

A total of 58 morphological characteristics were measured on flower-colour sport and original cultivar according to Disticness, Uniformity, Stability＇ （DUS） Test for New Plant Cultivar of Chrysanthemum published by Ministry of Agriculture of China The results showed that five characteristics such as the surface colour, the back color of ray floret among them were siginificantly different, their MS （mo by AFLP showed that rphological s GS （genetic imilarity） was 91.4%, and MD （morphological difference） was 8.62%. DNA polymorphic analysis similarity） was 98.6%, and GD （genetic polymorphic diversity） was 2.81%. Five distinct bands which may include the flower-colour sport genes or be the molecular marker linkaged flower-color characteristics were amplified.

Heterogeneity across the murine small and large intestine

The small and large intestine of the gastrointestinal tract(GIT) have evolved to have discrete functions with distinct anatomies and immune cell composition.The importance of these differences is underlined when considering that different pathogens have uniquely adapted to live in each region of the gut.Furthermore,different regions of the GIT are also associated with differences in susceptibility to diseases such as cancer and chronic inflammation.The large and small intestine,given their anatomical and functional differences,should be seen as two separate immunological sites.However,this distinction is often ignored with findings from one area of the GIT being inappropriately extrapolated to the other.Focussing largely on the murine small and large intestine,this review addresses the literature relating to the immunology and biology of the two sites,drawing comparisons between them and clarifying similarities and differences.We also highlight the gaps in our understanding and where further research is needed.

Interdecadal Variability in Large and Small Warm Pools in Western Pacific and Their Association with Rainfall Anomalies

This study investigated interdecadal variability of June–October(JJASO) the large and small warm pools in western Pacific and their association with rainfall anomalies using station and reanalysis data from 1958 to 2008.The results indicated that the large and small warm pools in western Pacific showed an interdecadal shift around 1986.The large warm pool years over western Pacific were found after 1986,whereas the small warm pool years were often seen throughout the periods before 1986.The analysis results also showed that there were obvious interdecadal variability in JJASO rainfall in Southeast China and warm pool in western Pacific.During 1958–1985(small warm pool years),the decrease in rainfall was associated with tropospheric moisture divergence and sinking motion over Southeast China and warm pool in western Pacific.However,during 1986–2008(large warm pool years),the increase in rainfall was associated with tropospheric moisture convergence and ascending motion.Further analysis showed that large warm pool contributed to the increase in surface latent heat fluxes over warm pool in the western Pacific.Thus,there was an increase in the amount of water vapor over Southeast China and warm pool in western Pacific,which contributed to increased rainfall in these regions.

Gas Holdups of Small and Large Bubbles in a Large-scale Bubble Column with Elevated Pressure

Gas holdups of large bubbles and small bubbles were measured by means of dynamic gas disengagement approach in the pressured bubble column with a diameter of 0.3 m and a height of 6.6 m. The effects of superficial gas velocity, liquid surface tension, liquid viscosity and system pressure on gas holdups of small bubbles and large bubbles were investigated. The holdup of large bubbles increases and the holdup of small bubbles decreases with an increase of liquid viscosity. Meanwhile, the holdup of large bubbles decreases with increasing the system pressure. A correlation for the holdup of small bubbles was obtained from the experimental data.

Pressure from surrounding rock of three shallow tunnels with large section and small spacing

With the increasing traffic demand, the closely built three or more tunnels with large section play a significant role in the tunnel construction. However, the interaction among tunnels has important influences on the security and economy of tunnel engineering, and the calculation of pressure from the surrounding rock during the excavation is one of the problems that need to be solved urgently. Based on the practical engineering of three tunnels, the load model of three tunnels was proposed in consideration of the interaction and excavation sequence between tunnels. In comparison with the load model of single tunnel, the construction mechanical characteristics of the three tunnels were analyzed. The results show that the rock pressure of three tunnels calculated by the current tunnel design code is not reliable, and the interaction force increases with the spacing between tunnels.

Coexistence of diffuse large B-cell lymphoma,acute myeloid leukemia,and untreated lymphoplasmacytic lymphoma/waldenström macroglobulinemia in a same patient:A case report

BACKGROUND The Coexistence of myeloid and lymphoid malignancies is rare.Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies.Synchronous diagnoses of diffuse large B-cell lymphoma(DLBCL),acute myeloid leukemia(AML),and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia(LPL/WM)in the same patient have not been reported.Here we report one such case.CASE SUMMARY An 89-year-old man had a chest wall mass histopathologically diagnosed as DLBCL.The bone marrow and peripheral blood contained two groups of cells.One group of cells fulfilled the criteria of AML,and the other revealed the features of small B lymphocytic proliferative disorder,which we considered LPL/WM.Multiple chromosomal or genetic changes were detected in bone marrow mononuclear cells,including ATM deletion,CCND1 amplification,mutations of MYD88(L265P)and TP53,WT1 overexpression,and fusion gene of BIRC2-ARAP1,as well as complex chromosomal abnormalities.The patient refused chemotherapy because of old age and died of pneumonia 1 mo after the final diagnosis.CONCLUSION The coexistence of DLBCL,AML,and untreated LPL/WM in the same patient is extremely rare,which probably results from multiple steps of genetic abnormalities.Asymptomatic LPL/WM might have occurred first,then myelodysplastic syndromerelated AML developed,and finally aggressive DLBCL arose.Therefore,medical staff should pay attention to this rare phenomenon to avoid misdiagnoses.

Multiple metastases to the small bowel from large cell bronchial carcinomas

AIM: Metastases from lung cancer to gastrointestinal tract are not rare atpostmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual.METHODS: Formalin-fixed, paraffin-embedded tissues were cut into 5 μm thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117.RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells,were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine.CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.

The Large Scale Instability in Rotating Fluid with Small Scale Force

In this paper, we find a new large scale instability in rotating flow forced turbulence. The turbulence is generated by a small scale external force at low Reynolds number. The theory is built on the rigorous asymptotic method of multi-scale development. The nonlinear equations for the instability are obtained at the third order of the perturbation theory. In this article, we explain the nonlinear stage of the instability and the generation vortex kinks.

LARGE TIME STEP GENERALIZATION OF RANDOM CHOICE FINITE DIFFERENCE SCHEME FOR HYPERBOLIC CONSERVATION LAWS

A natural generalization of random choice finite difference scheme of Harten and Lax for Courant number larger than 1 is obtained. We handle interactions between neighboring Riemann solvers by linear superposition of their conserved quantities. We show consistency of the scheme for arbitrarily large Courant numbers. For scalar problems the scheme is total variation diminishing.A brief discussion is given for entropy condition.

Associations between thromboxane A synthase 1 gene polymorphisms and the risk of ischemic stroke in a Chinese Han population

Thromboxane A synthase 1 （TBXAS1） catalyses the synthesis of thromboxane A2 （TXA2）, which plays an important role in the pathogenesis of ischemic stroke. Thus, the TBXAS1 gene was investigated as a candidate gene involved in the formation of atherosclerosis. This case-control study collected peripheral blood specimens and clinical data of 370 ischemic stroke patients and 340 healthy controls in the Northern Chinese Han population from October 2010 to May 2011. Two TBXAS1 single-nucleotide polymorphisms, rs2267682 and rs10487667, were analyzed using a SNaPshot Multiplex sequencing assay to explore the relationships between the single-nucleotide polymorphisms in TBXAS1 and ischemic stroke. The TT genotype frequency and T allele frequency of rs2267682 in the patients with ischemic stroke were significantly higher than those in the controls （P 〈 0.01 and P = 0.02）. Furthermore, compared with the GG ＋ GT genotype, the TT rs2267682 genotype was associated with increased risk of ischemic stroke （odds ratio （OR） = 1.80, 95% confidence interval （CI）： 1.16–2.79, P 〈 0.01）. Multivariate logistic analysis with adjustments for confounding factors revealed that rs2267682 was still associated with ischemic stroke （OR = 1.94,95% CI ： 1.13–3.33, P = 0.02）. The frequency of the T-G haplotype in the patients was significantly higher than that in the controls according haplotype analysis （OR = 1.49, 95% CI： 1.10–2.00, P 〈 0.01）. These data reveal that the rs2267682 TBXAS1 polymorphism is associated with ischemic stroke. The TT genotype of TBXAS1 and T allele of rs2267682 increase susceptibility to ischemic stroke in this Northern Chinese Han population. The protocol has been registered with the Chinese Clinical Trial Registry （registration number： ChiCTR-COC-17013559）.

Endoscopic papillary large balloon dilation alone or combined with small or complete sphincterotomy for the removal of large common bile duct stones

Background:Endoscopic papillary large balloon dilation(EPLBD)has been proposed as an alternative to manage large bile duct stones.However,EPLBD alone or combined with sphincterotomy remains controversial.Methods:Between Jan.2014 and Dec.2017,195 consecutive patients with proven large common bile duct stones(size≥10 mm)were retrospectively analyzed.We compared the baseline characteristics,procedure time,success rate of stone removal and morbidity outcomes in different groups.Results:There were no significant difference between baseline characteristics of the groups compared.A total of 89.2%,95.4%,and 93.8% of the patients in the EPLBD,EPLBD+small sphincterotomy(SES),and EPLBD+complete sphincterotomy(CES)groups had stones cleared(P=0.473),respectively.There was no difference in terms of procedure time(33.5±10.2,34.8±9.0,34.9±8.2,in the EPLBD,EPLBD+SES,and EPLBD+CES groups,respectively).However,when assigned to tvvo groups according to bile duct stones diameter(bile duct stones<13 mm,bile duct stones≥13 mm).in the bile duct stones<13 mm group,the procedure time was significantly less in the EPLBD group than the EPLBD+SES group and the EPLBD+CES group(P=0.028).In the bile duct stones≥13 mm group,the mechanical lithotripsy rate of EPLBD was significantly higher compared to EPLBD+SES or EPLBD+CES(P=0.032).The complication rates were similar among all groups.Conclusions:The diameter of bile duct stones should be taken into consideration when choosing EPLBD alone or combined with small sphincterotomy for the removal of common bile duct stones.

Hydrogen and steam distribution following a small-break LOCA in large dry containment

The hydrogen deflagration is one of the major risk contributors to threaten the integrity of the containment in a nuclear power plant, and hydrogen control in the case of severe accidents is required by nuclear regulations. Based on the large dry containment model developed with the integral severe-accident analysis tool, a small-break loss-of-coolant-accident (LOCA) without HPI, LPI, AFW and containment sprays, leading to the core degradation and large hydrogen generation, is calculated. Hydrogen and steam distribution in containment compartments is investi- gated. The analysis results show that significant hydrogen deflagration risk exits in the reactor coolant pump (RCP) compartment and the cavity during the early period, if no actions are taken to mitigate the effects of hydrogen accu- mulation.

Neuroendocrine carcinoma of the extrahepatic bile duct: Case report and literature review

Neuroendocrine carcinoma (NEC) of the extrahepatic bile duct is rare, and only 22 cases have been reported. Only two of these were large-cell NEC (LCNEC); the vast majority were small-cell NEC. Here, we report a third case of LCNEC of the extrahepatic bile duct. A 76-year-old male presented to a local hospital with painless jaundice. Imaging studies revealed a tumor at the hepatic hilum. The patient underwent right hepatic lobectomy, bile duct resection, and cholecystectomy. The resection specimen showed a 5.0-cm invasive neoplasm involving the hilar bile ducts and surrounding soft tissue. Histologically, the tumor consisted of nests of medium to large cells with little intervening stroma. The tumor invaded a large portal vein branch. All four excised lymph nodes were positive for metastasis, and metastatic deposits were also present in the gallbladder wall. The tumor was diffusely positive for synaptophysin and focally positive for chromogranin A. Approximately 70%-80% of the tumor cells were positive for Ki-67, indicating strong proliferative activity. A diagnosis of LCNEC was made. A few bile ducts within and adjacent to the invasive tumor showed dysplasia of the intestinal phenotype and were focally positive for synaptophysin and chromogranin A, suggesting that the dysplastic intestinal-type epithelium played a precursor role in this case. A postoperative computer tomography scan revealed rapid enlargement of the abdominal and retroperitoneal lymph nodes. The patient died 21 d after the operation. NEC of the bile duct is an aggressive neoplasm, and its biological characteristics remain to be better defined.

Bias of the Random Forest Out-of-Bag (OOB) Error for Certain Input Parameters

Random Forest is an excellent classification tool, especially in the –omics sciences such as metabolomics, where the number of variables is much greater than the number of subjects, i.e., “n p.” However, the choices for the arguments for the random forest implementation are very important. Simulation studies are performed to compare the effect of the input parameters on the predictive ability of the random forest. The number of variables sampled, m-try, has the largest impact on the true prediction error. It is often claimed that the out-of-bag error (OOB) is an unbiased estimate of the true prediction error. However, for the case where n p, with the default arguments, the out-of-bag (OOB) error overestimates the true error, i.e., the random forest actually performs better than indicated by the OOB error. This bias is greatly reduced by subsampling without replacement and choosing the same number of observations from each group. However, even after these adjustments, there is a low amount of bias. The remaining bias occurs because when there are trees with equal predictive ability, the one that performs better on the in-bag samples will perform worse on the out-of-bag samples. Cross-validation can be performed to reduce the remaining bias.

Some Limit Theorems for Weighted Sums of Random Variable Fields

Let{Xn^-,n^-∈N^d}be a field of Banach space valued random variables, 0 〈r〈p≤2 and{an^-,k^-, （n^-,k^-） ∈ N^d × N^d ,k^-≤n^-} a triangular array of real numhers, where N^d is the d-dimensional lattice （d≥1 ）. Under the minimal condition that {｜｜Xn^-｜｜ r,n^- ∈N^d} is {｜an^-,k^-｜^r,（n^-,k^-）} ∈ N^d ×N^d,k^-≤n^-}-uniformly integrable, we show that ∑（k^-≤n^-）an^-,k^-,Xk^-^（L^r（or a,s,）→0 as ｜n^-｜→∞ In the above, if 0〈r〈1, the random variables are not needed to be independent. If 1≤r〈p≤2, and Banach space valued random variables are independent with mean zero we assume the Banaeh space is of type p. If 1≤r≤p≤2 and Banach space valued random variables are not independent we assume the Banach space is p-smoothable.

A LARGE EDDY SIMULATION OF THE NEAR WAKE OF A CIRCULAR CYLINDER

Viscous flow around a circular cylinder at a subcritical Reynolds number is investigated using a large eddy simulation (LES) coupled with the Smagorinsky subgrid-scale (SGS) model. A fractional-step method with a second-order in time and a combined finite-difference/spectral approximations are used to solve the filtered three-dimensional incompressible Navier-Stokes equations. Calculations have been performed with and without the SGS model. Turbulence statistical behaviors and flow structures in the near wake of the cylinder are studied. Some calculated results, including the lift and drag coefficients, shedding frequency, peak Reynolds stresses, and time-average velocity profile, are in good agreement with the experimental and computational data, which shows that the Smagorinsky model can reasonably predict the global features of the flow and some turbulent statistical behaviors.

Serum uric acid is a risk factor for large-artery atherosclerosis cerebral infarction

Using the Trial of Org 10172 in Acute Stroke Treatment （TOAST） classification for acute ischemic stroke, 371 patients with either acute large-artery atherosclerosis or small-artery oc-clusion cerebral infarction were recruited to investigate the potential impact of elevated serum uric acid on cerebrovascular disorders. The results showed that patients who have suffered from large-artery atherosclerosis, relative to small-artery occlusion patients, were characterized by elevated serum uric acid but reduced high-density lipoprotein cholesterol and triglyceride levels. Logistic regression showed that elevated uric acid and lower triglyceride levels were the main risk factors for patients with large-artery atherosclerosis. The findings of this study suggest that hyperuricemia may be a risk factor for stroke.

Current trends and future directions in turbulent thermal convection

The system of turbulent thermal convection is introduced. Progresses in recent decades in the four major areas of research in turbulent convection are briefly reviewed. Some of the recent trends of the field are then discussed, which also serve to point out that the future directions in this important field of fluid mechanics lie in the extension to the non-standard or non-classical Rayleigh-Bénard configuration.