Proactive Polypharmacy Management Using Large Language Models: Opportunities to Enhance Geriatric Care

Polypharmacy remains an important challenge for patients with extensive medical complexity. Given the primary care shortage and the increasing aging population, effective polypharmacy management is crucial to manage the increasing burden of care. The capacity of large language model (LLM)-based artificial intelligence to aid in polypharmacy management has yet to be evaluated. Here, we evaluate ChatGPT's performance in polypharmacy management via its deprescribing decisions in standardized clinical vignettes. We inputted several clinical vignettes originally from a study of general practicioners' deprescribing decisions into ChatGPT 3.5, a publicly available LLM, and evaluated its capacity for yes/no binary deprescribing decisions as well as list-based prompts in which the model was prompted to choose which of several medications to deprescribe. We recorded ChatGPT responses to yes/no binary deprescribing prompts and the number and types of medications deprescribed. In yes/no binary deprescribing decisions, ChatGPT universally recommended deprescribing medications regardless of ADL status in patients with no overlying CVD history; in patients with CVD history, ChatGPT's answers varied by technical replicate. Total number of medications deprescribed ranged from 2.67 to 3.67 (out of 7) and did not vary with CVD status, but increased linearly with severity of ADL impairment. Among medication types, ChatGPT preferentially deprescribed pain medications. ChatGPT's deprescribing decisions vary along the axes of ADL status, CVD history, and medication type, indicating some concordance of internal logic between general practitioners and the model. These results indicate that specifically trained LLMs may provide useful clinical support in polypharmacy management for primary care physicians.

Models and approaches for building knowledge translation capacity and capability in health services: a scoping review

BACKGROUND

Building healthcare service and health professionals' capacity and capability to rapidly translate research evidence into health practice is critical to the effectiveness and sustainability of healthcare systems. This review scoped the literature describing programmes to build knowledge translation capacity and capability in health professionals and healthcare services, and the evidence supporting these.

METHODS

This scoping review was undertaken using the Joanna Briggs Institute scoping review methodology. Four research databases (Ovid MEDLINE, CINAHL, Embase, and PsycInfo) were searched using a pre-determined strategy. Eligible studies described a programme implemented in healthcare settings to build health professional or healthcare service knowledge translation capacity and capability. Abstracts and full texts considered for inclusion were screened by two researchers. Data from included papers were extracted using a bespoke tool informed by the scoping review questions.

RESULTS

Database searches yielded 10,509 unique citations, of which 136 full texts were reviewed. Thirty-four papers were included, with three additional papers identified on citation searching, resulting in 37 papers describing 34 knowledge translation capability building programmes. Programmes were often multifaceted, comprising a combination of two or more strategies including education, dedicated implementation support roles, strategic research-practice partnerships and collaborations, co-designed knowledge translation capability building programmes, and dedicated funding for knowledge translation. Many programmes utilised experiential and collaborative learning, and targeted either individual, team, organisational, or system levels of impact. Twenty-seven programmes were evaluated formally using one or more data collection methods. Outcomes measured varied significantly and included participant self-reported outcomes, perceived barriers and enablers of knowledge translation, milestone achievement and behaviour change. All papers reported that programme objectives were achieved to varying degrees.

CONCLUSIONS

Knowledge translation capacity and capability building programmes in healthcare settings are multifaceted, often include education to facilitate experiential and collaborative learning, and target individual, team, organisational, or supra-organisational levels of impact. Although measured differently across the programmes, the outcomes were positive. The sustainability of programmes and outcomes may be undermined by the lack of long-term funding and inconsistent evaluation. Future research is required to develop evidence-informed frameworks to guide methods and outcome measures for short-, medium- and longer-term programme evaluation at the different structural levels.

Evaluating GPT as an Adjunct for Radiologic Decision Making: GPT-4 Versus GPT-3.5 in a Breast Imaging Pilot

OBJECTIVE

Despite rising popularity and performance, studies evaluating the use of large language models for clinical decision support are lacking. Here, we evaluate ChatGPT (Generative Pre-trained Transformer)-3.5 and GPT-4's (OpenAI, San Francisco, California) capacity for clinical decision support in radiology via the identification of appropriate imaging services for two important clinical presentations: breast cancer screening and breast pain.

METHODS

We compared ChatGPT's responses to the ACR Appropriateness Criteria for breast pain and breast cancer screening. Our prompt formats included an open-ended (OE) and a select all that apply (SATA) format. Scoring criteria evaluated whether proposed imaging modalities were in accordance with ACR guidelines. Three replicate entries were conducted for each prompt, and the average of these was used to determine final scores.

RESULTS

Both ChatGPT-3.5 and ChatGPT-4 achieved an average OE score of 1.830 (out of 2) for breast cancer screening prompts. ChatGPT-3.5 achieved a SATA average percentage correct of 88.9%, compared with ChatGPT-4's average percentage correct of 98.4% for breast cancer screening prompts. For breast pain, ChatGPT-3.5 achieved an average OE score of 1.125 (out of 2) and a SATA average percentage correct of 58.3%, as compared with an average OE score of 1.666 (out of 2) and a SATA average percentage correct of 77.7%.

DISCUSSION

Our results demonstrate the eventual feasibility of using large language models like ChatGPT for radiologic decision making, with the potential to improve clinical workflow and responsible use of radiology services. More use cases and greater accuracy are necessary to evaluate and implement such tools.

Patient-Specific Safe Zones for Acetabular Component Positioning in Total Hip Arthroplasty: Mathematically Accounting for Spinopelvic Biomechanics

BACKGROUND

Despite a growing understanding of spinopelvic biomechanics in total hip arthroplasty (THA), there is no validated approach for executing patient-specific acetabular component positioning. The purpose of this study was to (1) validate quantitative, patient-specific acetabular "safe zone" component positioning from spinopelvic parameters and (2) characterize differences between quantitative patient-specific acetabular targets and qualitative hip-spine classification targets.

METHODS

From 2,457 consecutive primary THA patients, 22 (0.88%) underwent revision for instability. Spinopelvic parameters were measured prior to index THA. Acetabular position was measured following index and revision arthroplasty. Using a mathematical proof, we developed an open-source tool translating a surgeon-selected, preoperative standing acetabular target to a patient-specific safe zone intraoperative acetabular target. Difference between the patient-specific safe zone and the actual component position was compared before and after revision. Hip-spine classification targets were compared to patient-specific safe zone targets.

RESULTS

Of the 22 who underwent revision, none dislocated at follow-up (4.6 [range, 1 to 6.9]). Patient-specific safe zone targets differed from prerevision acetabular component position by 9.1 ± 4.2° inclination/13.3 ± 6.7° version; after revision, the mean difference was 3.2 ± 3.0° inclination/5.3 ± 2.7° version. Differences between patient-specific safe zones and the median and extremes of recommended hip-spine classification targets were 2.2 ± 1.9° inclination/5.6 ± 3.7° version and 3.0 ± 2.3° inclination/7.9 ± 3.5° version, respectively.

CONCLUSION

A mathematically derived, patient-specific approach accommodating spinopelvic biomechanics for acetabular component positioning was validated by approximating revised, now-stable hips within 5° version and 3° inclination. These patient-specific safe zones augment the hip-spine classification with prescriptive quantitative targets for nuanced preoperative planning.

Assessing the Utility of ChatGPT Throughout the Entire Clinical Workflow: Development and Usability Study

BACKGROUND

Large language model (LLM)-based artificial intelligence chatbots direct the power of large training data sets toward successive, related tasks as opposed to single-ask tasks, for which artificial intelligence already achieves impressive performance. The capacity of LLMs to assist in the full scope of iterative clinical reasoning via successive prompting, in effect acting as artificial physicians, has not yet been evaluated.

OBJECTIVE

This study aimed to evaluate ChatGPT's capacity for ongoing clinical decision support via its performance on standardized clinical vignettes.

METHODS

We inputted all 36 published clinical vignettes from the Merck Sharpe & Dohme (MSD) Clinical Manual into ChatGPT and compared its accuracy on differential diagnoses, diagnostic testing, final diagnosis, and management based on patient age, gender, and case acuity. Accuracy was measured by the proportion of correct responses to the questions posed within the clinical vignettes tested, as calculated by human scorers. We further conducted linear regression to assess the contributing factors toward ChatGPT's performance on clinical tasks.

RESULTS

ChatGPT achieved an overall accuracy of 71.7% (95% CI 69.3%-74.1%) across all 36 clinical vignettes. The LLM demonstrated the highest performance in making a final diagnosis with an accuracy of 76.9% (95% CI 67.8%-86.1%) and the lowest performance in generating an initial differential diagnosis with an accuracy of 60.3% (95% CI 54.2%-66.6%). Compared to answering questions about general medical knowledge, ChatGPT demonstrated inferior performance on differential diagnosis (β=-15.8%; P<.001) and clinical management (β=-7.4%; P=.02) question types.

CONCLUSIONS

ChatGPT achieves impressive accuracy in clinical decision-making, with increasing strength as it gains more clinical information at its disposal. In particular, ChatGPT demonstrates the greatest accuracy in tasks of final diagnosis as compared to initial diagnosis. Limitations include possible model hallucinations and the unclear composition of ChatGPT's training data set.

Enhancement of blue and ultraviolet components in PCF-based supercontinuum generation through inter-modal dispersive-wave radiation

Broadband supercontinuum (SC) light sources generated through nonlinear effects in solid-core photonic crystal fibers (PCFs) have been widely used in spectroscopy, metrology, and microscopy, leading to great application successes. The short-wavelength extension of such SC sources, a longstanding challenge, has been the subject of intensive study over the past two decades. However, the exact mechanism of blue and ultraviolet light generation, especially for some resonance spectral peaks in the short-wavelength regime, is not yet fully understood. Here, we demonstrate that the effect of inter-modal dispersive-wave radiation, which results from phase matching between pump pulses at the fundamental optical mode and packets of linear waves at some higher-order modes (HOMs) propagating in the PCF core, might be one of the critical mechanisms that can result in some resonance spectral components with wavelengths much shorter than that of the pump light. We observed in an experiment that several spectral peaks resided in the blue and ultraviolet regimes of the SC spectrum, whose central wavelengths can be tuned by varying the PCF-core diameter. These experimental results can be interpreted well using the inter-modal phase-matching theory, providing some useful insights into the SC generation process.

Hip resurfacing arthroplasty as an alternative to total hip arthroplasty in patients aged under 40 years

Aims

The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate.

Methods

This retrospective analysis identified 267 hips from 224 patients who underwent an hip resurfacing arthroplasty (HRA) from a single fellowship-trained surgeon using the direct lateral approach between 2007 and 2019. Inclusion criteria was minimum two-year follow-up, and age younger than 40 years. Patients were followed using a prospectively maintained institutional database.

Results

A total of 217 hips (81%) were included for follow-up analysis at a mean of 3.8 years. Of the 23 females who underwent HRA, none were revised, and the median head size was 46 mm (compared to 50 mm for males). The most common indication for HRA was femoroacetabular impingement syndrome (n = 133), and avascular necrosis ( (n = 53). Mean postoperative HHS was 100 at two and five years. No dislocations occurred. A total of four hips (1.8%) required reoperation for resection of heterotopic ossification, removal of components for infection, and subsidence with loosening. The overall revision rate was 0.9%.

Conclusion

For younger patients with higher functional expectations and increased lifetime risk for revision, HRA is an excellent bone preserving intervention carrying low complication rates, revision rates, and excellent patient outcomes without lifetime restrictions allowing these patients to return to activity and sport. Thus, in younger male patients with end-stage hip disease and higher demands, referral to a high-volume HRA surgeon should be considered.

Massively parallel base editing to map variant effects in human hematopoiesis

Systematic evaluation of the impact of genetic variants is critical for the study and treatment of human physiology and disease. While specific mutations can be introduced by genome engineering, we still lack scalable approaches that are applicable to the important setting of primary cells, such as blood and immune cells. Here, we describe the development of massively parallel base-editing screens in human hematopoietic stem and progenitor cells. Such approaches enable functional screens for variant effects across any hematopoietic differentiation state. Moreover, they allow for rich phenotyping through single-cell RNA sequencing readouts and separately for characterization of editing outcomes through pooled single-cell genotyping. We efficiently design improved leukemia immunotherapy approaches, comprehensively identify non-coding variants modulating fetal hemoglobin expression, define mechanisms regulating hematopoietic differentiation, and probe the pathogenicity of uncharacterized disease-associated variants. These strategies will advance effective and high-throughput variant-to-function mapping in human hematopoiesis to identify the causes of diverse diseases.

Assessing the Utility of ChatGPT Throughout the Entire Clinical Workflow

IMPORTANCE

Large language model (LLM) artificial intelligence (AI) chatbots direct the power of large training datasets towards successive, related tasks, as opposed to single-ask tasks, for which AI already achieves impressive performance. The capacity of LLMs to assist in the full scope of iterative clinical reasoning via successive prompting, in effect acting as virtual physicians, has not yet been evaluated.

OBJECTIVE

To evaluate ChatGPT's capacity for ongoing clinical decision support via its performance on standardized clinical vignettes.

DESIGN

We inputted all 36 published clinical vignettes from the Merck Sharpe & Dohme (MSD) Clinical Manual into ChatGPT and compared accuracy on differential diagnoses, diagnostic testing, final diagnosis, and management based on patient age, gender, and case acuity.

SETTING

ChatGPT, a publicly available LLM.

PARTICIPANTS

Clinical vignettes featured hypothetical patients with a variety of age and gender identities, and a range of Emergency Severity Indices (ESIs) based on initial clinical presentation.

EXPOSURES

MSD Clinical Manual vignettes.

MAIN OUTCOMES AND MEASURES

We measured the proportion of correct responses to the questions posed within the clinical vignettes tested.

RESULTS

ChatGPT achieved 71.7% (95% CI, 69.3% to 74.1%) accuracy overall across all 36 clinical vignettes. The LLM demonstrated the highest performance in making a final diagnosis with an accuracy of 76.9% (95% CI, 67.8% to 86.1%), and the lowest performance in generating an initial differential diagnosis with an accuracy of 60.3% (95% CI, 54.2% to 66.6%). Compared to answering questions about general medical knowledge, ChatGPT demonstrated inferior performance on differential diagnosis (β=-15.8%, p<0.001) and clinical management (β=-7.4%, p=0.02) type questions.

CONCLUSIONS AND RELEVANCE

ChatGPT achieves impressive accuracy in clinical decision making, with particular strengths emerging as it has more clinical information at its disposal.

Evaluating ChatGPT as an Adjunct for Radiologic Decision-Making

BACKGROUND

ChatGPT, a popular new large language model (LLM) built by OpenAI, has shown impressive performance in a number of specialized applications. Despite the rising popularity and performance of AI, studies evaluating the use of LLMs for clinical decision support are lacking.

PURPOSE

To evaluate ChatGPT's capacity for clinical decision support in radiology via the identification of appropriate imaging services for two important clinical presentations: breast cancer screening and breast pain.

MATERIALS AND METHODS

We compared ChatGPT's responses to the American College of Radiology (ACR) Appropriateness Criteria for breast pain and breast cancer screening. Our prompt formats included an open-ended (OE) format, where ChatGPT was asked to provide the single most appropriate imaging procedure, and a select all that apply (SATA) format, where ChatGPT was given a list of imaging modalities to assess. Scoring criteria evaluated whether proposed imaging modalities were in accordance with ACR guidelines.

RESULTS

ChatGPT achieved an average OE score of 1.83 (out of 2) and a SATA average percentage correct of 88.9% for breast cancer screening prompts, and an average OE score of 1.125 (out of 2) and a SATA average percentage correct of 58.3% for breast pain prompts.

CONCLUSION

Our results demonstrate the feasibility of using ChatGPT for radiologic decision making, with the potential to improve clinical workflow and responsible use of radiology services.

Concerns surrounding application of artificial intelligence in hip and knee arthroplasty

Literature surrounding artificial intelligence (AI)-related applications for hip and knee arthroplasty has proliferated. However, meaningful advances that fundamentally transform the practice and delivery of joint arthroplasty are yet to be realized, despite the broad range of applications as we continue to search for meaningful and appropriate use of AI. AI literature in hip and knee arthroplasty between 2018 and 2021 regarding image-based analyses, value-based care, remote patient monitoring, and augmented reality was reviewed. Concerns surrounding meaningful use and appropriate methodological approaches of AI in joint arthroplasty research are summarized. Of the 233 AI-related orthopaedics articles published, 178 (76%) constituted original research, while the rest consisted of editorials or reviews. A total of 52% of original AI-related research concerns hip and knee arthroplasty (n = 92), and a narrative review is described. Three studies were externally validated. Pitfalls surrounding present-day research include conflating vernacular (“AI/machine learning”), repackaging limited registry data, prematurely releasing internally validated prediction models, appraising model architecture instead of inputted data, withholding code, and evaluating studies using antiquated regression-based guidelines. While AI has been applied to a variety of hip and knee arthroplasty applications with limited clinical impact, the future remains promising if the question is meaningful, the methodology is rigorous and transparent, the data are rich, and the model is externally validated. Simple checkpoints for meaningful AI adoption include ensuring applications focus on: administrative support over clinical evaluation and management; necessity of the advanced model; and the novelty of the question being answered.

Cite this article: Bone Joint J 2022;104-B(12):1292–1303.

Meaningless Applications and Misguided Methodologies in Artificial Intelligence-Related Orthopaedic Research Propagates Hype Over Hope

There exists great hope and hype in the literature surrounding applications of artificial intelligence (AI) to orthopaedic surgery. Between 2018 and 2021, a total of 178 AI-related articles were published in orthopaedics. However, for every 2 original research papers that apply AI to orthopaedics, a commentary or review is published (30.3%). AI-related research in orthopaedics frequently fails to provide use cases that offer the uninitiated an opportunity to appraise the importance of AI by studying meaningful questions, evaluating unknown hypotheses, or analyzing quality data. The hype perpetuates a feed-forward cycle that relegates AI to a meaningless buzzword by rewarding those with nascent understanding and rudimentary technical knowhow into committing several basic errors: (1) inappropriately conflating vernacular ("AI/machine learning"), (2) repackaging registry data, (3) prematurely releasing internally validated algorithms, (4) overstating the "black box phenomenon" by failing to provide weighted analysis, (5) claiming to evaluate AI rather than the data itself, and (6) withholding full model architecture code. Relevant AI-specific guidelines are forthcoming, but forced application of the original Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines designed for regression analyses is irrelevant and misleading. To safeguard meaningful use, AI-related research efforts in orthopaedics should be (1) directed toward administrative support over clinical evaluation and management, (2) require the use of the advanced model, and (3) answer a question that was previously unknown, unanswered, or unquantifiable.

[A descriptive analysis of tea consumption in adult twins in China]

Objective: To describe the distribution characteristics of tea consumption in adult twins recruited in the Chinese National Twin Registry (CNTR) and provide clues to genetic and environmental influences on tea consumption. Methods: Enrolled in CNTR during 2010-2018, 25 264 twin pairs aged 18 years and above were included in subsequent analysis. Random effect models were used to estimate tea consumption in the population and regional distribution characteristics. The concordance rate of the behavior and difference in consumption volume of tea within pairs were also described. Results: The mean age of all subjects was (35.38±12.45) years old. The weekly tea consumers accounted for 17.0%, with an average tea consumption of (3.36±2.44) cups per day. The proportion of weekly tea consumers was higher among males, 50-59 years old, southern, urban, educated, and the first-born in the twin pair (P<0.05), and lower among unmarried individuals (P<0.001). Within-pair analysis showed that the concordance rate of tea consumption of monozygotic (MZ) twins was higher than that of dizygotic (DZ) twins and the overall heritability of tea consumption was 13.45% (11.38%-15.51%). Stratified by the characteristics mentioned above, only in males, the concordance rate of MZ showed a tendency to be greater than that of DZ (all P<0.05). The differences in consumption volume of tea within twin pairs were minor in MZ among males (P<0.05), while the differences were not significant in female twins. Conclusion: There were discrepancies in the distribution of tea consumption among twins of different demographic and regional characteristics. Tea consumption was mainly influenced by environmental factors and slightly influenced by genetic factors. The size of genetic factors varied with gender, age, and region, and gender was a potential modified factor.

[A descriptive analysis on coronary heart disease in adult twins in China]

Objective: To describe the distribution characteristics of coronary heart disease in adult twins recruited from Chinese Twin Registry (CNTR), and provide clues and evidence for the effect of genetic and environmental influences on coronary heart disease. Methods: By using the data of CNTR during 2010-2018, a total of 34 583 twin pairs aged ≥18 years who completed questionnaire survey and had related information were included in the current study to analyze the population and area distribution characteristics of coronary heart disease. Random effect models were used to compare the differences between groups. The concordane rate of coronary heart disease were calculated respectively in monozygotic (MZ) twin pairs and dizygotic (DZ) twin pairs to estimate the heritability. Results: The twin pairs included in this analysis were aged (34.2±12.4) years. The overall prevalence rate of coronary heart disease in twin pairs was 0.7%. Twin pairs who were women, older, obese and lived in northern China had higher prevalence of coronary heart disease (P<0.05). Intra-pair analysis in the same-sex twin pairs found that the concordane rate of coronary heart disease was higher in MZ twin pairs (25.3%) than in DZ twins (7.4%), and the difference was statistically significant (P<0.001). The overall heritability of coronary heart disease was 19.3% (95%CI: 11.8%-26.8%). Stratified by gender, age and area, the concordane rate was still higher in MZ twin pairs than in DZ pairs. Participants who were women, aged 18-30 years or ≥60 years and lived in northern China had a higher heritability of coronary heart disease. Conclusion: The distribution of coronary heart disease in twin pairs differed in populations and areas. The prevalence of coronary heart disease was affected by genetic factors, but the effect varied with age, gender and area.

[A descriptive analysis on type 2 diabetes in twins in China]

Objective: To describe the distribution characteristics of type 2 diabetes in twins in Chinese National Twin Registry (CNTR), provide clues and evidence for revealing the influence of genetic and environmental factors for type 2 diabetes. Methods: Of all twins registered in the CNTR during 2010-2018, a total 18 855 twin pairs aged ≥30 years with complete registration information were included in the analysis. The random effect model was used to describe the population and area distribution characteristics and concordance of type 2 diabetes in twin pairs. Results: The mean age of the subjects was (42.8±10.2) years, the study subjects included 10 339 monozygotic (MZ) twin pairs and 8 516 dizygotic (DZ) twin pairs. The self-reported prevalence rate of type 2 diabetes was 2.2% in total population and there was no sighificant difference between MZ and DZ. Intra-twin pairs analysis showed that the concordance rate of type 2 diabetes was 38.2% in MZ twin pairs, and 16.0% in DZ twin pairs, the difference was statistically significant (P<0.001). The concordance rate of type 2 diabetes in MZ twin parts was higher than that in DZ twin pairs in both men and women, in different age groups and in different areas (P<0.05). Further stratified analysis showed that in northern China, only MZ twin pairs less than 60 years old were found to have a higher concordance rate of type 2 diabetes compared with DZ twin pairs (P<0.05). In southern China, the co-prevalence rate in male MZ twin pairs aged ≥60 years was still higher than that in DZ twin pairs (P<0.05). Conclusion: The twin pairs in this study had a lower self-reported prevalence of type 2 diabetes than the general population. The study results suggested that genetic factors play a role in type 2 diabetes prevalence in both men and women, in different age groups and in different areas, however, the effect might vary.

Immune checkpoint inhibitors and cellular treatment for lymphoma immunotherapy

Malignant lymphoma (ML) is a common hematological malignancy with many subtypes. Patients with ML usually undergo traditional treatment failure and become relapsed or refractory (R/R) cases. Recently, immunotherapy, such as immune checkpoint inhibitors (ICIs) and cellular treatment, has gradually emerged and used in clinical trials with encouraging achievements for ML treatment, which exerts anti-tumor activity by blocking the immune evasion of tumor cells and enhancing the attack ability of immune cells. Targets of immune checkpoints include programmed cell death-1 (PD-1), programmed cell death-ligand 1 (PD-L1), cytotoxic T lymphocyte-associated protein 4 (CTLA-4), T cell immunoglobulin and ITIM domain (TIGIT), T cell immunoglobulin-3 (TIM-3) and lymphocyte activation gene 3 (LAG-3). Examples of cellular treatment are chimeric antigen receptor (CAR) T cells, cytokine-induced killer (CIK) cells and natural killer (NK) cells. This review aimed to present the current progress and future prospects of immunotherapy in lymphoma, with the focus upon ICIs and cellular treatment.

Structure and thermal properties of beeswax-based oleogels with different types of vegetable oil

Beeswax-based oleogels with different types of vegetable oil, including camellia oil (CO), soybean oil (SO), sunflower oil (SFO), or flaxseed oil (FO), were prepared and their structure and thermal properties were evaluated. The critical concentration of oleogel obtained from each of CO, SO, and SFO at 25 °C was 3% (w/w), and that from FO was 4%. Thermal measurements revealed similar thermodynamic curves for oleogels in different lipid phases. X-Ray diffraction showed orthorhombic perpendicular subcell packing and characteristic peaks of the β’ form. Furthermore, a morphology analysis of the crystals showed that they were needle shaped. Fourier transform-infrared spectra revealed that beeswax-based oleogels were formed via non-covalent bonds and may be stabilized with physical entanglements. The oleogels showed oil type-dependent oxidative abilities, but they were all stable and showed no obvious changes in peroxide value during 90 days of storage at 5 °C.

[Clinical, myopathological and genetic features of two Chinese families with paramyotonia congenita]

Objective: To investigate the clinical, myopathological and genetic mutation characteristics in two Chinese families with paramyotonia congenita (PMC). Methods: Clinical manifestations, electrophysiology, muscle pathology and gene sequencing of two Chinese families with PMC were analyzed retrospectively. Results: Family 1 involved 12 patients in 4 consecutive generations and family 2 involved only 1 patient in 3 generations. The onset of symptoms in all patients started at early childhood. Both probands presented with myotonia triggered by cold and paroxysmal weakness. However, the other 11 patients in family 1 only manifested cold-induced myotonia. Serum creatine kinase (CK) was slightly elevated between attacks of weakness in the 2 probands, and was even greater than 10 000 U/L during the episodes of weakness in the second proband, whose lower limb MRI revealed edema in bilateral medial gastrocnemius. Electromyography showed diffuse myotonia discharge and myogenic impairment in both probands, and myotonia discharge in the first proband's mother. Muscle pathology of both probands showed mild myopathic changes, and tube aggregation was occasionally observed in the second one. Genetic testing revealed a maternally inherited heterozygous R1448H mutation of SCN4A gene in the first proband and part of his family. A novel heterozygous R1448G mutation of SCN4A gene was reported in the second proband. Conclusions: Cold-triggered myotonia with or without paroxysmal weakness are the common characteristics of PMC. Myotonic potential and myogenic impairment can be tested in electromyography. The p.R1448G mutation is a new missense mutation.

Single-scan, dual-functional interferometer for fast spatio-temporal characterization of few-cycle pulses

Accurate and fast characterization of spatio-temporal information of high-intensity, ultrashort pulses is crucial in the field of strong-field laser science and technology. While conventional self-referenced interferometers were widely used to retrieve the spatial profile of the relative spectral phase of pulses, additional measurements of temporal and spectral information at a particular position of the laser beam, however, were necessary to remove the indeterminacy, which increases the system complexity. Here we report an advanced, dual-functional interferometer that is able to reconstruct the complete spatio-temporal information of ultrashort pulses with a single scan of the interferometer arm. The setup integrates an interferometric frequency-resolved optical gating (FROG) with a radial shearing Michelson interferometer. Through scanning one arm of the interferometer, both the cross-correlated FROG trace at the central part of the laser beam and the delay-dependent interferograms of the entire laser profile are simultaneously obtained, allowing a fast three-dimensional reconstruction of few-cycle laser pulses.

Neuropsychiatric Symptoms and Risk Factors in Mild Cognitive Impairment: A Cohort Investigation of Elderly Patients

BACKGROUND

Neuropsychiatric symptoms (NPS) have been shown to affect the progression and development of Alzheimer's disease (AD) in the elderly. However, the published data are still controversial and limited in large cohort-based NPS study.

AIM

To explore the potential relationship between NPS and mild cognitive impairment (MCI) among the elderly of Chinese community.

METHODS

A total of 465 Chinese community-dwelling elderly (age ≥ 60 years) with mild cognitive impairment (MCI) were recruited into this investigation. At baseline, enrolled participants were assessed for Clinical Dementia Rating (CDR), mini-psychiatric examination. They were also subjected to categorical language fluency test, list learning and delayed recall. We assessed the NPS severity by Neuropsychological Inventory (NPI). The global cognitive status (GCS) of the participants at the end of the 3-year study period were measured with the CDR.

RESULTS

Approximately 41.6% of subjects had 1 or more NPS (total NPI score ≥ 1) at baseline. The most common NPSs were nocturnal behavior (20.8%), depression (17.3%), apathy (12.7%) and anxiety (13.2%). At the end of 3-year follow-up, 26.9% of baseline depressed patients developed AD, while 15.2% of baseline non-depressed patients developed AD (χ2 = 4.86, P=0. 04). Abnormal motor behavior was significantly correlated with cognitive deterioration as well (χ2 = 5.75, P=0. 03). Logistic regression analysis revealed that depression was considered as a risk factor for AD progression at baseline (95% CI: 1.12-5.67, OR=2.37, P=0.03).

CONCLUSIONS

Depression may be an independent factor representing early neurodegeneration in elder patients with MCI. Further studies are warranted to assess whether effective management of NPS promotes the cognitive functions.

Formation of optical supramolecular structures in a fibre laser by tailoring long-range soliton interactions

Self-assembly of fundamental elements through weak, long-range interactions plays a central role in both supramolecular DNA assembly and bottom-up synthesis of nanostructures. Optical solitons, analogous in many ways to particles, arise from the balance between nonlinearity and dispersion and have been studied in numerous optical systems. Although both short- and long-range interactions between optical solitons have attracted extensive interest for decades, stable soliton supramolecules, with multiple aspects of complexity and flexibility, have thus far escaped experimental observation due to the absence of techniques for enhancing and controlling the long-range inter-soliton forces. Here we report that long-range soliton interactions originating from optoacoustic effects and dispersive-wave radiations can be precisely tailored in a fibre laser cavity, enabling self-assembly of large numbers of optical solitons into highly-ordered supramolecular structures. We demonstrate several features of such optical structures, highlighting their potential applications in optical information storage and ultrafast laser-field manipulation.

Route from single-pulse to multi-pulse states in a mid-infrared soliton fiber laser

State-of-the-art ultrafast mid-IR fiber lasers deliver optical solitons with durations of several hundred femtoseconds. The Er- or Ho-doped fluoride gain fibers generally used in these lasers have strong anomalous dispersion at ∼3 µm, which generally forces them to operate in the soliton regime. Here we report that a pulse-energy clamping effect, caused by the buildup of intracavity nonlinearities, limits the shortest obtainable pulse durations in these mid-infrared soliton fiber lasers. Excessive intra-cavity energy results in soliton instability, collapse and fragmentation into a variety of stable multi-pulse states, including phase-locked soliton molecules and harmonically mode-locked states. We report that the spectral evolution of the mid-IR laser pulses can be recorded between roundtrips through stretching their second-harmonic signal in a 25-km-length of single-mode fiber. Using a modified dispersive Fourier transform set-up, we were able to perform for the first time spectro-temporal measurements of mid-IR laser pulses both in the pulsed state and during pulse collapse and fragmentation. The results provide insight into the complex nonlinear dynamics of mid-IR soliton fiber lasers and open up new opportunities for obtaining a variety of stable multi-pulse mode-locked states at mid-IR wavelengths.

Continuously wavelength-tunable blueshifting soliton generated in gas-filled photonic crystal fibers

We experimentally report the generation of wavelength-tunable blueshifting soliton in the visible spectral region through a gas-filled single-ring photonic crystal fiber (SR-PCF). In particular, in a He-filled SR-PCF, we observed a sharp narrow-band spectral peak at the first resonant spectral region of the SR-PCF, which results from phase-matched nonlinear processes. To the best of our knowledge, this is the first time investigating the influence of the core-cladding resonance on the blueshifting soliton. In addition, when Ar gas was filled into the SR-PCF, some interference fringes on the blueshifting soliton were observed at high pulse-energy levels due to plasma-induced pulse fission. These two experimental observations are confirmed by numerical simulations. Furthermore, through properly adjusting input pulse energy, we found that the blueshifting soliton can obtain a high conversion efficiency (∼84%) and its wavelength can be tuned over hundreds of nanometers (∼240  nm).

[Skeletal muscle MRI of lower limbs in patients with facioscapulohumeral dystrophy]

Objective: To investigate MRI features of lower limbs in patients with facioscapulohumeral dystrophy(FSHD). Methods: The clinical manifestations, myopathological findings and MRI images of 5 FSHD patients were studied retrospectively from June 2016 to December 2017 at Department of Neurology, Henan Provincial People's Hospital, 3 of which had a family history. Analysis of T(1)WI images enabled us to describe muscle fatty infiltration and STIR images to describe muscle edema. Each muscle was scored according to its fatty degeneration (fat replacement score range from 0-4). Results: The 5 patients were all asymmetrically involved. At the thigh level, the hamstrings were more affected than anterior muscles in 4 patients, and anterior muscles were more affected than hamstrings in only 1 patient. The most affected thigh muscles were usually the adductor magnus, semimembranosus, semitendinosus, femoral biceps long head and vastus medialis muscles (average fat replacement score of each muscle was more than 3). The calves were less affected than thighs.The average fat replacement score of the calf muscles was 1.0 for soleus, 0.9 for medial gastrocnemius, 0.8 for tibialis anterior, and 0.4 for lateral gastrocnemius. There was no fatty infiltration in peroneus and tibialis posterior. 4 out of 5 patients had edema in the lower limb muscles. Conclusion: Asymmetric involvement is a definitely helpful clue suggesting FSHD, and edema is a common phenomenon. At the thigh level, no unique imaging pattern can be highlighted in all the FSHD patients, overall, the hamstring, adductor magnus and vastus medialis are usually the most severely affected muscles. The calf muscles are less affected than the thigh muscles or spared. Soleus, medial gastrocnemius, and tibialis anterior are preferentially involved at the calf level.

[Analysis of survival and treatment outcome of patients with primary diffuse large B cell lymphoma in reproductive system]

Objective: To analyze clinical feature and treatment outcome of patients with primary diffuse large B cell lymphoma(DLBCL) in reproductive system. Methods: A total of 26 patients with DLBCL in reproductive system were retrospectively analyzed, and the clinical features, laboratory data were included in Kaplan-Meier and prognostic analysis. Results: In our center, the incidence of primary diffuse large B cell lymphoma in reproductive system was 3.5% in all DLBCL patients, and the median age was 62.0 years. Male are more common with unilateral testicular involvement, and 38.5% patients belong to Ⅲ and Ⅳstage while 84.6% patients belong to non-germinal center B cell-like subgroup. The overall response rate(ORR) for the whole group was 88.5%. The complete response rate was 76.9%. The 3, 5-year progression free survival rate was 70.5% and 62.7% , and the 3, 5-year overall survival rate was 83.5% and 69.6%, respectively. The most common recurrent sites were contralateral testis and central nervous system. Rituximab can improve the survival of patients and combined with contralateral irradiation can furtherly improve progression free survival of patients(P=0.047). Clinical stage, B symptom, IPI, the level of LDH, and CRP, age>60 years, and initial treatment outcome were predictive of overall survival. Conclusion: Primary diffuse large B cell lymphoma in reproductive system is a rare type of extranodal DLBCL which occurs in older men with aggressive features. The most common sites of recurrence were contralateral testis and central nervous system. Surgery, rituximab , radiotherapy and prophylactic intrathecal injection can improve the survival of patients and may be the first-line treatment.

Neuropeptide Y Y2 antagonist treated ovariectomized mice exhibit greater bone mineral density

Osteoporosis, a disease characterized by progressive bone loss and increased risk of fracture, often results from menopausal loss of estrogen in women. Neuropeptide Y has been shown to negatively regulate bone formation, with amygdala specific deletion of the Y2 receptor resulting in increased bone mass in mice. In this study, ovariectomized (OVX) mice were injected once daily with JNJ-31020028, a brain penetrant Y2 receptor small molecule antagonist to determine the effects on bone formation. Antagonist treated mice had reduced weight and showed increased whole-body bone mineral density compared to vehicle-injected mice. Micro computerized tomography (micro-CT) demonstrated increased vertebral trabecular bone volume, connectivity density and trabecular thickness. Femoral micro-CT analysis revealed increased bone volume within trabecular regions and greater trabecular number, without significant difference in other parameters or within cortical regions. A decrease was seen in serum P1NP, a measure used to confirm positive treatment outcomes in bisphosphonate treated patients. C-terminal telopeptide 1 (CTX-1), a blood biomarker of bone resorption, was decreased in treated animals. The higher bone mineral density observed following Y2 antagonist treatment, as determined by whole-body DEXA scanning, is indicative of either enhanced mineralization or reduced bone loss. Additionally, our findings that ex vivo treatment of bone marrow cells with the Y2 antagonist did not affect osteoblast and osteoclast formation suggests the inhibitor is not affecting these cells directly, and suggests a central role for compound action in this system. Our results support the involvement of Y2R signalling in bone metabolism and give credence to the hypothesis that selective pharmacological manipulation of Y2R may provide anabolic benefits for treating osteoporosis.

Gigahertz-repetition-rate Tm-doped fiber laser passively mode-locked by optoacoustic effects in nanobore photonic crystal fiber

We report a Tm-doped soliton fiber laser passively mode-locked by intense optoacoustic interactions in a short length of solid-core silica photonic crystal fiber (PCF) with a nanobore in core-center. A repetition rate of 1.446 GHz pulse is achieved, corresponding to the 52nd harmonic of the 27.8 MHz cavity round-trip frequency. Strong optoacoustic interactions in this PCF-based, Tm-doped fiber laser ensure stable and repeatable gigahertz-rate pulse train generation at 1.85 μm wavelength, with a high supermode noise suppression ratio and low pulse timing jitter.

Mouse Models of Frailty: an Emerging Field

Frailty is highly prevalent in the elderly, increasing the risk of poor outcomes that include falls, incident disability, hospitalization, and mortality. Thus, a great need exists to characterize the underlying mechanisms and ultimately identify strategies that prevent, delay, and even reverse frailty. Mouse models can provide insight into molecular mechanisms of frailty by reducing variability in lifestyle and genetic factors that can complicate interpretation of human clinical data. Frailty, generally recognized as a syndrome involving reduced homeostatic reserve in response to physiologic challenges and increasing susceptibility to poor health outcomes, is predominantly assessed using two independent strategies, integrated phenotype and deficit accumulation. The integrated phenotype defines frailty by the presentation of factors affecting functional capacity such as weight loss, exhaustion, low activity levels, slow gait, and grip strength. The deficit accumulation paradigm draws parameters from a greater range of physiological systems, such as the ability to perform daily activities, coordination and gait, mental components, physiological problems, and history and presence of medical morbidities. This strategic division also applies within the emerging field of mouse frailty models, with both methodologies showing usefulness in providing insight into physiologic mechanisms and testing interventions. Our review will explore the strategies used, caveats in methodology, and future directions in the application of animal models for the study of the frailty syndrome.

Effects of microwave ablation or its combination with whole-body chemotherapy on serum vascular endothelial growth factor levels in patients with stage IIIB/IV NSCLC

We aimed to analyze the changes of serum vascular endothelial growth factor (VEGF) before and after microwave ablation (MWA) in patients with stage IIIB-IV non-small cell lung cancer (NSCLC), and to observe the effects of MWA combined with chemotherapy on short-term therapeutic efficacy and long-term survival. Concentrations of serum VEGF in 20 healthy subjects were considered as controls. Changes of serum VEGF were detected by ELISA before and after MWA (1 and 7 days after treatment). Seven days after MWA, patients were divided into a combination chemotherapy group of 22 subjects and a MWA alone group of 18 subjects. Serum VEGF was measured 1 month after MWA and 4 cycles after chemotherapy (3 months) to evaluate term effects; and 1- and 2-year survival rates. Serum VEGF concentrations declined sharply 1 day after MWA, and were significantly different from the levels before treatment. Subsequently, VEGF rebounded 7 days after ablation, higher than that before treatment. At 1 and 3 months, serum VEGF levels in both treatment groups were remarkably lower than that before treatment; efficiency, or for the 1-year survival rate. However, the 2-year survival rates were significantly different between the two groups. We demonstrated that after MWA, the serum VEGF concentration undergoes a process of increasing, which might promote metastasis and recurrence of NSCLC. MWA combined with whole-body chemotherapy appears to be an effective method to increase the disease control rate, reduce the probability of metastasis and recurrence, and thus improve long-term survival.

T-cell receptor ζ mRNA with an alternatively spliced 3' untranslated region is generated predominantly in the peripheral blood T cells of systemic lupus erythematosus patients

Abstract  To investigate the mechanism of the downregulation of T-cell receptor ζ chain (TCRζ) expression in the peripheral blood T cells (PBTs) of systemic lupus erythematosus (SLE) patients, we analyzed the 3' untranslated region (3'UTR) of TCRζ mRNA, because the 3'UTR in mRNA is responsible for posttranscriptional regulation. Use of the reverse transcriptase polymerase chain reaction (RT-PCR) to amplify the 917 bp TCRζ 3'UTR cDNA demonstrated that the short variant cDNA (355 bp), expressed as an alternatively spliced 3'UTR with 562-bp deletion, was predominated in the PBTs of 11 of 14 SLE patients, whereas mainly the wild-form cDNA (917 bp) was detected in the PBTs of seven negative controls (two systemic sclerosis patients, five normal controls) and in two T-cell line hybridomas. Semiquantitative PCR also revealed the predominant expression of the TCRζ mRNA with alternatively spliced 3'UTR (TCRζ mRNA/as-3'UTR), and a decreased expression of TCRζ mRNA with the wild form 3'UTR (TCRζ mRNA/w-3'UTR) in SLE T cells. However, there was no difference in the expression of the open reading frame (ORF) TCRζ mRNA between the negative controls and SLE patients. The TCRζ protein expression level according to Western blot analysis correlated well with that of TCRζ mRNA/w-3'UTR (r= 0.931) and reversibly with TCRζ mRNA/as-3'UTR (r=-0.614), but not with ORF TCRζ mRNA (r=-0.296). It can be concluded that the reduced expression of TCRζ mRNA/w-3'UTR and the predominant expression of TCRζ mRNA/as-3'UTR lead to downregulation of the TCRζ protein in SLE T cells.

Randomized trial of albinterferon alfa-2b every 4 weeks for chronic hepatitis C virus genotype 2/3

Albinterferon alfa-2b (albIFN) is a fusion protein of recombinant human albumin/recombinant interferon (IFN)-α-2b, with ∼200-h half-life. Safety/efficacy of albIFN q4wk was evaluated in 391 treatment-naive patients with chronic hepatitis C virus (HCV) genotype 2/3. Patients were randomized 3:4:4:4 to one of four open-label treatment groups: pegylated IFN (Peg-IFN)-α-2a 180 μg qwk or albIFN 900, 1200 or 1500 μg q4wk, plus oral ribavirin 800 mg/day, for 24 weeks. Primary efficacy endpoint was sustained virologic response (SVR; HCV RNA <20 IU/mL 24 weeks post-treatment). SVR rates were as follows: 85%, 76%, 76% and 78% with Peg-IFNα-2a and albIFN 900, 1200 and 1500 μg, respectively (P = NS); corresponding rapid virologic response rates (HCV RNA <43 IU/mL at week 4) were as follows: 78%, 49% (P < 0.001), 60% (P = 0.01) and 71%. SVR rates were not influenced by interleukin 28B genotype, although rapid virologic response rates were greater with interleukin 28B CC (P = NS). Serious adverse event rates were as follows: 4%, 11%, 3% and 3% with Peg-IFNα-2a and albIFN 900, 1200 and 1500 μg, respectively. No increase in serious/severe respiratory events was noted with albIFN. Fewer absolute neutrophil count reductions <750/mm(3) occurred with albIFN (P = 0.03), leading to fewer IFN dose reductions. Haemoglobin reductions <10 g/dL were less frequent with albIFN 900 and 1200 μg vs 1500 μg and Peg-IFNα-2a (P = 0.02), leading to fewer ribavirin dose reductions. albIFN administered q4wk produced fewer haematologic reductions than Peg-IFNα-2a, but had numerically lower SVR rates (P = NS) in patients with chronic HCV genotype 2/3.

Prospective study to validate HpOne in the diagnosis of Helicobacter pylori infection

INTRODUCTION

The HpOne test is a new five-minute rapid urease test developed for the rapid detection of Helicobacter pylori infection during gastroscopy. However, evidence in the literature supporting its use clinically is scarce. The most commonly used rapid urease test remains the Campylobacter-like organism (CLO) test, which generates accurate readings only after 24 hours. The aim of this study was to evaluate the efficacy of the HpOne test in our local population.

METHODS

From August 2007 to May 2008, consecutive patients undergoing gastroscopy for various indications were recruited into this prospective study. Patients who were pregnant, lactating, on proton pump inhibitors, antibiotics, immunosuppressants or had previous gastric surgery were excluded. During gastroscopy, six gastric mucosal biopsies were taken; three from the body and three from the antrum. One body and one antral biopsy were used for each of the HpOne test, CLO test and histology. Results of the HpOne and CLO tests were then compared against the gold standard of histology.

RESULTS

Of the 149 patients recruited, 82 (55 percent) were men and 67 (45 percent) were women. The prevalence of Helicobacter pylori infection was 38.9 percent (n is 58). The sensitivity and specificity of the HpOne test were 65.5 percent and 85.7 percent, respectively, while those for the CLO test were 63.8 percent and 84.6 percent, respectively.

CONCLUSION

The HpOne test is as efficacious as the CLO test, with the added advantage of yielding results faster. It is thus a superior alternative and should be considered for clinical use.

The Strength and Fracture of Passive Oxide Films on Metals

Passive films have been grown electrochemically on a polycrystalline titanium alloy. By varying the applied voltages, the film thickness is varied. A testing apparatus has been constructed to allow measurements of nanomechanical properties during electrochemical testing using a Ag/AgCl reference electrode in a traditional three-electrode potentiostatic scan. The stress at which oxide film fracture occurs is correlated to the applied potential. Observations of in situ film fracture measurements on single grains during immersion show the strength of the film remains constant in environments in which the film is inert, but decreases by approximately 20% in solutions which lead to corrosion. The fracture mode of the oxide has been observed using atomic force microscopy, and is shown to qualitatively match the largest tensile stresses which develop using elastic contact mechanics. A simplified model for determining the maximum tensile stress around an indentation is presented, and is used to show the stress required for fracture increases approximately linearly with increasing applied anodic polarization, from 850 MiPa to approximately 3 GPa for applied potentials between 1 and 9 V.

A hollow-core photonic bandgap fiber polarization controller

A polarization controller was built by pressurizing laterally three segments of a commercial hollow-core photonic bandgap fiber. By varying the magnitudes of the applied pressures, the output state of polarization showed a good coverage of all the possible polarization states on the surface of the Poincaré sphere.

Influence of strain and pressure to the effective refractive index of the fundamental mode of hollow-core photonic bandgap fibers

We investigate the phase sensitivity of the fundamental mode of hollow-core photonic bandgap fibers to strain and acoustic pressure. A theoretical model is constructed to analyze the effect of axial strain and acoustic pressure on the effective refractive index of the fundamental mode. Simulation shows that, for the commercial HC-1550-02 fiber, the contribution of mode-index variation to the overall phase sensitivities to axial strain and acoustic pressure are respectively approximately -2% and approximately -17%. The calculated normalized phase-sensitivities of the HC-1550-02 fiber to strain and acoustic pressure are respectively 1 epsilon(-1) and -331.6 dB re microPa(-1) without considering mode-index variation, and 0.9797 epsilon(-1) and -333.1 dB re microPa(-1) when mode-index variation is included in the calculation. The latter matches better with the experimentally measured results.