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Application of large language models in disease diagnosis and treatment

中华医学杂志(英文版) 2025年第2期138卷 130-142页

作者： Yang Xintian Li Tongxin Su Qin Liu Yaling Kang Chenxi Lyu Yong Zhao Lina Nie Yongzhan Pan Yanglin State Key Laboratory of Holistic Integrative management of Gastrointestinal Cancers and National clinical Research Center for digestive diseases Xijing Hospital of Digestive Diseases Fourth Military Medical University Xi’an Shaanxi China Department of Radiotherapy Xijing Hospital Fourth Military Medical University Xi’an Shaanxi China

Large language models (LLMs) such as ChatGPT, Claude, Llama, and Qwen are emerging as transformative technologies for the diagnosis and treatment of various diseases. With their exceptional long-context reasoning capabilities, LLMs are proficient in clinically relevant tasks, particularly in medical text analysis and interactive dialogue. They can enhance diagnostic accuracy by processing vast amounts of patient data and medical literature and have demonstrated their utility in diagnosing common diseases and facilitating the identification of rare diseases by recognizing subtle patterns in symptoms and test results. Building on their image-recognition abilities, multimodal LLMs (MLLMs) show promising potential for diagnosis based on radiography, chest computed tomography (CT), electrocardiography (ECG), and common pathological images. These models can also assist in treatment planning by suggesting evidence-based interventions and improving clinical decision support systems through integrated analysis of patient records. Despite these promising developments, significant challenges persist regarding the use of LLMs in medicine, including concerns regarding algorithmic bias, the potential for hallucinations, and the need for rigorous clinical validation. Ethical considerations also underscore the importance of maintaining the function of supervision in clinical practice. This paper highlights the rapid advancements in research on the diagnostic and therapeutic applications of LLMs across different medical disciplines and emphasizes the importance of policymaking, ethical supervision, and multidisciplinary collaboration in promoting more effective and safer clinical applications of LLMs. Future directions include the integration of proprietary clinical knowledge, the investigation of open-source and customized models, and the evaluation of real-time effects in clinical diagnosis and treatment practices.

关键词： Large language models Artificial intelligence Diagnosis Treatment planning clinical decision support

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“No-donor” liver transplantation

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Hepatobiliary & Pancreatic diseases International 2025年第1期24卷 23-28页

作者： Yong-Fa Huang Zhi-Jun Zhu Liver Transplantation Center National Clinical Research Center for Digestive Diseases Beijing Friendship Hospital Capital Medical University clinical Center for Pediatric Liver Transplantation Capital Medical University

Liver transplantation is hindered by organ shortage. The potential way to relieve this issue is to expand the donor pool via extending the donor criteria and make full use of all available grafts. The concept of “no-donor” liver transplantation allows grafts to be recovered from other liver recipients. This review summarizes the current clinical practice of “no-donor” liver transplantation, focusing on the experiences of Chinese transplant teams. Domino liver transplantation was introduced by Furtado in 1995 and implemented later in 2013 in China, and novel donor indications including some essential-to-treat inherited metabolic liver-based diseases have emerged. The concept of cross-auxiliary domino liver transplantation brings a further expansion of the domino liver graft pool, and the first pair of liver transplantation performed “rigorously without donation” was accomplished in our center in 2018. Our experience with this original transplantation procedure is hereby reviewed. In order to further promote and make successful “no-donor” liver transplantation, close co-operation between researchers, surgeons, physicians, organ procurement organizations, as well as ethical committees is required.

关键词： Domino liver transplantation Cross-auxiliary domino liver transplantation Inherited metabolic liver-based disease

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Internal transcribed spacer sequencing to explore the intrinsic composition of fungal communities in fungal esophagitis

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World Journal of Gastroenterology 2025年第7期31卷 26-38页

作者： Yi-Kang Song Lin Zheng Ai-Xin Liu Jun-Ji Ma Department of Gastroenterology The Second Hospital of Hebei Medical UniversityHebei Key Laboratory of GastroenterologyHebei Institute of GastroenterologyHebei Clinical Research Center for Digestive DiseasesShijiazhuang050000Hebei ProvinceChina

BACKGROUND Fungal esophagitis(FE)is caused by fungal invasion of the esophageal *** endoscopy,the esophageal mucosa shows edema,congestion,erosion,and ulceration,and bleeds easily when touched,and the surface of the mucosa is covered with small white spots like"bean curd residue".clinical cases showing typical FE under endoscopic imaging but negative esophageal mucosal brush(referred to as suspected FE)have increased the difficulty and challenge of clinical diagnosis and *** present,the esophageal fungal flora of suspected case has not been thoroughly *** To characterize the fungal flora in FE,suspected FE,and the esophageal normal controls(NCs),and to identify marker species to improve detection of *** This was a case-control study.A total of 19 patients with FE,16 with suspected FE,and 10 NCs were selected by *** esophageal cell brush samples of each group were sequenced by internal transcribed spacer(ITS)1 and analyzed by *** In FE and suspected FE patients,species richness,species diversity and species evenness,as measured by the Chao1 index,Shannon index and Pielou index,were lower than in the NCs,and the comparison between the FE and NCs was the most significant(Punity was similar in the F

关键词： Fungal microbiota Esophagitis Candida Yarrowia Biomarker

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The gut microbiome modulate response to immunotherapy in cancer

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Science China(Life Sciences) 2025年第2期68卷 381-396页

作者： Shan-Shan Jiang Zi-Ran Kang Ying-Xuan Chen Jing-Yuan Fang Division of Gastroenterologyand Hepatology Shanghai Instituteof Digestive DiseaseNHC KeyLaboratoryof Digestive DiseasesState KeyLaboratoryfor Oncogenesand Related GenesRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200001China

Gut microbiota have been reported to play an important role in the occurrence and development of malignant ***,clinical studies have identified specific gut microbiota and its metabolites associated with efficacy of immunotherapy in multiple types of *** investigations have elucidated that gut microbiota modulate the antitumor immunity and affect the efficacy of cancer *** microbiota and its metabolites may favorably remodel the tumor microenvironment by engaging innate and/or adaptive immune *** how the gut microbiome interacts with cancer immunotherapy opens new avenues for improving treatment *** microbial transplants,probiotics,dietary interventions,and other strategies targeting the microbiota have shown promise in preclinical studies to enhance the *** clinical trials are evaluating these *** review presents the recent advancements in understanding the dynamic interplay among the host immunity,the microbiome,and cancer immunotherapy,as well as strategies for modulating the microbiome,with a view to translating into clinical applications.

关键词： cancer immunotherapy gut microbiota intratumoral microbiota microbiota-derived metabolites innate and adaptive immunity

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Exploring the performance of large language models on hepatitis B infection-related questions:A comparative study

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World Journal of Gastroenterology 2025年第3期31卷 103-112页

作者： Yu Li Chen-Kai Huang Yi Hu Xiao-Dong Zhou Cong He Jia-Wei Zhong Department of Gastroenterology Jiangxi Provincial Key Laboratory of Digestive DiseasesJiangxi Clinical Research Center for GastroenterologyDigestive Disease HospitalThe First Affiliated HospitalJiangxi Medical CollegeNanchang UniversityNanchang 330006Jiangxi ProvinceChina HuanKui Academy Nanchang UniversityNanchang 330006Jiangxi ProvinceChina

BACKGROUND Patients with hepatitis B virus(HBV)infection require chronic and personalized care to improve *** language models(LLMs)can potentially provide medical information for *** To examine the performance of three LLMs,ChatGPT-3.5,ChatGPT-4.0,and Google Gemini,in answering HBV-related *** LLMs’responses to HBV-related questions were independently graded by two medical professionals using a four-point accuracy scale,and disagreements were resolved by a third *** question was run three times using three *** was assessed via the Gunning Fog index and Flesch-Kincaid grade *** Overall,all three LLM chatbots achieved high average accuracy scores for subjective questions(ChatGPT-3.5:3.50;ChatGPT-4.0:3.69;Google Gemini:3.53,out of a maximum score of 4).With respect to objective questions,ChatGPT-4.0 achieved an 80.8%accuracy rate,compared with 62.9%for ChatGPT-3.5 and 73.1%for Google *** the six domains,ChatGPT-4.0 performed better in terms of diagnosis,whereas Google Gemini demonstrated excellent clinical ***,in the readability analysis,the mean Gunning Fog index and Flesch-Kincaid grade level scores of the three LLM chatbots were significantly higher than the standard level eight,far exceeding the reading level of the normal *** Our results highlight the potential of LLMs,especially ChatGPT-4.0,for delivering responses to HBV-related *** may be an adjunctive informational tool for patients and physicians to improve ***,current LLMs should not replace personalized treatment recommendations from physicians in the management of HBV infection.

关键词： ChatGPT-3.5 ChatGPT-4.0 Google Gemini Hepatitis B infection Accuracy

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Gut microbiota-astrocyte axis: new insights into age-related cognitive decline

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Neural Regeneration Research 2025年第4期20卷 990-1008页

作者： Lan Zhang Jingge Wei Xilei Liu Dai Li Xiaoqi Pang Fanglian Chen Hailong Cao Ping Lei Haihe Laboratory of Cell Ecosystem Department of GeriatricsTianjin Medical University General HospitalTianjinChina Tianjin Geriatrics Institute Tianjin Medical University General HospitalTianjinChina Department of Gastroenterology and Hepatology Tianjin Medical University General HospitalNational Key Clinical SpecialtyTianjin Institute of Digestive DiseasesTianjin Key Laboratory of Digestive DiseasesTianjinChina Department of Urology Tianjin Medical University General HospitalTianjinChina Tianjin Neurological Institution Tianjin Medical University General HospitalTianjinChina

With the rapidly aging human population,age-related cognitive decline and dementia are becoming increasingly prevalent *** is considered the main risk factor for cognitive decline and acts through alterations in the composition of the gut microbiota,microbial metabolites,and the functions of *** microbiota–gut–brain axis has been the focus of multiple studies and is closely associated with cognitive *** article provides a comprehensive review of the specific changes that occur in the composition of the gut microbiota and microbial metabolites in older individuals and discusses how the aging of astrocytes and reactive astrocytosis are closely related to age-related cognitive decline and neurodegenerative *** article also summarizes the gut microbiota components that affect astrocyte function,mainly through the vagus nerve,immune responses,circadian rhythms,and microbial ***,this article summarizes the mechanism by which the gut microbiota–astrocyte axis plays a role in Alzheimer’s and Parkinson’s *** findings have revealed the critical role of the microbiota–astrocyte axis in age-related cognitive decline,aiding in a deeper understanding of potential gut microbiome-based adjuvant therapy strategies for this condition.

关键词： age aging Alzheimer’s disease astrocytes cognitive decline dementia gut microbiota gut–brain axis microbial metabolites neuroinflammation Parkinson’s disease

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Effect of cholesterol metabolism on hepatolithiasis

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World Journal of Gastroenterology 2025年第1期31卷 157-162页

作者： Lin Zheng Zi-Yu Ye Jun-Ji Ma Department of Gastroenterology The Second Hospital of Hebei Medical UniversityHebei Key Laboratory of GastroenterologyHebei Institute of GastroenterologyHebei Clinical Research Center for Digestive DiseasesNo.215 Heping West RoadShijiazhuang 050000Hebei ProvinceChina

Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after *** metabolism seems to play an important role in hepatoli-thiasis pathogenesis.A high cholesterol diet is one of the significant reasons for the increasing incidence of ***,regular diet and appropriate medical intervention are crucial measures to prevent hepatolithiasis and reduce recurrence rate after *** dietary cholesterol and drugs that increase cholesterol stone solubility are key therapeutic approaches in treating *** article discusses the cholesterol metabolic pathways related to the pathogenesis of hepatolithiasis,as well as food intake and targeted therapeutic drugs.

关键词： Hepatolithiasis Cholesterol metabolism High-fat diet 3-hydroxy-3-methylglutaryl-coenzyme A reductase Interlobular bile duct

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Metamorphopsia after surgery for rhegmatogenous retinal detachment

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International Journal of Ophthalmology(English edition) 2025年第1期18卷 168-177页

作者： Han-Tao Zhou Zhong Lin National clinical Research Center for Ocular diseases Eye HospitalWenzhou Medical UniversityWenzhou 325027Zhejiang ProvinceChina

Improvements in surgical techniques have led to 90% success in the surgical repair of rhegmatogenous retinal detachment(RRD).However,anatomical reattachment of the retina does not ensure complete recovery of visual *** incidence of metamorphopsia remains the most common postoperative complaint,from 24% to 88.6%.Currently,the risk factors of metamorphopsia are categorized into macular involvement,retinal shift,outer retinal folds,subretinal fluid,secondary epiretinal membrane,outer retinal layer damage,and surgical *** associations of metamorphopsia with postoperative best-corrected visual acuity and postoperative vision-related quality of life were still *** most popular methods for assessment of metamorphopsia remain the Amsler grid and *** treatments cannot progress beyond the management of negative visual sensations,through methods such as occlusion therapy and aniseikonia-correcting *** main treatment approach involves RRD prevention and the management of risk factors that can lead to postoperative metamorphopsia after RRD *** research concerning metamorphopsia treatment,further upgrades of auxiliary inspection methods,and more accurate microstructural assessments are needed to address this common complication.

关键词： retinal detachment rhegmatogenous retinal detachment metamorphopsia visual distortion

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Trans-jugular intrahepatic portosystemic stent shunting benefits and limits

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World Journal of Gastrointestinal Surgery 2025年第1期17卷 307-309页

作者： Salvatore Stefano Sciarrone Lucia Fini Luca De Luca Department of Surgery Gastroenterology and Digestive Endoscopy UnitASST Santi Paolo e CarloUniversity of MilanMilan 20142LombardyItaly

Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many *** procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic *** time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal *** the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of *** that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for *** has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of ***,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the *** the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?

关键词： Hepatic compensation Decompensation Trans-jugular intrahepatic portosystemic stent-shunt Bleeding Ascites

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Unwanted disorders and xenogeneic graft-versus-host disease in experimental immunodeficient mice:How to evaluate and how to report

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Animal Models and Experimental Medicine 2025年第1期8卷 20-29页

作者： Seyed Mostafa Monzavi Samad Muhammadnejad Vahid Mansouri Hami Ashraf Naser Ahmadbeigi Gene Therapy Research Center Digestive Diseases Research InstituteTehran University of Medical SciencesTehranIran INSERM U981 Institut Gustave RoussyVillejuifFrance Chronic Respiratory diseases Research Center National Research Institute of Tuberculosis and Lung Diseases(NRITLD)Shahid Beheshti University of Medical SciencesTehranIran

Human-derived tumor models are essential for preclinical development of new anti-cancer drug *** animal models bearing tumors of human origin,such as patient-derived or cell line-derived xenograft tumors,is dependent on immuno-deficient ***-bearing immunodeficient mice are susceptible to develop-ing unwanted disorders primarily irrelevant to the tumor nature;and if get involved with such disorders,reliability of the study results will be undermined,inevitably con-founding the research in ***,a rigorous health surveillance and clinical monitoring system,along with the establishment of a strictly controlled barrier facility to maintain a pathogen-free state,are *** if all pathogen control and biosafety measures are followed,there are various noninfectious disorders capable of causing tissue and multiorgan damage in immunodeficient ***,the re-searchers should be aware of sentinel signs to carefully monitor and impartially report *** review discusses clinical signs of common unwanted disorders in experi-mental immunodeficient mice,and how to examine and report them.

关键词： animal models graft-versus-host disease health surveillance preclinical drug evaluation xenograft model antitumor assays

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