[Reflections on the Implications of the Developments in ChatGPT for Changes in Medical Education Models].

Ever since its official launch, Chat Generative Pre-Trained Transformer, or ChatGPT, a natural language processing tool driven by artificial intelligence (AI) technology, has attracted much attention from the education community. ChatGPT can play an important role in the field of medical education, with its potential applications ranging from assisting teachers in designing individualized teaching scenarios to enhancing students' practical ability for solving clinical problems and improving teaching and research efficiency. With the developments in technology, it is inevitable that ChatGPT, or other generative AI models, will be thoroughly integrated in more and more medical contexts, which will further enhance the efficiency and quality of medical services and allow doctors to spend more time interacting with patients and implement personalized health management. Herein, we suggested that proactive reflections be made to figure out the best way to cultivate health professional in the context of New Medical Education, to help more medical professionals enhance their understanding of developments in artificial intelligence, and to make preparations for the challenges that will emerge in the new round of technological revolution. Medical educators should focus on guiding students to make proper use of AI tools in the appropriate context, thereby prevening abuse or overreliance caused by a lack of discrimating ability. Teachers should focus on helping medical students make improvements in clinical reasoning skills, self-directed learning, and clinical practical skills. Teachers should stress the importance for medical students to understand the philosophical implications of the mind-body unity concept, holistic medical thinking, and systematic medical thinking. It is important to enhance medical students' humanistic qualities, cultivate their empathy and communication skills, and continually enhance their ability to meet the requirements of individualized precision diagnosis and treatment so that they will better adapt to the future developments in medicine.

[Effects of Hengyan medicinal recipe on the regulation of immunity in patients with severe sepsis: a prospective clinical trial].

OBJECTIVE: To observe the role of Hengyan medicinal recipe on the regulation of immunity in patients with severe sepsis. METHODS: Patients with severe sepsis included in the study were randomly divided into two groups. Hengyan medicinal recipe group (n=22), in which patients were treated with Hengyan medicinal recipe 50 ml, 3 times daily, for 7 days.The recipe was composed of Bombyx batryticatus 10 g, Cicada slough 10 g, Curcuma 10 g, Rhubarb 3 g, Radix astragalus 10 g, Radix ophiopogonis 10 g, Red ginseng 10 g, Paeony 10 g, Walnut kernel 10 g, Safflower 10 g, combined with western medicine treatment.The patients in control group (n=23) were treated with western medicine same as above. In all patients the number of bowel movement and the scores of acute physiology and chronic health evaluationII (APACHEII) were recorded. Blood was taken for the determination of the levels of interleukins (IL-6, IL-10), tumor necrosis factor-α (TNF-α), CD3(+), CD4(+), CD8(+) T cell before and 1, 3, 7 days after the treatment. RESULTS: Compared with the control group, the number of bowel movement, scores of APACHEII and IL-6, IL-10, IL-6/IL-10, TNF-α in Hengyan medicinal recipe group were decreased significantly at 7 days, while the levels of CD3(+), CD4(+), CD8(+) T cell were increased significantly [the number of bowel movement (times): 2.1±0.7 vs. 0.6±0.6, APACHEII score: 13.8±5.6 vs. 16.8±5.6, IL-6 (ng/L): 45 (32, 89) vs. 80 (41, 116), IL-10 (ng/L): 4.2 (3.6, 9.8) vs. 6.6 (3.5, 10.6), IL-6/IL-10:10.6 (7.2, 24.8) vs. 12.8 (7.6, 28.8), TNF-α (ng/L):4.2±2.6 vs. 5.6±2.7, CD3(+): 6.59±2.80 vs. 5.65±2.92, CD4(+): 3.65±2.17 vs. 3.25±2.46, CD8(+): 2.73±1.29 vs. 2.26±1.48, P<0.05 or P<0.01]. CONCLUSION: Hengyan medicinal recipe could not only reduce the systemic inflammation, but also plays a role in bidirectional regulation of the immune disturbance to ameliorate immune suppression of sepsis patients.

Distribution and development of the TCM syndromes in psoriasis vulgaris.

OBJECTIVE: To study the distribution and development rules of the TCM syndromes in psoriasis vulgaris. METHODS: Based on the clinical epidemiologic mass survey, the study was carried out by means of a status survey, multi-center and large-sample research. The data base was set up by EPIINFO6.0. The SPSS was used to do the statistical analyses in 2651 cases of psoriasis vulgaris to study the correlations among the distribution and development of the TCM syndromes, the stages of the disease, nationality, psoriasis history, family history, smoking history, alcohol drinking history, and severity of the disease. RESULTS: The TCM syndromes in psoriasis vulgaris mainly include the blood-heat syndrome (53.8%), blood-dryness syndrome (27.4%), and blood-stasis syndrome (18.1%). Other syndromes were rarely seen, covering 0.6%. The concurrent syndromes mainly involve dampness, heat, blood stasis and toxin. The distribution differences of the main syndromes at different stages of the disease had statistical significance (P < 0.01). The syndrome distribution is not related with nationality and family history (P > 0.05), but it was closely related with the psoriasis history, smoking history, alcohol drinking history, and severity of the disease (P < 0.01). CONCLUSION: At the initial stage, psoriasis vulgaris usually manifests itself as the blood-heat syndrome, and later it may be improved or turn into the blood-dryness or blood-stasis syndrome. Smoking, alcohol consumption, and severity of the disease may play a role in the syndrome's transformation.

[Clinical and experimental study on effect of qinbal ointment in treating psoriasis in the active stage of blood-heat syndrome type].

OBJECTIVE: To investigate and compare the efficacy and safety of two kinds of Qinbai ointment prepared conventionally and finely (C-QBO and F-QBO) in treating psoriasis in the active stage of blood-heat syndrome type, and to observe their influences on vaginal epithelial cell mitosis, also on keratinization of caudal flakes in mice. CLINICAL OBSERVATION: Adopting randomized, single-blinded, controlled design, 93 patients administered orally with Liangxue Huoxue Decoction were randomized into three groups treated externally with C-QBO, F-QBO and white vaseline respectively, applied twice a day for 8 weeks. The safety was checked and the changes of modified psoriasis area severity index (PASI), as well as the conditions of skin lesions (size, erythema, infiltration, squama, and itching) and symptom improving time were compared. Experimental study 1: Mice were randomized into the model group, the C-QBO group, the F-QBO group and the blank group, 7 in each group. Their vaginal epithelial cell mitosis indices were compared after 3 days of treatment with corresponding remedies. Experimental study 2: Mice were randomized into the C-QBO group, the F-QBO group and the blank group, 7 in each group. After the mice had been treated with corresponding remedies for 28 days, the granular layer formation in their caudal scales was compared. CLINICAL OBSERVATION: The markedly effective rate was 63.3% (25/30) in the C-QBO group, 66.7% (20/30) in the F-QBO group, and 36.7% (11/30) in the control group. No statistical difference was showen between the two QBO treated groups (P > 0.05), but that in both of them was significantly different from that in the control group (P < 0.05). PASI scores lowered after treatment in all the three groups (P < 0.01), but the improvement in the two QBO groups was better than that in the control group (P < 0.05); the conditions of skin lesion were improved in all groups, but the improvements were more significant in the two QBO groups in terms of squama, infiltration and itching (P < 0.05), in aspects of improving time on erythema, infiltration and itching, especially the itching, F-QBO was superior to the C-QBO. Experimental study 1: The mitosis index in both QBO groups was lower than that in the blank group and the model group (P < 0.01). Experimental study 2: Number of scales with granular layer formation was higher in the two QBO groups than in the blank group (P < 0.01). CONCLUSION: C-QBO and F-QBO can effectively relieve the skin lesion of psoriasis patients in the active stage of blood-heat type, and they could also promote the formation of epithelial granular layer in the caudal scales of mice.

Treatment of hyperhomocysteinemia and endothelial dysfunction in renal transplant recipients with B vitamins in the Chinese population.

PURPOSE: We studied the efficacy of B vitamins as a treatment for hyperhomocysteinemia and endothelial dysfunction in renal transplant recipients in the Chinese population. MATERIALS AND METHODS: A total of 36 stable renal transplant recipients with hyperhomocysteinemia were randomly assigned to folate treatment (5 mg folic acid per day, 50 mg vitamin B6 per day and 1,000 microg vitamin B12 per day) or to the control group (placebo only) for 6 months. All subjects underwent tests for creatinine, creatinine clearance rate, average blood pressure, total cholesterol, triglyceride and fasting homocysteine. Endothelial function was evaluated using high resolution vascular ultrasound. RESULTS: Homocysteine significantly decreased in those with folate treatment after intervention compared with baseline (12.6 +/- 3.9 vs 20.1 +/- 5.4 micromol/l, t = 5.3, p <0.01), whereas no significant changes were observed in controls. In the folate treatment group endothelium dependent and independent vasodilatation responses significantly increased after intervention (12.2% +/- 4.6% vs 8.8% +/- 5.2%, t = 2.9, p <0.01 and 17.6% +/- 3.9% vs 12.2% +/- 4.7%, t = 3.4, p <0.01, respectively). However, no significant changes were observed in controls. Endothelium dependent and independent vasodilatation responses were significantly lower in controls compared to levels in the folate group after treatment (8.7% +/- 6.3%, t = 2.8, p <0.01 and 12.2% +/- 5.3%, t = 3.5, p <0.01, respectively). CONCLUSIONS: Based on these data B vitamin supplementation may decrease blood homocysteine and improve endothelial function in renal transplant recipients with hyperhomocysteinemia.

Effect of Xiaobailing decoction on melanocytes in vitro.

OBJECTIVE: To observe the effect of xiaobailing decoction ([Chinese characters: see text) on murine melanocytes in vitro and to explore the mechanism of xiaobailing Decoction in the treatment of vitiligo. METHODS: B-16F10 murine melanoma cells were cultured in 1640 medium and treated respectively with different concentrations (1 mg/ml, 2 mg/ml, 3 mg/ml) of the Chinese drug xiaobailing Decoction and its main components, the drugs for replenishing the kidney-yang, and the drugs for nourishing blood and activating blood circulation, etc. for 7 days. MMT assay was used to determine the proliferation of B-16F10 murine melanoma cells. NaOH cleavage assay was adopted to measure the melanogenesis of melanocytes. RESULTS: xiaobailing Decoction, the drugs for replenishing the kidney-yang and the drugs for nourishing blood and activating blood circulation at different concentrations significantly improved the proliferation of B-16F10 murine melanoma cells from the 3rd day to the 5th day (P < 0.05), with xiaobailing Decoction at the concentrations of 1 mg/ml having the most distinct action on promoting the proliferation of melanocytes on the 3rd day (P < 0.001); And the drugs for replenishing the kidney-yang at the concentrations of 2 mg/ml and 3 mg/ml and the drugs for nourishing blood and activating blood circulation at 3 mg/ml significantly increased melanogenesis of melanocytes (P < 0.05). CONCLUSION: Xiaobailing Decoction can promote melanocytic proliferation and melanogenesis in vitro, and it is indicated that the drugs for replenishing the kidney-yang and the drugs for nourishing blood and activating blood circulation play an important role in treating vitiligo.

[Treatment of hyperhomocysteinemia and endothelial dysfunction in renal-transplant recipients with vitamin B].

OBJECTIVE: To study the effect of vitamin B on treatment of hyperhomocysteinemia and endothelial dysfunction in renal-transplant recipients. METHODS: Thirty-six stable hyperhomocysteinemic renal-transplant recipients were randomly assigned to vitamin treatment (group A, n = 18, folic acid 5 mg/d, vitamin B(6) 50 mg/d, B(12) 1000 microg/d) or controlled group (group B, n = 18) for 6 months. All subjects underwent assessment of levels for creatinine, creatinine clearance, average pressure, total cholesterol, triglyceride and fasting homocysteine. Endothelial function was evaluated using high-resolution vascular ultrasound. RESULTS: The levels of homocysteine markedly decreased in group A [(13 +/- 4) micromol/L vs (20 +/- 5) micromol/L, t = 5.3, P < 0.01] after treatment, whereas no significant changes were observed in group B. In group A, endothelium dependent [(12 +/- 5)% vs (9 +/- 5)%, t = 2.9, P < 0.01] and independent [(18 +/- 4)% vs (12 +/- 5)%, t = 3.4, P < 0.01] vasodilatation responses significantly increased after treatment, no significant changes were observed in group B. Endothelium dependent [(9 +/- 6)%, t = 2.8, P < 0.01] and independent [(12 +/- 5)%, t = 3.5, P < 0.01] vasodilatation responses of group A were significantly lower than that of group B after treatment. CONCLUSIONS: Vitamin B supplementation can reduce the levels of homocysteine and improve the endothelial function in hyperhomocysteinemic renal-transplant recipients.

Advances in experimental studies on treatment of psoriasis by traditional Chinese medicine.

Traditional Chinese medicine has demonstrated its strength in treating psoriasis, which is characterized by a variety of methods of treatment, flexible use of drugs, high efficacy, low recurrence, and few side-effects. Experimental studies on the mechanism governing the TCM treatment of psoriasis have been conducted at the cellular level and the molecular level. The studies on proliferation and differentiation of keratinocytes and the inhibitory effect against them, apoptosis, intercellular adhesion molecules, cytokine, and haemorheology indicate that the laboratory studies on the treatment of psoriasis have now entered a very high stage since the eighties. The studies on relationship between typing of psoriasis based on TCM differentiation of symptoms and signs and changes in some laboratory indexes have been carried out by some researchers to explore the inherent pathological changes in typing of psoriasis based on TCM differentiation of symptoms and signs and to provide scientific basis for the differentiation and typing under a unified standard. However, the present studies lack depth and scope in the methods. In future, the laboratory studies should be enhanced to go further into the principles governing the TCM treatment of psoriasis and to seek new drugs that will be even more effective for psoriasis and can bring its relapse under control.