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This study aims to explore the feasibility and accuracy of utilizing large language models (LLMs) to assess the risk of bias (ROB) in cohort studies. We conducted a pilot and feasibility study in 30 cohort studies randomly selected from reference lists of published Cochrane reviews. We developed a structured prompt to guide the ChatGPT-4o, Moonshot-v1-128k, and DeepSeek-V3 to assess the ROB of each cohort twice. We used the ROB results assessed by three evidence-based medicine experts as the gold standard, and then we evaluated the accuracy of LLMs by calculating the correct assessment rate, sensitivity, specificity, and F1 scores for overall and item-specific levels. The consistency of the overall and item-specific assessment results was evaluated using Cohen’s kappa (κ) and prevalence-adjusted bias-adjusted kappa. Efficiency was estimated by the mean assessment time required. This study assessed three LLMs (ChatGPT-4o, Moonshot-v1-128k, and DeepSeek-V3) and revealed distinct performance across eight assessment items. Overall accuracy was comparable (80.8%–83.3%). Moonshot-v1-128k showed superior sensitivity in population selection (0.92 versus ChatGPT-4o’s 0.55, P < 0.001). In terms of F1 scores, Moonshot-v1-128k led in population selection (F = 0.80 versus ChatGPT-4o’s 0.67, P = 0.004). ChatGPT-4o demonstrated the highest consistency (mean κ = 96.5%), with perfect agreement (100%) in outcome confidence. ChatGPT-4o was 97.3% faster per article (32.8 seconds versus 20 minutes manually) and outperformed Moonshot-v1-128k and DeepSeek-V3 by 47–50% in processing speed. The efficient and accurate assessment of ROB in cohort studies by ChatGPT-4o, Moonshot-v1-128k, and DeepSeek-V3 highlights the potential of LLMs to enhance the systematic review process.
This study investigated the factors influencing the mental health of rural doctors in Hebei Province, to provide a basis for improving the mental health of rural doctors and enhancing the level of primary health care.
Background:
The aim of this study was to understand the mental health of rural doctors in Hebei Province, identify the factors that influence it, and propose ways to improve their psychological status and the level of medical service of rural doctors.
Methods:
Rural doctors from 11 cities in Hebei Province were randomly selected, and their basic characteristics and mental health status were surveyed via a structured questionnaire and the Symptom Checklist-90 (SCL-90). The differences between the SCL-90 scores of rural doctors in Hebei Province and the Chinese population norm, as well as the proportion of doctors with mental health problems, were compared. Logistic regression was used to analyse the factors that affect the mental health of rural doctors.
Results:
A total of 2593 valid questionnaires were received. The results of the study revealed several findings: the younger the rural doctors, the greater the incidence of mental health problems (OR = 0.792); female rural doctors were more likely to experience mental health issues than their male counterparts (OR = 0.789); rural doctors with disabilities and chronic diseases faced a significantly greater risk of mental health problems compared to healthy rural doctors (OR = 2.268); rural doctors with longer working hours have a greater incidence of mental health problems; and rural doctors with higher education backgrounds have a higher prevalence of somatization (OR = 1.203).
Conclusion:
Rural doctors who are younger, male, have been in medical service longer, have a chronic illness or disability, and have a high degree of education are at greater risk of developing mental health problems. Attention should be given to the mental health of the rural doctor population to improve primary health care services.
Clinical high risk for psychosis (CHR) is often managed with antipsychotic medications, but their effects on neurocognitive performance and clinical outcomes remain insufficiently explored. This study investigates the association between aripiprazole and olanzapine use and cognitive and clinical outcomes in CHR individuals, compared to those receiving no antipsychotic treatment.
Methods
A retrospective analysis was conducted on 127 participants from the Shanghai At Risk for Psychosis (SHARP) cohort, categorized into three groups: aripiprazole, olanzapine, and no antipsychotic treatment. Neurocognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were assessed through the Structured Interview for Prodromal Syndromes (SIPS) at baseline, 8 weeks, and one year.
Results
The non-medicated group demonstrated greater improvements in cognitive performance, clinical symptoms, and functional outcomes compared to the medicated groups. Among the antipsychotic groups, aripiprazole was associated with better visual learning outcomes than olanzapine. Improvements in neurocognition correlated significantly with clinical symptom relief and overall functional gains at follow-up assessments.
Conclusions
These findings suggest potential associations between antipsychotic use and cognitive outcomes in CHR populations while recognizing that observed differences may reflect baseline illness severity rather than medication effects alone. Aripiprazole may offer specific advantages over olanzapine, underscoring the importance of individualized risk-benefit evaluations in treatment planning. Randomized controlled trials are needed to establish causality.
The sulphur microbial diet (SMD), a dietary pattern associated with forty-three sulphur-metabolising bacteria, may influence gut microbiota composition and contribute to ageing process through gut-produced hydrogen sulfide (H2S). We aimed to explore the association between SMD and biological age (BA) acceleration, using the cross-sectional study that included 71 579 individuals from the UK Biobank. The SMD score was calculated by multiplying β-coefficients by corresponding serving sizes and summing them, based on dietary data collected using the Oxford WebQ, a 24-hour dietary assessment tool. BA was assessed using Klemerae–Doubal (KDM) and PhenoAge methods. The difference between BA and chronological age refers to the age acceleration (AgeAccel), termed ‘KDMAccel’ and ‘PhenoAgeAccel’. Generalised linear regression was performed. Mediation analyses were used to investigate underlying mediators including BMI and serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio. Following adjustment for multiple variables, a positive association was observed between consuming a dietary pattern with a higher SMD score and both KDMAccel (βQ4 v. Q1 = 0·35, 95 % CI = 0·27, 0·44, P < 0·001) and PhenoAgeAccel (βQ4 v. Q1 = 0·32, 95 % CI = 0·23, 0·41, P < 0·001). Each 1-SD increase in SMD score was positively associated with the acceleration of BA by 7·90 % for KDMAccel (P < 0·001) and 7·80 % for PhenoAgeAccel (P < 0·001). BMI and AST/ALT mediated the association. The stratified analysis revealed stronger accelerated ageing impacts in males and smokers. Our study indicated a higher SMD score is associated with elevated markers of biological ageing, supporting the potential utility of gut microbiota-targeted dietary interventions in attenuating the ageing process.
This study evaluated the effects of chenodeoxycholic acid (CDCA), a farnesoid X receptor (FXR) potential activator, on growth performance, antioxidant capacity, glucose metabolism and inflammation in largemouth bass (Micropterus salmoides) (initial body weight: 5·45 ± 0·02 g) fed a high-carbohydrate diet. Experimental diets included a positive control (5 % α-starch), a negative control (10 % α-starch) and two diets containing 10 % α-starch supplemented with either 0·05 % or 0·10 % CDCA. After 8 weeks, the high-carbohydrate diet reduced growth performance and increased hepatosomatic and viscerosomatic indexes, which were mitigated by 0·10 % CDCA supplementation. The high-carbohydrate diet also increased hepatic glycogen and crude lipid content, both of which were reduced by 0·10 % CDCA. Furthermore, the high-carbohydrate diet-induced oxidative stress, histopathological changes and reduced liver lysozyme activity, which were ameliorated by CDCA supplementation. Molecular analysis showed that the high-carbohydrate diet suppressed FXR and phosphorylated AKT1 (p-AKT1) protein expression in the liver, downregulated insulin signalling (ira, irs, pi3kr1 and akt1), gluconeogenesis (pepck and g6pc) and glycolysis genes (gk, pk and pfkl). CDCA supplementation upregulated fxr expression, activated shp, enhanced the expression of insulin signalling and glycolytic genes (gk, pk and pfkl) and inhibited gluconeogenesis. Additionally, CDCA reduced inflammatory markers (nf-κb and il-1β) and restored anti-inflammatory mediators (il-10, iκb and tgf-β). In conclusion, 0·10 % CDCA improved carbohydrate metabolism and alleviated liver inflammation in largemouth bass fed a high dietary carbohydrate, partially through FXR activation.
Depressive and anxiety disorders constitute a major component of the disease burden of mental disorders in China.
Aims
To comprehensively evaluate the disease burden of depressive and anxiety disorders in China.
Method
The raw data is sourced from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. This study presented the disease burden by prevalence and disability-adjusted life years (DALYs) of depressive and anxiety disorders at both the national and provincial levels in China from 1990 to 2021, and by gender (referred to as 'sex' in the GBD 2021) and age.
Results
From 1990 to 2021, the number of depressive disorder cases (from 34.4 to 53.1 million) and anxiety disorders (from 40.5 to 53.1 million) increased by 54% (95% uncertainty intervals: 43.9, 65.3) and 31.2% (19.9, 43.8), respectively. The age-standardised prevalence rate of depressive disorders decreased by 6.4% (2.9, 10.4), from 3071.8 to 2875.7 per 100 000 persons, while the prevalence of anxiety disorders remained stable. COVID-19 had a significant adverse impact on both conditions. There was considerable variability in the disease burden across genders, age groups, provinces and temporal trends. DALYs showed similar patterns.
Conclusion
The burden of depressive and anxiety disorders in China has been rising over the past three decades, with a larger increase during COVID-19. There is notable variability in disease burden across genders, age groups and provinces, which are important factors for the government and policymakers when developing intervention strategies. Additionally, the government and health authorities should consider the potential impact of public health emergencies on the burden of depressive and anxiety disorders in future efforts.
The paper presents a novel control method aimed at enhancing the trajectory tracking accuracy of two-link mechanical systems, particularly nonlinear systems that incorporate uncertainties such as time-varying parameters and external disturbances. Leveraging the Udwadia–Kalaba equation, the algorithm employs the desired system trajectory as a servo constraint. First, the system’s constraints to construct its dynamic equation and apply generalized constraints from the constraint equation to an unconstrained system. Second, we design a robust approximate constraint tracking controller for manipulator control and establish its stability using Lyapunov’s law. Finally, we numerically simulate and experimentally validate the controller on a collaborative platform using model-based design methods.
Rapid advancements in high-energy ultrafast lasers and free electron lasers have made it possible to obtain extreme physical conditions in the laboratory, which lays the foundation for investigating the interaction between light and matter and probing ultrafast dynamic processes. High temporal resolution is a prerequisite for realizing the value of these large-scale facilities. Here, we propose a new method that has the potential to enable the various subsystems of large scientific facilities to work together well, and the measurement accuracy and synchronization precision of timing jitter are greatly improved by combining a balanced optical cross-correlator (BOC) with near-field interferometry technology. Initially, we compressed a 0.8 ps laser pulse to 95 fs, which not only improved the measurement accuracy by 3.6 times but also increased the BOC synchronization precision from 8.3 fs root-mean-square (RMS) to 1.12 fs RMS. Subsequently, we successfully compensated the phase drift between the laser pulses to 189 as RMS by using the BOC for pre-correction and near-field interferometry technology for fine compensation. This method realizes the measurement and correction of the timing jitter of ps-level lasers with as-level accuracy, and has the potential to promote ultrafast dynamics detection and pump–probe experiments.
In this study, nine isonitrogenous experimental diets containing graded levels of carbohydrates (40 g/kg, 80 g/kg and 120 g/kg) and crude lipids (80 g/kg, 120 g/kg and 160 g/kg) were formulated in a two-factor (3 × 3) orthogonal design. A total of 945 mandarin fish with similar body weights were randomly assigned to twenty-seven tanks, and the experiment diets were fed to triplicate tanks twice daily for 10 weeks. Results showed that different dietary treatments did not significantly affect the survival rate and growth performance of mandarin fish. However, high dietary lipid and carbohydrate levels significantly decreased the protein content of the whole body and muscle of cultured fish. The lipid content of the whole body, liver and muscle all significantly increased with increasing levels of dietary lipid, while only liver lipid level was significantly affected by dietary carbohydrate level. Hepatic glycogen content increased significantly with increasing dietary carbohydrate levels. As to liver antioxidant capacity, malondialdehyde content increased significantly with increasing dietary lipid or carbohydrate content, and catalase activity showed an opposite trend. Superoxide dismutase activity increased significantly with increasing levels of dietary lipid but decreased first and then increased with increasing dietary carbohydrate levels. Additionally, the increase in both dietary lipid and carbohydrate levels resulted in a significant reduction in muscle hardness. Muscle chewiness, gumminess and shear force were only affected by dietary lipid levels and decreased significantly with increasing dietary lipid levels. In conclusion, considering all the results, the appropriate dietary lipids and carbohydrate levels for mandarin fish were 120 g/kg and 80 g/kg, respectively.
Compacted bentonite, used as an engineering barrier for permanent containment of high-level radioactive waste, is susceptible to mineral evolution resulting in compromise of the expected barrier performance due to alkaline–thermal chemical interaction in the near-field. To elucidate the mineral-evolution mechanisms within bentonite and the transformation of the nuclide adsorption properties during that period, experimental evolution of bentonite was conducted in a NaOH solution with a pH of 14 at temperatures ranging from 60 to 120°C. The results showed that temperature significantly affects the stability of minerals in bentonite under alkali conditions. The dissolution rate of fine-grained cristobalite in bentonite exceeds that of smectite, with the phase-transition products of smectite being temperature-dependent. As the temperature rises, smectite experiences a three-stage transformation: initially, at 60°C, the lattice structure thins due to the collapse of the octahedral sheets; at 80°C, the lattice disintegrates and reorganizes into a loose framework akin to albite; and by 100°C, it further reorganizes into a denser framework resembling analcime. The adsorption properties of bentonite exhibit a peak inflection point at 80°C, where the dissolution of the smectite lattice eliminates interlayer pores and exposes numerous polar or negatively charged sites which results in a decrease in specific surface area and an increase in cation exchange capacity and adsorption capacity of Eu3+. This research provides insights into the intricate evolution of bentonite minerals and the associated changes in radionuclide adsorption capacity, contributing to a better understanding of the stability of bentonite barriers and the effective long-term containment of nuclear waste.
We aimed to evaluate the association of coffee consumption with different additives, including milk and/or sweetener (sugar and/or artificial sweetener), and different coffee types, with new-onset acute kidney injury (AKI), and examine the modifying effects of genetic variation in caffeine metabolism. 194 324 participants without AKI at baseline in the UK Biobank were included. The study outcome was new-onset AKI. During a median follow-up of 11·6 years, 5864 participants developed new-onset AKI. Compared with coffee non-consumers, a significantly lower risk of new-onset AKI was found in coffee consumers adding neither milk nor sugar to coffee (hazard ratio (HR), 0·86; 95 % CI, 0·78, 0·94) and adding only milk to coffee (HR,0·83; 95 % CI, 0·78, 0·89), but not in coffee consumers adding only sweetener (HR,1·14; 95 % CI, 0·99, 1·31) and both milk and sweetener to coffee (HR,0·96; 95 % CI, 0·89, 1·03). Moreover, there was a U-shaped association of coffee consumption with new-onset AKI, with the lowest risk at 2–3 drinks/d, in unsweetened coffee (no additives or milk only to coffee), but no association was found in sweetened coffee (sweetener only or both milk and sweetener to coffee). Genetic variation in caffeine metabolism did not significantly modify the association. A similar U-shaped association was found for instant, ground and decaffeinated coffee consumption in unsweetened coffee consumers, but not in sweetened coffee consumers. In conclusion, moderate consumption (2–3 drinks/d) of unsweetened coffee with or without milk was associated with a lower risk of new-onset AKI, irrespective of coffee type and genetic variation in caffeine metabolism.
This research communication screened and identified differentiated expressed genes in bovine mammary epithelial cells (BMECs) upon prolactin (PRL) stimulation. PRL of 5 μg/ml increased β-casein synthesis in BMECs with milk protein synthesis capacity. RNA sequencing (RNA-seq) was used to screen differentially expressed genes (DEGs). A total of 375 DEGs (165 up-regulated and 210 down-regulated) were identified between PRL-stimulated group and the control group. Gene ontology enrichment analysis showed that the up-regulated genes were primarily associated with cell functions, metabolic processes, and biological regulatory processes. Pathway enrichment analysis showed that the up-regulated genes were mainly enriched in JAK-STAT, Rap1, Ras and Notch signaling pathways, which are widely involved in cell proliferation, differentiation and milk component synthesis. This study provides an initial understanding of the changes in gene expression in BMECs with PRL-stimulation, as determined by RNA-seq transcriptomic analysis, thereby enhancing our knowledge of the molecular regulation of lactation metabolism.
This paper retrospectively analysed the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in some parts of China. Between January 2013 and December 2019, we collected 4,145 respiratory samples, including pharyngeal swabs and alveolar lavage fluid. The highest PCR-positive rate of M. pneumoniae was 74.5% in Beijing, the highest resistance rate was 100% in Shanghai, and Gansu was the lowest with 20%. The highest PCR-positive rate of M. pneumoniae was 74.5% in 2013, and the highest MRMP was 97.4% in 2019; the PCR-positive rate of M. pneumoniae for adults in Beijing was 17.9% and the MRMP was 10.48%. Among the children diagnosed with community-acquired pneumonia (CAP), the PCR-positive and macrolide-resistant rates of M. pneumoniae were both higher in the severe ones. A2063G in domain V of 23S rRNA was the major macrolide-resistant mutation, accounting for more than 90%. The MIC values of all MRMP to erythromycin and azithromycin were ≥ 64 μg/ml, and the MICs of tetracycline and levofloxacin were ≤ 0.5 μg/ml and ≤ 1 μg/ml, respectively. The macrolide resistance varied in different regions and years. Among inpatients, the macrolide-resistant rate was higher in severe pneumonia. A2063G was the common mutation, and we found no resistance to tetracycline and levofloxacin.
Amygdala subregion-based network dysfunction has been determined to be centrally implicated in major depressive disorder (MDD). Little is known about whether ketamine modulates amygdala subarea-related networks. We aimed to investigate the relationships between changes in the resting-state functional connectivity (RSFC) of amygdala subregions and ketamine treatment and to identify important neuroimaging predictors of treatment outcomes.
Methods
Thirty-nine MDD patients received six doses of ketamine (0.5 mg/kg). Depressive symptoms were assessed, and magnetic resonance imaging (MRI) scans were performed before and after treatment. Forty-five healthy controls underwent one MRI scan. Seed-to-voxel RSFC analyses were performed on the amygdala subregions, including the centromedial amygdala (CMA), laterobasal amygdala (LBA), and superficial amygdala subregions.
Results
Abnormal RSFC between the left LBA and the left precuneus in MDD patients is related to the therapeutic efficacy of ketamine. There were significant differences in changes in bilateral CMA RSFC with the left orbital part superior frontal gyrus and in changes in the left LBA with the right middle frontal gyrus between responders and nonresponders following ketamine treatment. Moreover, there was a difference in the RSFC of left LBA and the right superior temporal gyrus/middle temporal gyrus (STG/MTG) between responders and nonresponders at baseline, which could predict the antidepressant effect of ketamine on Day 13.
Conclusions
The mechanism by which ketamine improves depressive symptoms may be related to its regulation of RSFC in the amygdala subregion. The RSFC between the left LBA and right STG/MTG may predict the response to the antidepressant effect of ketamine.
Collaborative robots are becoming intelligent assistants of human in industrial settings and daily lives. Dynamic model identification is an active topic for collaborative robots because it can provide effective ways to achieve precise control, fast collision detection and smooth lead-through programming. In this research, an improved iterative approach with a comprehensive friction model for dynamic model identification is proposed for collaborative robots when the joint velocity, temperature and load torque effects are considered. Experiments are conducted on the AUBO I5 collaborative robots. Two other existing identification algorithms are adopted to make comparison with the proposed approach. It is verified that the average error of the proposed I-IRLS algorithm is reduced by over 14% than that of the classical IRLS algorithm. The proposed I-IRLS method can be widely used in various application scenarios of collaborative robots.
Cryo-electron microscopy (cryo-EM) is an imaging technique that allows the visualization of proteins and macromolecular complexes at near-atomic resolution. The low electron doses used to prevent radiation damage to the biological samples result in images where the power of noise is 100 times stronger than that of the signal. Accurate identification of proteins from these low signal-to-noise ratio (SNR) images is a critical task, as the detected positions serve as inputs for the downstream 3D structure determination process. Current methods either fail to identify all true positives or result in many false positives, especially when analyzing images from smaller-sized proteins that exhibit extremely low contrast, or require manual labeling that can take days to complete. Acknowledging the fact that accurate protein identification is dependent upon the visual interpretability of micrographs, we propose a framework that can perform denoising and detection in a joint manner and enable particle localization under extremely low SNR conditions using self-supervised denoising and particle identification from sparsely annotated data. We validate our approach on three challenging single-particle cryo-EM datasets and projection images from one cryo-electron tomography dataset with extremely low SNR, showing that it outperforms existing state-of-the-art methods used for cryo-EM image analysis by a significant margin. We also evaluate the performance of our algorithm under decreasing SNR conditions and show that our method is more robust to noise than competing methods.
This paper proposes a robust control approach to achieve high-precision trajectory tracking for permanent magnet linear motor (PMLM) system containing uncertainties by describing the dynamic model of PMLM based on the Udwadia-Kalaba equation combined with constraint-following method. First, the system of PMLM is described as a constraint-following system by adding the generalized constraint force to the unconstrained Udwadia-Kalaba equation of PMLM system. Second, the robust constraint-following controller is designed based on the proposed model after uncertainty analysis. Moreover, the proposed controller is verified to guarantee deterministic performance for uncertain systems: uniformly bounded and uniformly ultimately bounded. Third, the numerical simulation and experimental validation demonstrate the effectiveness of proposed controller. Finally, the design approach of constraint-following can be applied to other systems with uncertainties.
A low-energy proton accelerator named pulsed synchronous linear accelerator (PSLA) is proposed and developed at the Institute of Fluid Physics, which is driven by unipolar-pulsed high voltages. Pulsed-accelerating electric fields and low-energy ion beams are precisely synchronized on temporal and spatial positions for continuous acceleration. The operating mode and the features of the PSLA are introduced. At present, the feasibility of a low-energy proton PSLA has been verified in principle. An average accelerating gradient up to 3 MV/m for protons is achieved.
Retropharyngeal lymphadenectomy is challenging. This study investigated a minimally invasive approach to salvage retropharyngeal lymphadenectomy in patients with nasopharyngeal carcinoma.
Methods
An anatomical study of four fresh cadaveric heads was conducted to demonstrate the relevant details of retropharyngeal lymphadenectomy using the endoscopic transoral medial pterygomandibular fold approach. Six patients with nasopharyngeal cancer with retropharyngeal lymph node recurrence, who underwent retropharyngeal lymphadenectomy with the endoscopic transoral medial pterygomandibular fold technique at the Eye and ENT Hospital of Fudan University from July to December 2021, were included in this study.
Results
The anatomical study demonstrated that the endoscopic transoral medial pterygomandibular fold approach offers a short path and minimally invasive approach to the retropharyngeal space. The surgical procedure was well tolerated by all patients, with no significant post-operative complications.
Conclusion
The endoscopic transoral medial pterygomandibular fold approach is safe and efficient for retropharyngeal lymphadenectomy.
This work characterizes the vanishing of the Fourier coefficients of all CM (Complex Multiplication) eta quotients. As consequences, we recover Serre’s characterization about that of $\eta(12z)^{2}$ and recent results of Chang on the pth coefficients of $\eta(4z)^{6}$ and $\eta(6z)^{4}$. Moreover, we generalize the results on the cases of weight 1 to the setting of binary quadratic forms.