Toward expert-level medical question answering with large language models.

Large language models (LLMs) have shown promise in medical question answering, with Med-PaLM being the first to exceed a 'passing' score in United States Medical Licensing Examination style questions. However, challenges remain in long-form medical question answering and handling real-world workflows. Here, we present Med-PaLM 2, which bridges these gaps with a combination of base LLM improvements, medical domain fine-tuning and new strategies for improving reasoning and grounding through ensemble refinement and chain of retrieval.

Safety and Efficacy of Remote Ischemic Conditioning in Patients With Intravenous Thrombolysis: The SERIC-IVT Trial.

Background: Approximately half of the patients with acute ischemic stroke who receive intravenous thrombolysis (IVT) do not achieve an excellent outcome. Remote ischemic conditioning (RIC) as a promising neuroprotective treatment may improve clinical outcomes in this population. This study aimed to assess the efficacy and safety of RIC in patients with IVT.

A Preclinical Immunogenicity Study of the Recombinant Human Papillomavirus Nine-Valent Virus-like Particle Vaccine.

Background: Cervical cancer is associated with persistent infection of high-risk human papillomaviruses (HPVs). Prophylactic HPV vaccines have been recommended and have significant efficacy in preventing cervical cancer. Multivalent HPV vaccines have a better preventative effect on HPV-related diseases.

A new class of penicillin-binding protein inhibitors to address drug-resistant .

β-Lactams are the most widely used antibiotics for the treatment of bacterial infections because of their proven track record of safety and efficacy. However, susceptibility to β-lactam antibiotics is continually eroded by resistance mechanisms. Emerging multidrug-resistant (MDR) strains possessing altered alleles (encoding PBP2) pose a global health emergency as they threaten the utility of ceftriaxone, the last remaining outpatient antibiotic.

Reaction kinetics and molecular characterization of the compounds formed by photosensitized degradation of the plastic additive bisphenol A in the atmospheric aqueous phase.

Bisphenol A (BPA, 4,4'-(propane-2,2-diyl)diphenol) is a common plasticizer that is very widespread in the environment and is also found at significant concentrations in the global oceans, due to contamination by plastics. Here we show that triplet sensitization is an important degradation pathway for BPA in natural surface waters, which could prevail if the water dissolved organic carbon is above 2-3 mg L. Bromide levels as per seawater conditions have the potential to slow down BPA photodegradation, a phenomenon that could not be offset by reaction of BPA with Br (second-order reaction rate constant of (2.

An antibody cocktail targeting two different CD73 epitopes enhances enzyme inhibition and tumor control.

CD73, an ectoenzyme responsible for adenosine production, is often elevated in immuno-suppressive tumor environments. Inhibition of CD73 activity holds great promise as a therapeutic strategy for CD73-expressing cancers. In this study, we have developed a therapeutic anti-human CD73 antibody cocktail, HB0045.

High Shear Stress Reduces ERG Causing Endothelial-Mesenchymal Transition and Pulmonary Arterial Hypertension.

Background: Computational modeling indicated that pathological high shear stress (HSS; 100 dyn/cm) is generated in pulmonary arteries (PAs; 100-500 µm) in congenital heart defects causing PA hypertension (PAH) and in idiopathic PAH with occlusive vascular remodeling. Endothelial-to-mesenchymal transition (EndMT) is a feature of PAH. We hypothesize that HSS induces EndMT, contributing to the initiation and progression of PAH.

Papillary Renal Neoplasm With Reverse Polarity: CT and MR Imaging Characteristics in 26 Patients.

Rationale And Objectives: To improve the diagnostic recognition of papillary renal neoplasm with reverse polarity (PRNRP) through comprehensive analysis of computed tomography (CT) and magnetic resonance imaging (MRI) findings.

Materials And Methods: A retrospective multi-center study was conducted on patients with pathologically confirmed PRNRPs from 2019 to 2024, encompassing six institutions. Clinical and pathological data were meticulously documented.

Hybrid integrated thin-film lithium niobate and a silicon carbide microcomb amplifier.

We demonstrate a hybrid integrated optical frequency comb amplifier composed of a silicon carbide microcomb and a lithium niobate waveguide amplifier, which generates a 10-dB on-chip gain for the C+L band microcombs under 1480-nm laser pumping and an 8-dB gain under 980-nm laser pumping. It will solve the problem of low output power of microcombs and can be applied in various scenarios such as optical communication, lidar, optical computing, astronomical detection, atomic clocks, and more.

Transcriptional Reprogramming Deploys a Compartmentalized 'Timebomb' in Catharanthus roseus to Fend Off Chewing Herbivores.

The evolutionary arms race between plants and insects has led to key adaptive innovations that drive diversification. Alkaloids are well-documented anti-herbivory compounds in plant chemical defences, but how these specialized metabolites are allocated to cope with both biotic and abiotic stresses concomitantly is largely unknown. To examine how plants prioritize their metabolic resources responding to herbivory and cold, we integrated dietary toxicity bioassay in insects with co-expression analysis, hierarchical clustering, promoter assay, and protein-protein interaction in plants.

An Integrated Whole-Process Repair System with Programmed Regulation of Healing Performance Facilitates Urethral Wound Restoration and Scarless Reconstruction.

The harsh microenvironment of the urethral injury often carries high risks of early undesirable healing as well as late scar tissue formation. Indeed, the infection and inflammatory response in the early stages as well as blood vessel formation and tissue regeneration in the later stages fundamentally impact the outcomes of urethral wound healing. Innovatively, an integrated whole-process repair hydrogel (APF/C/L@dECM) is designed.

Fracture Criterion Calibration and Finite Element Simulation in SUS304 Stainless Steel.

In order to calibrate the ductile fracture criterion in SUS304 stainless steel, four tensile samples were designed, their finite element models were established, and uniaxial tensile tests were carried out. The simulation results were compared with the tests. Due to the limitations of finite element software, only a few criteria can be solved in MENTAT of MSC.

Electrochemical reduction method for leaching terbium and cerium from waste phosphors.

Rare earth elements are commonly used in various fields due to their unique physical and chemical properties. Waste phosphors represent an important secondary source of rare earth elements, and their recovery is a crucial means of improving the utilization of these resources. When using FeCl as a reducing agent to reduce Tb and Ce from washed phosphors, a large amount of reducing agent is required, and the Fe cycle becomes complicated.

DCBLD1 Modulates Angiogenesis by Regulation of the VEGFR-2 Endocytosis in Endothelial Cells.

Background: Unwanted angiogenesis is involved in the progression of various malignant tumors and cardiovascular diseases, and the factors that regulate angiogenesis are potential therapeutic targets. We tested the hypothesis that DCBLD1 (discoidin, CUB, and LCCL domain-containing protein 1) is a coreceptor of VEGFR-2 (vascular endothelial growth factor receptor-2) and modulates angiogenesis in endothelial cells.

Methods: A carotid artery ligation model and retinal angiogenesis assay were used to study angiogenesis using globe knockout or endothelial cell-specific conditional knockout mice in vivo.

Dissolved organic carbon can alter coastal sediment phosphorus dynamic: Effects of different carbon forms and concentrations.

Coastal waters are receiving increasing loads of dissolved organic carbon (DOC), differing in structural complexity and molecular weights with potential different effects on the phosphorus (P) dynamics in these waters. This study conducted an in-situ investigation in Xiangshan Harbor, China, to explore the patterns of P release in response to DOC inputs. To further elucidate the underlying mechanisms behind the DOC-affected sediment P release, a two-month mesocosm experiment was undertaken with coastal sediment (Xiangshan Harbor) to which acetate, glucose, and humic acid (representing the fermentation product, the simple available carbon, and the refractory humic-like carbon sources, respectively) were separately added to the overlying water at dosages of 0, 5, 10, and 20 mg C L.

Imlunestrant with or without Abemaciclib in Advanced Breast Cancer.

Background: Imlunestrant is a next-generation, brain-penetrant, oral selective estrogen-receptor (ER) degrader that delivers continuous ER inhibition, even in cancers with mutations in the gene encoding ERα ().

Methods: In a phase 3, open-label trial, we enrolled patients with ER-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer that recurred or progressed during or after aromatase inhibitor therapy, administered alone or with a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor. Patients were assigned in a 1:1:1 ratio to receive imlunestrant, standard endocrine monotherapy, or imlunestrant-abemaciclib.

Endothelial FUNDC1 Deficiency Drives Pulmonary Hypertension.

Background: Pulmonary hypertension (PH) is associated with endothelial dysfunction. However, the cause of endothelial dysfunction and its impact on PH remain incompletely understood. We aimed to investigate whether the hypoxia-inducible FUNDC1 (FUN14 domain-containing 1)-dependent mitophagy pathway underlies PH pathogenesis and progression.

Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration.

To investigate how home optical coherence tomography (OCT) influences the clinical decision-making of retina specialists for the management of neovascular age-related macular degeneration (nAMD). In this retrospective imaging review, 15 retina specialists each evaluated 10 home OCT data segments from 29 eyes being treated for nAMD. Based on OCT data, indications were identified for when eyes should be treated, which antivascular endothelial growth factor should be used, and the specific retinal fluid and time thresholds for notification.

Association Between Time to Treatment and Outcomes of Endovascular Therapy vs Medical Management in Patients With Large Ischemic Stroke.

Background And Objectives: Randomized trials have proven the benefit of endovascular therapy (EVT) for acute large ischemic stroke. This study was to characterize the effect of time to treatment on benefit of EVT vs medical management (MM) among patients with large ischemic stroke.

Methods: This was a post hoc analysis of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core randomized trial.

Serum GFAP and UCH-L1 Levels for the Assessment of the Absence of Hemorrhagic Transformation: A Multicenter Prospective Cohort Study.

Background: Currently, validated biomarkers for assessing hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) are lacking. We aimed to validate a test combining GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin C-terminal hydrolase-L1) to indicate the absence of HT after IVT.

Methods: We prospectively enrolled consecutive patients with stroke treated with IVT from 16 hospitals.

Partial revision of Promalactis Meyrick (Lepidoptera: Oecophoridae), based on specimens deposited in the Natural History Museum, London.

Promalactis Meyrick, 1908 is one of the most diverse genera of Oecophoridae in the Old World with 407 previously accepted species. Ninety-three species of Promalactis Meyrick, 1908 (Oecophoridae) are here recognized based on the specimens in the collection of Natural History Museum, London. Among them, 33 species are described as new under the authorship of Wang: P.

Review of the wolf spider genus Xerolycosa Dahl, 1908 from China (Araneae: Lycosidae).

The wolf spider of genus Xerolycosa Dahl, 1908 from China is reviewed, including four species: X. miniata (C.L.

Pharmacokinetics of infigratinib and its active metabolites in Chinese patients with advanced gastric cancer harboring FGFR2 gene amplification.

Infigratinib, an FGFR1-3 selective oral tyrosine kinase inhibitor, has shown clinical activity in cancers with FGFR alterations. The pharmacokinetics (PK) of infigratinib and its major metabolites have been characterized in global populations. This study examined the PK profile of infigratinib and its metabolites in Chinese patients.