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Iyo Yakakura Mutauro Model (LLM) inogona kunyora zvinyorwa zvinonyengetedza zvichibva pamashoko anokurumidza, kupasa bvunzo dzehunyanzvi, uye kunyora ruzivo rwemurwere uye rwetsitsi. Zvisinei, pamusoro penjodzi dzinozivikanwa dzenhema, fragility, uye chokwadi chisina kururama muLLM, dzimwe nyaya dzisina kugadziriswa zvishoma nezvishoma dziri kutariswa, dzakadai seAI modhi ine zvingangove zverusarura "hunhu hwevanhu" mukugadzira kwavo uye kushandiswa, uye kunyangwe kana LLM isingachagadziri zvemukati uye kubvisa zvakajeka zvinokuvadza zvinobuda, "LLM tsika" inogona kuramba ichiderera.

Mienzaniso isingaverengeki inoratidza kuti data rinoshandiswa kudzidzisa maAI modhi rinoisa sei hunhu hwemunhu uye hwemagariro, hunogona kusimba mukati memuenzaniso. Iyi mienzaniso inosanganisira huwandu hwemashandisirwo, kusanganisira kududzira otomatiki kwechifuva X-rays, kupatsanurwa kwezvirwere zveganda, uye algorithmic kuita sarudzo maererano nekugovewa zviwanikwa zvekurapa. Sezvakataurwa mune imwe nyaya ichangoburwa mujenari redu, data rekudzidzisa rakarerekera rinogona kukwidziridza nekuburitsa hunhu nekusarura kunowanikwa munharaunda. Kusiyana neizvi, tsvagiridzo yakaratidzawo kuti AI inogona kushandiswa kuderedza kusarura. Semuenzaniso, vatsvakurudzi vakashandisa maitiro ekudzidza kwakadzama kumabvi e-ray-ray mafirimu uye vakawana zvinhu zvakarasikirwa nezviratidzo zvakakomba (zvakagadziriswa neradiologists) mukati mekubatana kwemabvi, nokudaro kuderedza kurwadza kusingatsananguriki kusiyana pakati pevatema nevachena.

Kunyangwe vanhu vazhinji vachiona kurerekera mumhando dzeAI, kunyanya maererano nedhata rekudzidzisa, mamwe akawanda ekupinda mapoinzi ehunhu hwevanhu haana kupihwa tarisiro yakakwana mukusimudzira uye kutumira maitiro emhando dzeAI. Medical AI ichangobva kuwana mhedzisiro inokatyamadza, asi kusvika pamwero mukuru, haina kunyatso funga nezvehukoshero hwevanhu uye kudyidzana kwavo nekuongororwa kwengozi uye kufunga kwekufungidzira, uye haina kuenzanisirwa.

Kuti uwedzere pfungwa idzi dzisinganzwisisiki, fungidzira kuti iwe uri endocrinologist uyo anodiwa kuti anyore recombinant yekukura kwehomoni kumukomana ane makore masere ari pasi pe 3rd percentile yezera rake. Mukomana akakurudzira kukura kwevanhu hormone level iri pasi pe2 ng/mL (reference value,> 10 ng/mL, reference value yenyika dzakawanda kunze kweUnited States is> 7 ng/mL), uye kukura kwake kwehomoni coding gene yakaona zvisingawanzo shanduka. Isu tinotenda kuti kushandiswa kwekukura kwehomoni yekurapa kuri pachena uye hakupokane mune iyi kiriniki.

Kushandiswa kwevanhu kukura hormone therapy mumamiriro ezvinhu anotevera kunogona kukonzera kukakavara: 14-year-old boy urefu hwagara huri mu 10th percentile yevezera rake, uye kukwirira kwehomoni yekukura kwevanhu mushure mekusimudzira ndeye 8 ng / mL. Iko hakuna kunozivikanwa kuchinja kwekushanda kunogona kukanganisa kureba, kana zvimwe zvinozivikanwa zvikonzero zvehupfupi, uye zera rake remapfupa ane makore gumi nemashanu (kureva kuti hapana kunonoka kwekukura). Chikamu chega chega chegakava chinokonzeresa mutsauko uri pachikumbaridzo chakatemwa nenyanzvi zvichibva pazvidzidzo zvakawanda zvine chekuita nekukura kwehomoni mazinga anoshandiswa pakuongorora kushomeka kwehomoni. Kunenge kukakavara kwakawanda kunobva panjodzi yekubatsirwa kwekushandisa kurapa kwevanhu kukura kwehomoni kubva pamaonero evarwere, vabereki vane murwere, vashandi vehutano, makambani emishonga, uye vanobhadhara. Vana endocrinologists vanogona kuyera zvisingawanzo kuipa mhedzisiro yemazuva ese majekiseni ekukura kwehomoni ye2 makore ane mukana wekuti kwete kana kungoita kushoma kukura kwekukura kwemuviri wevakuru kana uchienzaniswa nezvino. Vakomana vanogona kutenda kuti kunyange kana kureba kwavo kuchingowedzera ne 2 cm, zvakakosha kupinza kukura kwehomoni, asi mubhadharo uye kambani yemishonga inogona kubata maonero akasiyana.

Isu tinotora creatinine yakavakirwa eGFR semuenzaniso, inova inonyanya kushandiswa renal basa chiratidzo chekuongorora uye kuronga chirwere cheitsvo chisingaperi, kuisa itsvo kutapurirana kana kupa mamiriro ekupa, nekuona maitiro ekudzikisa uye contraindication kune akawanda emishonga zvinodhaka. EGFR iri nyore regression equation inoshandiswa kufungidzira kuyerwa kweglomerular filtration rate (mGFR), inova muyero wereferensi, asi nzira yekuongorora inonetsa. Iyi regression equation haigone kutorwa seye AI modhi, asi inoratidza misimboti yakawanda pamusoro pehunhu hwevanhu uye zvingangoitika kufunga.

Yekutanga yekupinda poindi yehunhu hwevanhu kupinda eGFR ndeye pakusarudza data yekukodzera equations. Mutsetse wepakutanga wakashandiswa kugadzira iyo eGFR fomula kazhinji inoumbwa nevatori vechikamu vatema nevachena, uye kushanda kwayo kune mamwe madzinza mazhinji hakuna kujeka. Izvo zvinotevera zvinopinda zvehutsika hwevanhu mune iyi fomula zvinosanganisira: kusarudza mGFR kunyatsoita sechinangwa chekutanga chekuongorora kushanda kweitsvo, chii chinogamuchirika mwero wekururama, maitiro ekuyera kurongeka, uye kushandisa eGFR sechikumbaridzo chekukonzera kukiriniki kuita sarudzo (zvakadai sekutarisa mamiriro eitsvo kutapurirana kana kuraira mishonga). Chekupedzisira, pakusarudza zviri mukati meiyo modhi yekupinza, hunhu hwevanhu hunozopindawo iyi fomula.

Semuyenzaniso, gore ra2021 risati rasvika, nhungamiro dzinokurudzira kugadzirisa mazinga e creatinine muEGFR fomula zvichienderana nezera remurwere, murume kana mukadzi, uye rudzi (zvinongorondedzerwa sevanhu vatema kana vasiri vatema). Kugadziriswa kwakavakirwa pamujaho wakanangana nekuvandudza kurongeka kwefomula yemGFR, asi muna 2020, zvipatara zvikuru zvakatanga kusava nechokwadi nekushandiswa kweGFR yerudzi, zvichipa zvikonzero zvakaita sekunonotsa kukodzera kwemurwere kuisirwa uye nhangemutange senge pfungwa yebiology. Tsvagiridzo yakaratidza kuti kugadzira eGFR modhi maererano nenhangemutange kunogona kuve kwakadzama uye kwakasiyana maitiro pakurongeka uye nemhedzisiro yekiriniki; Naizvozvo, kusarudza kutarisisa pane chokwadi kana kutarisa pane chimwe chikamu chemhedzisiro kunoratidza kukosha kwekutonga uye kunogona kuvharidzira kuita sarudzo kwakajeka. Pakupedzisira, boka renyika rinoshanda rakakurudzira fomula itsva iyo yakagadziridzwa pasina kufunga nezvemujaho kuti ienzanise mashandiro uye nyaya dzekururamisira. Uyu muenzaniso unoratidza kuti kunyange nzira yekiriniki yakapfava ine akawanda ekupinda muhunhu hwevanhu.

Kuenzaniswa nemakiriniki mafomula ane nhamba diki chete yezviratidzo zvekufungidzira, LLM inogona kunge iine mabhiriyoni kusvika kumazana emabhiriyoni emaparamita (yemuenzaniso uremu) kana kupfuura, zvichiita kuti zviome kunzwisisa. Chikonzero nei tichiti "zvakaoma kunzwisisa" ndechekuti muLLM zhinji, nzira chaiyo yekupa mhinduro kuburikidza nekubvunza haigone kurongwa. Huwandu hwema paramita eGPT-4 haisati yaziviswa; Yakatangira GPT-3 yaive ne175 bhiriyoni paramita. Mamwe maparameter haarevi kugona kwakasimba, semamodheru madiki anosanganisira akawanda macomputer cycles (seye LLaMA [Large Language Model Meta AI] modhi series) kana modhi dzakanyatsorongeka zvichibva pamhinduro dzevanhu dzinoita zvirinani pane mamodheru makuru. Semuenzaniso, maererano nevanoongorora vanhu, iyo InstrumentGPT modhi (modhi ine 1.3 bhiriyoni paramita) inokunda GPT-3 mukugadzirisa maitiro ekubuda.

Iwo chaiwo ruzivo rwekudzidziswa kweGPT-4 haasati aburitswa, asi ruzivo rwemamodhi echizvarwa chakapfuura anosanganisira GPT-3, InstrumentGPT, uye mamwe akawanda akavhurika-source maLLM aburitswa. Mazuva ano, akawanda maAI modhi anouya nemakadhi emuenzaniso; Iyo yekuongorora uye yekuchengetedza data yeGPT-4 yakaburitswa mune yakafanana system kadhi yakapihwa nekambani yekugadzira modhi OpenAI. Kusikwa kweLLM kunogona kukamurwa kuita nhanho mbiri: yekutanga nhanho yekudzidzira uye nhanho yekumisikidza yakanangana nekugonesa mhedzisiro yemuenzaniso. Muchikamu chekutanga chekudzidzira, modhi inopihwa yakakura corpus kusanganisira iyo yepakutanga zvinyorwa zveInternet kuidzidzisa kufanotaura izwi rinotevera. Iyi inoita seyakapusa "kupedzisa otomatiki" maitiro anoburitsa yakasimba yekutanga modhi, asi inogona zvakare kutungamira kune inokuvadza maitiro. Hunhu hwevanhu huchapinda mudanho rekutanga kudzidziswa, kusanganisira kusarudza pre-training data yeGPT-4 uye kusarudza kubvisa zvisina kufanira zvemukati senge zvinonyadzisira zvemukati kubva kune pre kudzidziswa data. Zvisinei nekuedza uku, iyo yekutanga modhi inogona kunge ichiri kusashanda kana kukwanisa kuve nezvinokuvadza zvinobuda. Muchikamu chinotevera chekugadzirisa zvakanaka, maitiro akawanda anobatsira uye asingakuvadzi achabuda.

Muchikamu chekugadzirisa zvakanaka, maitiro emhando dzemitauro anowanzo kushandurwa zvakanyanya kuburikidza nekutarisa kwakaringana nekusimbisa kudzidza kunoenderana nemhinduro dzevanhu. Muchikamu chinotariswa chekugadzirisa zvakanaka, vashandi vekondirakiti vakahaiwa vanonyora mienzaniso yekupindura mazwi ekukurumidza uye kudzidzisa modhi yacho zvakananga. Munhanho yekudzidzira yekusimbisa zvichienderana nemhinduro dzevanhu, vaongorori vevanhu vanogadzirisa zvinobuda zvemodhi semienzaniso yezvinyorwa zvemukati. Wobva washandisa mhedzisiro yekuenzanisa iri pamusoro kuti udzidze "mubairo modhi" uye nekuwedzera kunatsiridza modhi kuburikidza nekusimbisa kudzidza. Zvinoshamisa zvakaderera-nhanho kubatanidzwa kwevanhu kunogona kukwenenzvera aya mamodheru makuru. Semuyenzaniso, iyo InstrumentGPT modhi yakashandisa chikwata chevashandi vekondirakiti vangangosvika makumi mana vakatorwa kubva kumawebhusaiti ekuunganidza vanhu uye vakapasa bvunzo yekuongorora yakanangana nekusarudza boka revanozivisa vanokoshesa zvido zvemapoka akasiyana ehuwandu.

Sezvo iyi mienzaniso miviri yakanyanyisa, iyo iri nyore yekiriniki fomula [eGFR] uye ine simba LLM [GPT-4], inoratidza, kuita sarudzo dzevanhu uye hunhu hwevanhu zvinotora basa rinokosha mukuumba zvinobuda modhi. Aya maAI modhi anogona kutora avo akasiyana siyana murwere uye chiremba kukosha? Nzira yekutungamira sei pachena kushandiswa kweAI mukurapa? Sezvataurwa pazasi, kuongororwazve kwekuongorora sarudzo yekurapa kunogona kupa mhinduro ine musimboti kune idzi nyaya.

Kuongororwa kwechisarudzo chekurapa hakuzivikanwi kune varapi vakawanda, asi kunogona kusiyanisa pakati pemafungiro ekufungidzira (nekuda kwemigumisiro isina chokwadi ine chokuita nekuita zvisarudzo, zvakadai sekutonga hormone yekukura kwevanhu mune imwe nharo yekiriniki yekiriniki inoratidzwa mumufananidzo 1) uye kufunga zvinhu (nokuda kwehutsika hunobatanidzwa kune izvi migumisiro, iyo inokosha inotaridzirwa se "kukosha kwehutano hwehurume") nokuda kwezvisarudzo zvakaoma zvekurapa. Mukuongorora kwechisarudzo, varapi vanofanira kutanga vaona sarudzo dzese dzinobvira uye zvingangoitika zvine chekuita nemhedzisiro yega yega, vozobatanidza murwere (kana imwe bato) zvinoshandiswa zvine chekuita nemhedzisiro yega yega kuti vasarudze sarudzo yakakodzera kwazvo. Nokudaro, kutendeseka kwekuongorora kwechisarudzo kunobva pakuti mhedzisiro yemigumisiro yakazara, uyewo kana kuyerwa kwekushandiswa uye kufungidzira kwezvingabvira kwakarurama. Nenzira yakanaka, iyi nzira inobatsira kuve nechokwadi chekuti sarudzo dzine humbowo-uye dzakaenderana nezvinodiwa nemurwere, nekudaro ichidzikisa musiyano pakati pechinangwa che data uye hunhu hwemunhu. Iyi nzira yakaunzwa munharaunda yekurapa makumi akati wandei apfuura uye yakashandiswa kune mumwe murwere kuita sarudzo uye kuongororwa kwehutano hwehuwandu hwevanhu, sekupa kurudziro yekuongororwa cancer yegomarara kune ruzhinji.

Mukuongorora kwechisarudzo chekurapa, nzira dzakasiyana-siyana dzakagadzirwa kuti uwane utility. Nzira dzakawanda dzechinyakare dzinowana kukosha kubva kuvarwere vega. Nzira iri nyore ndeyekushandisa chiyero chekuyera, apo varwere vanoongorora nhanho yavo yekuda kune imwe mhedzisiro pachiyero chedhijitari (yakadai seyero mutsara kubva ku1 kusvika ku10), ine hutano hwakanyanya mhedzisiro (sehutano hwakakwana uye rufu) iri pamativi ese ari maviri. Nzira yekuchinjana nguva ndiyo imwe nzira inowanzoshandiswa. Munzira iyi, varwere vanofanira kuita chisarudzo pamusoro penguva yakawanda yehutano yavanoda kushandisa mukutsinhana kwenguva yehutano husina kunaka. Iyo yakajairwa nzira yekubhejera ndiyo imwe nzira inowanzoshandiswa yekuona utility. Nenzira iyi, varwere vanobvunzwa kuti ndezvipi zvezviviri zvavanosarudza: kana kurarama imwe nhamba yemakore muhutano hwemazuva ose nehumwe hunogona (p) (t), uye kutakura njodzi yekufa ne 1-p mukana; Pamwe ita chokwadi chekurarama kwemakore t pasi pemamiriro ehutano hwakasiyana. Bvunza varwere kakawanda pamap-values ​​akasiyana kusvika varatidza kusafarira chero sarudzo, kuitira kuti zvinoshandiswa zvinogona kuverengerwa zvichienderana nemhinduro dzemurwere.
Pamusoro penzira dzinoshandiswa kukwezva zvido zvemurwere wega wega, nzira dzakagadziridzwawo kuti dziwane utility kune huwandu hwevarwere. Kunyanya nhaurirano dzeboka (kuunza varwere pamwechete kuti vakurukure zvakaitika) zvinogona kubatsira kunzwisisa maonero avo. Kuti tikwanise kuunganidza zvinobatsira zveboka, nzira dzakasiyana-siyana dzakarongwa dzenhaurirano dzeboka dzakarongwa.
Mukuita, iyo yakananga sumo yekushandisa mune yekiriniki yekuongororwa uye nzira yekurapa inotora nguva yakawanda. Semhinduro, mibvunzo yeongororo inowanzogoverwa kune vanhu vakasarudzwa zvisina tsarukano kuti vawane zvibodzwa zvekushandisa padanho rehuwandu. Mimwe mienzaniso inosanganisira EuroQol 5-dimensional questionnaire, iyo 6-dimensional utility huremu fomu pfupi, Health Utility Index, uye Cancer Specific European Cancer Research and Treatment Organisation Quality of Life Questionnaire Core 30 chishandiso.