ObjectivesDepression and depressive symptoms are common mental disorders that have a considerable effect on patients’ health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaThe PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738.ResultsEighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ2=25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%).ConclusionOur study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial hete...

Background: Artificial intelligence (AI) is an increasingly popular tool in medical investigations.However, AI's potential of aiding medical teaching has not been explored. This study aimed to evaluate the effectiveness of AI-tutoring problem-based-learning (PBL) in ophthalmology clerkship and to assess the student evaluations of this module.Methods: Thirty-eight Grade-two students in ophthalmology clerkship at Sun Yat-Sen University were randomly assigned to two groups. In Group A, students learned congenital cataracts through an AI-tutoring PBL module by exploring and operating an AI diagnosis platform. In Group B, students learned congenital cataracts through traditional lecture given with the same faculty. The improvement in student performance was evaluated by comparing the pre-and post-lecture scores of a specific designed test using paired-T tests.Student evaluations of AI-tutoring PBL were measured by a 17-item questionnaire. Results:The post-lecture scores were significantly higher than the pre-lecture scores in both groups (Group A: P<0.0001, Group B: P<0.0001). The improvement of group A in the part of sign and diagnosis test (Part I) was more significant than that of group B (P=0.016). However, there was no difference in the improvement in the part of treatment plan test (Part II) between two groups (P=0.556). Overall, all respondents were satisfied and agreed that AI-tutoring PBL was helpful, effective, motive and beneficial to help develop critical and creative thinking. Conclusions:The application of AI-tutoring PBL into ophthalmology clerkship improved students' performance and satisfaction. AI-tutoring PBL teaching showed advantage in promoting students' understanding of signs of diseases. The instructors play an indispensable role in AI-tutoring PBL curriculum.

Polymorphism of HLA‐DRB1, DQB1 and DPB1 was revealed with a sequencing‐based typing (SBT) method in unrelated healthy volunteers from the Naxi ethnic group. Among the 43 DRB1 alleles detected, the most common allele was DRB1*12021 with a frequency of 17%, followed by DRB1*08032, DRB1*09012 and DRB1*1404 with frequencies of 8.5%, 7.4% and 7.4%, respectively. Among 23 DQB1 alleles detected, the most frequent DQB1 allele was DQB1*03011/0309 (21.9%), followed by DQB1*0502 (16.4%) and DQB1*05031 (9.6%). For the DPB1 locus, the most common alleles were DPB1*0501 (25.5%), DPB1*0402 (14.6%) and DPB1*02012 (12.0%). The most common DRB1‐DQB1‐DPB1 haplotype was DRB1*1404‐DQB1*05031‐DPB1*0402 with a frequency of 5.26%, followed by the DRB1*08032‐DQB1*06011‐DPB1*1301 (3.51%). The distribution characteristics of the HLA class II alleles revealed that the Naxi ethnic group belonged to the Southern group of Chinese.

The ubiquitin-proteasome pathway (UPP) plays an important role in regulating gene expression. Retinal pigment epithelial cells (RPE) are a major source of ocular inflammatory cytokines. In this work we determined the relationship between impairment of the UPP and expression of inflammation-related factors. The UPP could be impaired by oxidative stress or chemical inhibition. Impairment of the UPP in RPE increased the expression of several inflammatory cytokines, such as IL-6 and IL-8. However, the expression of monocyte chemoattractant protein-1 (MCP-1) and complement factor H (CFH) and was reduced upon impairment of the UPP. These data suggest that impairment of the UPP in RPE may be one of the causes of retinal inflammation and abnormal functions of monocyte and the complement system during the pathogenesis of age-related macular degeneration.