return to the old version

core/config.py

@@ -87,7 +87,7 @@ def get_llm():
         
         try:
             _llm = ChatOpenAI(
-                model="gpt-4.1",
+                model="gpt-4o",
                 api_key=openai_key,
                 base_url=settings.OPENAI_BASE_URL,
                 temperature=0.0,
@@ -153,4 +153,4 @@ try:
     validate_config()
 except Exception as e:
     logger.error(f"Configuration validation failed: {e}")
-    raise e
+    raise e

core/hbv_assessment.py

@@ -123,21 +123,14 @@ SASLT_GUIDELINES = """
 • Patients with HBV DNA > 20,000 IU/mL and ALT > 2xULN, regardless of the degree of fibrosis (Grade B) [SASLT 2021, p. 6]
 • Patients with HBeAg-positive chronic HBV infection (persistently normal ALT and high HBV DNA levels) may be treated if they are > 30 years, regardless of the severity of liver histological lesions (Grade D) [SASLT 2021, p. 6]
 • Patients with chronic HBV infection (HBV DNA > 2,000 IU/mL, ALT > ULN), regardless of HBeAg status, and a family history of HCC or cirrhosis and extrahepatic manifestations (Grade D) [SASLT 2021, p. 6]
-• Non‑cirrhotic patients should be considered for treatment if they have HBV DNA levels >2,000 IU/mL, serum ALT >~40 IU/L and severity of liver disease assessed by liver biopsy showing at least moderate necroinflammation and/or at least moderate fibrosis. 
 
-Patients with HBV DNA greater than 20,000 IU/mL and ALT greater than 2x ULN can begin treatment without a liver biopsy. 
-
-Patients with HBV DNA >2,000 IU/mL and at least moderate fibrosis may initiate treatment even if ALT levels are normal.
 
 ### 2. MANAGEMENT ALGORITHM [SASLT 2021, p. 6]
-• HBsAg positive with chronic HBV infection and no signs of chronic hepatitis —+ Monitor
-(HBsAg, HBV ALT, fibrosis assessment). Consider: risk ofHCC, risk 0fHBV
-reactivation, extrahepatic manifestations, risk of HBV transmission [SASLT 2021 , p. 61
-• HBsAg positive with chronic hepatitis B (CHB) with/without cirrhosis —+ Start antiviral
-treatment [SASLT 2021, p. 6]
-• HBsAg negative, anti-HBc positive —i No specialist follow-up (inform about HBV
-reactivation risk). In case of immunosuppression: start oral antiviral prophylaxis or monitor
-ISASLT 2021, p. 61
+
+• HBsAg positive with chronic HBV infection and no signs of chronic hepatitis → Monitor (HBsAg, HBeAg, HBV DNA, ALT, fibrosis assessment). Consider: risk of HCC, risk of HBV reactivation, extrahepatic manifestations, risk of HBV transmission [SASLT 2021, p. 6]
+• CHB (with/without cirrhosis) → Start antiviral treatment if indicated, otherwise return to monitoring [SASLT 2021, p. 6]
+• HBsAg negative, anti-HBc positive → No specialist follow-up (inform about HBV reactivation risk). In case of immunosuppression: start oral antiviral prophylaxis or monitor [SASLT 2021, p. 6]
+
 
 ### 3. MONITORING OF UNTREATED PATIENTS [SASLT 2021, p. 6-7]
 
@@ -203,8 +196,6 @@ ISASLT 2021, p. 61
 
 * **ALT (Alanine Aminotransferase):** Normal range in Adults falls between 4-42 units/L (U/L).
 * **ULN (Upper Limit of Normal):** ULN means Upper Limit of Normal for ALT which is set at 40 units/L for the purpose of these guidelines.
-* **Necroinflammatory Activity Scale:** A1 = mild, A2 = moderate, A3 = severe.
-* **Liver Fibrosis Stages:** F0—no fibrosis; F1—mild fibrosis, pericellular collagen deposits; F2—moderate fibrosis, beginning bridging fibrosis; F3—severe fibrosis, defined as presence of numerous bridges and septa; F4—cirrhosis.
 """
 
 
@@ -255,15 +246,27 @@ def assess_hbv_eligibility(patient_data: Dict[str, Any]) -> Dict[str, Any]:
         
         # Create prompt for LLM to analyze patient against guidelines
         analysis_prompt = f"""You are an HBV treatment eligibility assessment system. Analyze the patient data against the SASLT 2021 guidelines.
+PATIENT DATA:
+- Sex: {sex}
+- Age: {age} years
+- Pregnancy Status: {pregnancy_status}
+- HBsAg Status: {hbsag_status}
+- HBsAg Duration: {duration_hbsag} months
+- HBV DNA Level: {hbv_dna:,.0f} IU/mL
+- HBeAg Status: {hbeag_status}
+- ALT Level: {alt_level} 
+- Fibrosis Stage: {fibrosis_stage}
+- Necroinflammatory Activity: {necroinflammatory}
+- Extrahepatic Manifestations: {extrahepatic}
+- Immunosuppression: {immunosuppression}
+- Coinfections: {', '.join(coinfections) if coinfections else 'None'}
+- Family History (Cirrhosis/HCC): {family_history}
+- Other Comorbidities: {', '.join(comorbidities) if comorbidities else 'None'}
 
 
 SASLT 2021 GUIDELINES (Retrieved Context):
 {SASLT_GUIDELINES}
 Based STRICTLY on the SASLT 2021 guidelines and criteria provided above, assess this patient's eligibility for HBV antiviral treatment.
-NUMERIC DATA AND COMPARISON RULES (MUST FOLLOW):
-- Pay EXTREME attention to all numeric values in PATIENT DATA (e.g., HBV DNA, ALT, age, durations) and all comparison signs in the guidelines (>, <, ≥, ≤).
-- When checking criteria (for example "HBV DNA > 2,000 IU/mL" or "ALT > 2xULN"), you MUST compare the patient numbers exactly against those thresholds and operators.
-- NEVER ignore available numeric patient data, NEVER assume missing values, and NEVER relax or tighten thresholds beyond what the SASLT text explicitly states.
 You MUST respond with a valid JSON object in this exact format:
 {{
   "eligible": true or false,
@@ -283,8 +286,7 @@ CRITICAL ELIGIBILITY HIERARCHY:
     * If patient has **HBV-HCV coinfection** AND meets HBV treatment criteria (Page 9): Set **"eligible": true"**.
 2.  **Check Standard Criteria SECOND (Page 6):**
     * If *not* eligible based on special populations, check standard criteria (HBV DNA, ALT, fibrosis, age, family history).
-    * For **HBeAg-negative** patients with **HBV DNA < 2,000 IU/mL** and **ALT ≤ ULN**, and **no cirrhosis** and **no special-population indication**, you MUST classify as **not eligible** and recommend monitoring only, even if fibrosis is moderate (F2–F3). Use Page 6 for thresholds and Page 7 for monitoring.
-    * If any other Page 6 criteria are met (e.g., Cirrhosis, or HBV DNA > 2,000 + ALT > ULN + moderate fibrosis, etc.): Set **"eligible": true"**.
+    * If any Page 6 criteria are met (e.g., Cirrhosis, or HBV DNA > 2,000 + ALT > ULN + moderate fibrosis, etc.): Set **"eligible": true"**.
 3.  **If NO criteria from (1) or (2) are met:** Set **"eligible": false"**.
 4.  The "eligible" flag MUST be consistent with the "Eligibility and Rationale" bullet. Do not contradict yourself.
 
@@ -327,7 +329,7 @@ EXAMPLE OUTPUT (ELIGIBLE - STANDARD CRITERIA) - Use SINGLE \\n only:
 EXAMPLE OUTPUT (NOT ELIGIBLE - STANDARD CRITERIA) - Use SINGLE \\n only:
 {{
   "eligible": false,
-  "recommendations": "Eligibility and Rationale:\\n- Not eligible: HBV DNA < 2,000 IU/mL, ALT ≤ ULN, moderate fibrosis (F2–F3) [SASLT 2021, Page 6]\\nTreatment Recommendations:\\n- Treatment not indicated at this time [SASLT 2021, Page 6]\\nMonitoring and Follow-up:\\n- Monitor every 6-12 months (HBeAg-negative, HBV DNA < 2,000 IU/mL) (Grade B) [SASLT 2021, Page 7]\\nReferences:\\n- Pages 6, 7: Treatment criteria, monitoring protocols"
+  "recommendations": "Eligibility and Rationale:\\n- Not eligible: HBV DNA < 2,000 IU/mL, ALT ≤ ULN, no significant fibrosis [SASLT 2021, Page 6]\\nTreatment Recommendations:\\n- Treatment not indicated at this time [SASLT 2021, Page 6]\\nMonitoring and Follow-up:\\n- Monitor every 6-12 months (HBeAg-negative, HBV DNA < 2,000 IU/mL) (Grade B) [SASLT 2021, Page 7]\\nReferences:\\n- Pages 6, 7: Treatment criteria, monitoring protocols"
 }}
 ---
 EXAMPLE OUTPUT (ELIGIBLE - IMMUNOSUPPRESSION) - Use SINGLE \\n only:
@@ -349,24 +351,6 @@ CRITICAL REQUIREMENTS:
 4. Use ONLY the 5 sections listed above.
 5. Cite exact page at end of each bullet: [SASLT 2021, Page X].
 6. Return ONLY valid JSON, no markdown, no extra text.
-
-PATIENT DATA:
-- Sex: {sex}
-- Age: {age} years
-- Pregnancy Status: {pregnancy_status}
-- HBsAg Status: {hbsag_status}
-- HBsAg Duration: {duration_hbsag} months
-- HBV DNA Level: {hbv_dna:,.0f} IU/mL
-- HBeAg Status: {hbeag_status}
-- ALT Level: {alt_level} 
-- Fibrosis Stage: {fibrosis_stage}
-- Necroinflammatory Activity: {necroinflammatory}
-- Extrahepatic Manifestations: {extrahepatic}
-- Immunosuppression: {immunosuppression}
-- Coinfections: {', '.join(coinfections) if coinfections else 'None'}
-- Family History (Cirrhosis/HCC): {family_history}
-- Other Comorbidities: {', '.join(comorbidities) if comorbidities else 'None'}
-
 """
         
         
@@ -450,4 +434,4 @@ PATIENT DATA:
     
     except Exception as e:
         logger.error(f"Error in assess_hbv_eligibility: {str(e)}")
-        raise
+        raise