Objective To evaluate answers to typical clinical questions related to neuro-ophthalmology generated by Artificial Intelligence(AI)Large Language Models(LLM)and to explore the performance of neuro-ophthalmology-related questions on LLM in a multidimensional manner using objective and expert assessment.Methods Multicenter,random-ized,cross-sectional pilot study.Thirty typical questions related to neuro-ophthalmology were selected based on four per-spectives:definition,etiology,clinical manifestations and signs,and treatment and prognosis,and were analyzed quantita-tively using Deepseek,Wenxin Yiyin 4.0,Doubao,and Kimi 1.5,which are four open-source LLMs in China,and quantita-tively analyzed with objective assessment;and quantitatively rated by three ophthalmologists using expert assessment for 120 answer texts.Three ophthalmology experts quantitatively scored the 120 answer texts.Three ophthalmologists quantita-tively scored the 120 answer texts.Level 3,5,and 4 Likert scales were developed according to the completeness,accura-cy,professionalism,relevance,and criticality of the question texts,respectively.The best-performing LLM was selected,and its performance was observed across the four types of questions.Additionally,three other experts assessed whether the best-performing one could be evaluated as a substitute for real-world doctor-patient communication.Results In the objective Chinese text reading difficulty analysis,the differences in total word count among the four LLMs were statistically significant(all P＜0.001).Of the four LLMs,Kimi 1.5 performed the best,with frequencies of 61％,29％,and 41％for the highest scores in completeness(3),accuracy and professionalism(5),and relevance and usefulness(4),respective-ly.Kimi 1.5 performed more consistently on the questions on the four areas of neuro-ophthalmologic disorders:definition,etiology,clinical manifestations and signs,treatment,and prognosis,with no between-group differences(P＞0.05).Con-clusion Chinese language LLMs have great potential in the clinical application of neuro-ophthalmology.Kimi 1.5 outper-forms other LLMs in terms of completeness,accuracy,professionalism,relevance,and usefulness,but it still cannot re-place real-world doctor-patient communication.There is a need to explore new diagnostic and therapeutic model of AI+physician in the future.

Objective To evaluate answers to typical clinical questions related to neuro-ophthalmology generated by Artificial Intelligence(AI)Large Language Models(LLM)and to explore the performance of neuro-ophthalmology-related questions on LLM in a multidimensional manner using objective and expert assessment.Methods Multicenter,random-ized,cross-sectional pilot study.Thirty typical questions related to neuro-ophthalmology were selected based on four per-spectives:definition,etiology,clinical manifestations and signs,and treatment and prognosis,and were analyzed quantita-tively using Deepseek,Wenxin Yiyin 4.0,Doubao,and Kimi 1.5,which are four open-source LLMs in China,and quantita-tively analyzed with objective assessment;and quantitatively rated by three ophthalmologists using expert assessment for 120 answer texts.Three ophthalmology experts quantitatively scored the 120 answer texts.Three ophthalmologists quantita-tively scored the 120 answer texts.Level 3,5,and 4 Likert scales were developed according to the completeness,accura-cy,professionalism,relevance,and criticality of the question texts,respectively.The best-performing LLM was selected,and its performance was observed across the four types of questions.Additionally,three other experts assessed whether the best-performing one could be evaluated as a substitute for real-world doctor-patient communication.Results In the objective Chinese text reading difficulty analysis,the differences in total word count among the four LLMs were statistically significant(all P＜0.001).Of the four LLMs,Kimi 1.5 performed the best,with frequencies of 61％,29％,and 41％for the highest scores in completeness(3),accuracy and professionalism(5),and relevance and usefulness(4),respective-ly.Kimi 1.5 performed more consistently on the questions on the four areas of neuro-ophthalmologic disorders:definition,etiology,clinical manifestations and signs,treatment,and prognosis,with no between-group differences(P＞0.05).Con-clusion Chinese language LLMs have great potential in the clinical application of neuro-ophthalmology.Kimi 1.5 outper-forms other LLMs in terms of completeness,accuracy,professionalism,relevance,and usefulness,but it still cannot re-place real-world doctor-patient communication.There is a need to explore new diagnostic and therapeutic model of AI+physician in the future.

Objective To explore the application of serum signal transducers and activators of transduction 3(STAT3)and SMAD4 expression levels in the early diagnosis and clinical staging of primary glaucoma patients.Methods 86 patients with primary glaucoma admitted to Cangzhou Eye Hospital from August 2021 to May 2023 were selected as the study group,according to the clinical symptoms and visual examination results of the research group,they were divided into mild injury stage(n=30),moderate injury stage(n=34)and severe injury stage(n=22).Another 86 healthy individuals who underwent physical examinations in Cangzhou Eye Hospital during the same period were collected as the control group.Enzyme linked immunosorbent assay(ELISA)was applied to detect the expression levels of serum STAT3 and SMAD4.Multivariate Logistic regression was applied to analyze the relevant factors affecting clinical staging of primary glaucoma,receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of serum STAT3 and SMAD4 in patients with moderate/severe primary glaucoma injury.Results The expression levels of serum STAT3(13.96±3.45 ng/ml)and SMAD4(11.23±2.85 ng/ml)in the study group were obviously higher than those in the control group(9.83±1.72 ng/ml,7.78±1.95 ng/ml),the differences were statistically significant(F=13.085,17.513,all P＜0.05).The expression levels of serum STAT3(11.88±2.52 ng/ml,13.85±3.51 ng/ml,16.96±4.63 ng/ml)and SMAD4(9.15±1.95 ng/ml,11.23±2.83 ng/ml,14.08±4.12 ng/ml)in patients with primary glaucoma in mild,moderate and severe injury groups were gradually increased,the differences were statistically significant(F=13.085,17.513,all P＜0.05).There was a statistically obvious difference in intraocular pressure among patients with mild,moderate(24.21±5.03 mmHg,28.16±6.31 mmHg,32.26±7.57mmHg),and severe injuries(F=10.577.P＜0.05).serum STAT3[OR(95%CI)=2.728(1.409～5.281)],SMAD4[OR(95%CI)=2.849(1.507～5.387)],and intraocular pressure[OR(95%CI)=2.435(1.094～5.417)]were risk factors affecting clinical staging of primary glaucoma(all P＜0.05).The area under the curve(AUC)of the combined diagnosis of serum STAT3 and SMAD4 for moderate/severe injury in patients with primary glaucoma was 0.963(95%CI:0.899～0.992),which was superior to their respective individual diagnoses(Z =2.558,1.961;P=0.010,0.049),their sensitivity and specificity were 96.43%and 83.33%,respectively.Conclusion The higher the expression levels of STAT3 and SMAD4 in serum,the more severe the clinical symptoms in patients.The combined detection of the two has good diagnostic value for patients with moderate/severe injury.

Accurate and efficient upper limb movement control is a critical guarantee for astronauts to complete their daily tasks in space.Exploring the laws and mechanisms of the influence of microgravity and nonspecific stressors(isolation,noise,fatigue,etc.)in spaceflight on astronauts'upper limb movement control is an important direction of spaceflight human factors engineering research.This article summarizes the research paradigms and findings of in-orbit upper limb movement control research,revealing patterns such as slowed movements and decreased motor control performance under high cognitive load in spaceflight.It also points out the potential mechanisms underlying the inconsistent research results under various research paradigms.On this basis,the paper addresses existing controversies and shortcomings in previous studies,and puts forward prospects and suggestions for subsequent in-orbit movement control research.

Klein-Levin syndrome (KLS) is a rare disease characterized by recurrent episodes of hypersomnia and cognitive and behavioral dysfunction. In addition, all functions remain intact during the intermittent period. Infection is a common risk factor for its onset. In this case, a 17-year-old patient with KLS was admitted to our hospital in March 2023 who first developed KLS symptoms and relapsed after being infected with influenza A Virus (H1N1). Based on the typical symptoms occurred during the patient′s attack, the absence of symptoms and signs during the interval, and the absence of other triggers, the patient was diagnosed with KLS recurrence secondary to influenza A Virus (H1N1). This case report aims to reveal that influenza A Virus (H1N1) may be contribute to the recurrence of KLS and that preventing infection is important in the treatment of KLS to draw the attention of clinical physicians.

Klein-Levin syndrome (KLS) is a rare disease characterized by recurrent episodes of hypersomnia and cognitive and behavioral dysfunction. In addition, all functions remain intact during the intermittent period. Infection is a common risk factor for its onset. In this case, a 17-year-old patient with KLS was admitted to our hospital in March 2023 who first developed KLS symptoms and relapsed after being infected with influenza A Virus (H1N1). Based on the typical symptoms occurred during the patient′s attack, the absence of symptoms and signs during the interval, and the absence of other triggers, the patient was diagnosed with KLS recurrence secondary to influenza A Virus (H1N1). This case report aims to reveal that influenza A Virus (H1N1) may be contribute to the recurrence of KLS and that preventing infection is important in the treatment of KLS to draw the attention of clinical physicians.

Transcranial direct current stimulation (tDCS) is a well-tolerated, safe and noninvasive physical brain stimulation method, which has been widely used in the treatment of some common mental disorders and neurological diseases and has achieved certain clinical effects. It is necessary to develop expert consensus on clinical treatment to improve the use norms in related fields. According to the clinical research published before August 2021 and the method of evidence-based medicine, we published an expert consensus on tDCS in the treatment of depressive disorders, schizophrenia, substance use-related disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, autism, anxiety disorders, post-traumatic stress disorder, sleep disorders, pain, Parkinson′s disease, stroke, and epilepsy. The consensus also introduced the safety and efficacy of the clinical use of tDCS, and standardized the treatment process and operation technology, aiming to provide guidance for the clinical application of tDCS and promote the standardized development of this treatment technology in the future.

Transcranial direct current stimulation (tDCS) is a well-tolerated, safe and noninvasive physical brain stimulation method, which has been widely used in the treatment of some common mental disorders and neurological diseases and has achieved certain clinical effects. It is necessary to develop expert consensus on clinical treatment to improve the use norms in related fields. According to the clinical research published before August 2021 and the method of evidence-based medicine, we published an expert consensus on tDCS in the treatment of depressive disorders, schizophrenia, substance use-related disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, autism, anxiety disorders, post-traumatic stress disorder, sleep disorders, pain, Parkinson′s disease, stroke, and epilepsy. The consensus also introduced the safety and efficacy of the clinical use of tDCS, and standardized the treatment process and operation technology, aiming to provide guidance for the clinical application of tDCS and promote the standardized development of this treatment technology in the future.

Objective:To analyze the cause of varicocele (VC) recurrence and investigate the efficacy of sub-inguinal microsurgical varicocelectomy (MV) for recurrent VC.Methods:All of 16 inpatients diagnosed as recurrent VC, in the Department of Andrology of the Affiliated Hospital of Qingdao University from 2015 April to 2019 April, were performed sub-inguinal MV. The age of the inpatients was 18-36 years old, median 27 years old.5 cases were originally performed retroperitoneal high ligation of spermatic vein and other 11 cases were originally performed laparoscopic varicocelectomy. During the review one to three years after the previous operation, all of 16 patients were diagnosed as VC recurrence. The complains of these patients during the review included male subfertility (10 cases) and scrotal pain (12 cases), in which 6 cases’ complains were male subfertility with scrotal pain. After admission, 13 patients were classified as Grade Ⅲ (left in 8 cases, bilateral in 5 cases) and 3 patients as Grade Ⅱ (all left). The median of their visual analogue scale (VAS) was 2.5. Color doppler flow imaging (CDFI) grading showed: Grade Ⅲ in 12 cases (left in 7 cases, bilateral in 5 cases), Grade Ⅱ in 4 cases (all left). Particularly, 12 of them were Graded as Ⅲ simultaneously accompanying with Nut-cracker Phenomenon (NCP). Preoperative tests showed that the average serum testosterone was (16.2±4.9)nmol/ml, the average sperm concentration was (11.8±3.9)×10 6/ml and the progressive motility rate (PR) was (24.4±4.2)%. All of the patients were performed sub-inguinal MV using general anesthesia and supine position. The spermatic cords were clearly exposed and padded up by inserting gauze strips under them. During the operation, the field was magnified 4-6 times with the microscope. Then all of the dilated external and internal spermatic veins were ligated, at the same time the internal spermatic artery and lymph vessels were well preserved. During these operations, 11 patients underwent left-side MV, while other 5 did bilateral MVs. During these MVs, we found twisted and dilated external and internal spermatic veins in all cases and well preserved the internal spermatic arteries and lymph vessels. The number of ligated left and right external spermatic veins were(2.1±0.6) and (1.4±0.5)respectively and the number of ligated left and right internal spermatic veins were (10.1±1.1) and (6.6±0.5) respectively. We also found out(1.3±0.5) internal spermatic arteries and (3.0±1.0)lymph-vessels on left side. On right side, there were (1.4±0.5) internal spermatic arteries and (2.6±0.5) lymph-vessels respectively. At last, we summarily analyzed the pre-operative and post-operative VAS, serum testosterone, CDFI and semen analysis data. Results:All of the 16 sub-inguinal MVs were successfully performed. All patients were reviewed comprehensively 6 months after MV. The reviewed results showed that the post-operative VAS was significantly reduced ( Z=-2.994, P<0.05), palpable scrotal vessels disappeared and Valsalva tests were negative. No obvious reflux of internal spermatic veins were detected by CDFI. Interestingly, the sperm concentration and motility were both significantly improved 6 months after MV ( P<0.05), while there was not remarkable increase of the serum testosterone after MV ( P>0.05). During the follow up, no testicular atrophy, hydrocele and other complications were found. Up to submission, five of the ten patients who presented for male subfertility have impregnated their wives. Conclusions:The most possible cause of VC recurrence could be the omission of the external and internal spermatic veins, particularly in the grade Ⅲ VC patients or VC accompanied with NCP. The sub-inguinal MV, which can discover more twisted spermatic veins and at the same time preserve the spermatic artery and lymph-vessels, shows better clinical efficacy than other procedures.

Objective:To investigate the clinical application of cervix-uterine internal target volume (ITV) in volume-modulated arc therapy (VMAT) for cervical cancer under different bladder filling conditions, aiming to obtain more accurate planning target volume (PTV).Methods:Sixty-two patients with cervical cancer receiving radiotherapy rather than surgery were selected and randomly divided into the study ( n=31) and control groups ( n=31). In the study group, individualized ITV, PTV and PTV margin were obtained under three bladder filling status by localization CT scan to compare the VMAT. The target area and organs at risk (OARs) within the target area were statistically compared between two groups. The target missing rate in CBCT, adverse events and short-term efficacy of radiotherapy were analyzed in two groups. Results:There was no significant difference in the volume of target area and OARs in the target area between two groups (both P>0.05). In the study group, the target missing rate and target missing volume were significantly lower compared with those in the control group (both P<0.05). There was no significant difference in the incidence of acute radiation-induced adverse events between two groups ( P>0.05). The 1-, 2-year overall survival and progress-free survival did not significantly differ between two groups (all P>0.05). One patient in the study group had uterine recurrence and 2 cases in the control group. Conclusion:Application of individualized cervix-uterine ITV and PTV in definitive VMAT under different bladder filling conditions can improve the accuracy of target area contouring and improve the local control rate in cervical cancer patients.