To conduct a bibliometric and keyword analysis on the domestic and international literature of medical artificial intelligence （AI） ethics， explore the research frontiers， hotspots， and development trends in this field， and provide references for promoting the construction of China’s ethical governance system on medical AI. Utilizing CiteSpace software， a comparative analysis was conducted between the reviewed domestic and international literature regarding their publication volume， author and institutional collaboration networks， as well as keyword co-occurrence， clustering， timeline graph， and burst， to explore the research hotspots and development trends in the field. A total of 2 393 Chinese and English publications were included. In recent years， research topics in medical AI ethics both domestically and internationally focused on three aspects， encompassing their theoretical research， emerging domains and their ethical risks， as well as the ethical governance and regulation of medical AI. International research hotspots included federated learning， computer-aided detection， informed consent， and other aspects， whereas domestic research hotspots were smart healthcare， responsibility ethics， ethical values， and other aspects. Internationally， greater attention was placed on ethical issues concerning population health and healthcare in the public health domain， whereas domestic research topics tended to focus more on theoretical discussions and the establishment of ethical principles. The ethical governance of medical AI represents a shared global challenge， necessitating enhanced research into both the variances and commonalities in this field.

Objective To investigate the effects of modified Zhujing Pill(ZJP)-medicated serum on mitochondrial autophagy and related proteins in a pressure-induced retinal ganglion cell(RGC)injury model in rats.Methods The modified ZJP-medicated serum and blank serum were prepared by the intragastric administration of modified ZJP(10 mL·kg-1)to 10 male Sprague-Dawley(SD)rats and equivalent normal saline to another 10 male SD rats.The RGC injury models of rats were constructed under the in vitro pressure of 0 mmHg,20 mmHg,40 mmHg,60 mmHg,and 80 mmHg(1 kPa=7.5 mmHg),respectively.According to the pressurization experiment results,the RGC injury model established under the in vitro pressure of 80 mmHg was selected for subsequent experiments.The RGCs of rats were divided into the normal group(NG group,untreated RGCs),model group(MG group,injured RGCs without serum intervention),blank serum group(KB group,injured RGCs treated with blank serum),and modified ZJP-medicated serum group(LVP group,injured RGCs treated with modified ZJP-medicated serum).The apoptosis of RGCs was detected by flow cytometry;the mitochondrial ultrastructure was observed via transmission electron microscopy;the protein expression level of PINK1,Parkin,LC3 Ⅱ/Ⅰ,and p62 was measured by Western blotting.Results Transmission electron microscopy revealed the in-tact double-membrane structure of mitochondria and evenly distributed mitochondrial crista in the NG group,while the MG and KB groups exhibited disrupted mitochondrial membranes,accompanied by a large number of vacuoles in the mitochon-dria.The mitochondria of the LVP group had a double-membrane structure and the vacuoles in the mitochondria decreased compared with those of the MG and KB groups,and the mitochondrial morphology was basically the same as that of the NG group.The flow cytometry results demonstrated the apoptosis rate of RGCs was(4.25±0.55)％,(20.79±3.06)％,(30.07±3.23)％,and(11.42±0.16)％in the NG,MG,KB,and LVP groups,respectively.Compared with the NG group,the ap-optosis rate of RGCs in rats increased in the MG group,and the difference was statistically significant(P＜0.01).Com-pared with the MG and KB groups,the apoptosis rate of RGCs in rats decreased in the LVP group,and the difference was statistically significant(both P＜0.05).The Western blotting results indicated that the MG group had an increased relative protein expression level of PINK1,Parkin,and LC3 Ⅱ/Ⅰ but a decreased relative protein expression level of p62 compared with the NG group,and the difference was statistically significant(all P＜0.01).Compared with the MG and KB groups,the LVP group had a decreased relative protein expression level of PINK1,Parkin,and LC3 Ⅱ/Ⅰ but an increased relative protein expression level of p62,and the difference was statistically significant(all P＜0.05).Conclusion The modified ZJP-medicated serum may protect RGCs by suppressing pressure-induced mitochondrial autophagy in vitro of rat RGCs via modulating PINK1/Parkin-mediated mitochondrial autophagy.

Objective To investigate the effects of modified Zhujing Pill(ZJP)-medicated serum on mitochondrial autophagy and related proteins in a pressure-induced retinal ganglion cell(RGC)injury model in rats.Methods The modified ZJP-medicated serum and blank serum were prepared by the intragastric administration of modified ZJP(10 mL·kg-1)to 10 male Sprague-Dawley(SD)rats and equivalent normal saline to another 10 male SD rats.The RGC injury models of rats were constructed under the in vitro pressure of 0 mmHg,20 mmHg,40 mmHg,60 mmHg,and 80 mmHg(1 kPa=7.5 mmHg),respectively.According to the pressurization experiment results,the RGC injury model established under the in vitro pressure of 80 mmHg was selected for subsequent experiments.The RGCs of rats were divided into the normal group(NG group,untreated RGCs),model group(MG group,injured RGCs without serum intervention),blank serum group(KB group,injured RGCs treated with blank serum),and modified ZJP-medicated serum group(LVP group,injured RGCs treated with modified ZJP-medicated serum).The apoptosis of RGCs was detected by flow cytometry;the mitochondrial ultrastructure was observed via transmission electron microscopy;the protein expression level of PINK1,Parkin,LC3 Ⅱ/Ⅰ,and p62 was measured by Western blotting.Results Transmission electron microscopy revealed the in-tact double-membrane structure of mitochondria and evenly distributed mitochondrial crista in the NG group,while the MG and KB groups exhibited disrupted mitochondrial membranes,accompanied by a large number of vacuoles in the mitochon-dria.The mitochondria of the LVP group had a double-membrane structure and the vacuoles in the mitochondria decreased compared with those of the MG and KB groups,and the mitochondrial morphology was basically the same as that of the NG group.The flow cytometry results demonstrated the apoptosis rate of RGCs was(4.25±0.55)％,(20.79±3.06)％,(30.07±3.23)％,and(11.42±0.16)％in the NG,MG,KB,and LVP groups,respectively.Compared with the NG group,the ap-optosis rate of RGCs in rats increased in the MG group,and the difference was statistically significant(P＜0.01).Com-pared with the MG and KB groups,the apoptosis rate of RGCs in rats decreased in the LVP group,and the difference was statistically significant(both P＜0.05).The Western blotting results indicated that the MG group had an increased relative protein expression level of PINK1,Parkin,and LC3 Ⅱ/Ⅰ but a decreased relative protein expression level of p62 compared with the NG group,and the difference was statistically significant(all P＜0.01).Compared with the MG and KB groups,the LVP group had a decreased relative protein expression level of PINK1,Parkin,and LC3 Ⅱ/Ⅰ but an increased relative protein expression level of p62,and the difference was statistically significant(all P＜0.05).Conclusion The modified ZJP-medicated serum may protect RGCs by suppressing pressure-induced mitochondrial autophagy in vitro of rat RGCs via modulating PINK1/Parkin-mediated mitochondrial autophagy.

Objective:To observe any clinical effect of supplementing ultrasound stimulation with balloon-guided injection of botulinum toxin into the upper esophageal sphincter in the treatment of cricopharyngeal achalasia.Methods:Forty patients with cricopharyngeal achalasia were randomly divided into an observation group and a control group, each of 20. Both groups were given routine swallowing rehabilitation training, while the observation group additionally had botulinum toxin injected into the upper esophageal sphincter guided by ultrasound and with the aid of balloon dilation. Before the experiment and after 2 weeks, both groups were evaluated videofluoroscopically and flexible endoscopic evaluation of swallowing was performed. Moreover, 2 weeks before the treatment and 2, 4 and 24 weeks afterward, everyone′s eating, leakage and aspiration, and oral and pharyngeal secretions were assessed using the functional oral intake scale (FOIS), the penetration-aspiration scale (PAS), the fiberoptic endoscopic dysphagia severity scale (FEDSS) and the Murray secretion scale (MSS).Results:After 2 weeks the average PAS, FEDSS and MSS scores of both groups had improved significantly, but the observation group′s averages[3(2, 5), 3(2, 5) and 2(1, 2)] were significantly better than those of the control group. 2, 4 and 24 weeks after the experiment the average FOIS scores of both groups also showed significant improvement, with the observation group′s average[3(2, 4), 4(2, 6) and 6(3, 7)] again significantly better than that of the control group.Conclusions:A botulinum toxin injection into the upper esophageal sphincter can effectively improve the swallowing of persons with cricopharyngeal achalasia with adequate safety and significant long-term benefits. Therefore, such treatment is worthy of clinical promotion and application.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective: To explore the related factors of subependymal hemorrhage (SEH) and cerebral hemodynamic changes. Methods: From October 2012 to October 2017, 200 cases of children with subependymal hemorrhage diagnosed by ultrasound in our department of pediatrics were selected as the observation group , and a total of 150 children who were admitted to the Department of Pediatrics in the same period due to craniocerebral diseases and other serious diseases were selected as control group. The independent risk factors of the children in the observation group were analyzed, and the difference of the maximum systolic blood flow velocity (SV), the diastolic maximum flow velocity (DV), the systolic and diastolic velocity ratio (S/D), the resistance index (RI), and the pulsatile index (PI) were compared between the two groups. Results: Neonatal asphyxia, preterm birth, acidosis, neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus and coagulation dysfunction were independent risk factors for subependymal hemorrhage. The bleeding side SV and DV of the observation group were higher than those of the control group, with statistically significant difference (P<0.001). In the observation group, the bleeding side SV and DV were higher than those of the healthy side, with statistically significant difference (P<0.001). There was no significant difference in bleeding side SV, DV, S/D, RI and PI in 110 cases of single side ependymal hemorrhage (P>0.05). Conclusions Children with ependymal hemorrhage can observe the hemodynamic indexes of anterior cerebral artery (ACA) dynamically by craniocerebral ultrasound, and judge the therapeutic effect by evaluating the systolic and diastolic blood flow velocity, so as to prevent the further aggravation of subependymal hemorrhage

Objective: To explore the effectiveness and cost of breast cancer screening strategy that is suitable for the current econom-ic conditions in China. Methods: We collected clinical and cost information of breast cancer screening for Chinese women based on previous screening programs conducted from February 2008 to December 2011 and collected the same information about breast can-cer cases diagnosed in hospitals at the same time. Markov models were developed to analyze the incremental cost-effectiveness ratios (ICER) for 132 breast cancer screening strategies compared to no screening for Chinese women. Results: In 2010, as compared to no screening, the most cost-effective breast cancer screening strategy was biennial screening with clinical breast examination (CBE) and breast ultrasound, in parallel, for women aged between 40 to 64. This screening strategy could save 1,394 quality-adjusted life years (QALY) per 100,000 women, and the cost of saving breast-cancer related QALY would be 91,944 RMB. Sensitivity analysis indicated that in 2016, the most cost-effective breast cancer screening strategy was biennial screening with CBE and mammography (MAM), in parallel, for women aged 40 to 64, with ICER of 159,637 RMB per QALY. Conclusions: Population-based breast cancer screening would be acceptable in the current conditions in China. As the Chinese economy and level of medical care improve, breast cancer screening would be more cost-effective.

Motor timing is an important part of sensorimotor control. Previous studies have shown that beta oscillations embody the process of temporal perception in explicit timing tasks. In contrast, studies focusing on beta oscillations in implicit timing tasks are lacking. In this study, we set up an implicit motor timing task and found a modulation pattern of beta oscillations with temporal perception during movement preparation. We trained two macaques in a repetitive visually-guided reach-to-grasp task with different holding intervals. Spikes and local field potentials were recorded from microelectrode arrays in the primary motor cortex, primary somatosensory cortex, and posterior parietal cortex. We analyzed the association between beta oscillations and temporal interval in fixed-duration experiments (500 ms as the Short Group and 1500 ms as the Long Group) and random-duration experiments (500 ms to 1500 ms). The results showed that the peak beta frequencies in both experiments ranged from 15 Hz to 25 Hz. The beta power was higher during the hold period than the movement (reach and grasp) period. Further, in the fixed-duration experiments, the mean power as well as the maximum rate of change of beta power in the first 300 ms were higher in the Short Group than in the Long Group when aligned with the Center Hit event. In contrast, in the random-duration experiments, the corresponding values showed no statistical differences among groups. The peak latency of beta power was shorter in the Short Group than in the Long Group in the fixed-duration experiments, while no consistent modulation pattern was found in the random-duration experiments. These results indicate that beta oscillations can modulate with temporal interval in their power mode. The synchronization period of beta power could reflect the cognitive set maintaining working memory of the temporal structure and attention.