AIM:To study the regulation of endoplasmic reticulum stress(ERS)using the glucose regulated protein 78(GRP78)/CCAAT/enhancer binding protein homologous protein(CHOP)pathway and explore the related mech-anism of Wenyang-Shengji ointment in facilitating the repair of diabetic refractory wounds.METHODS:To establish a rat model of diabetic refractory wound repair,Sprague-Dawley(SD)rats were fed a high-fat diet and intraperitoneally in-jected with streptozotocin.Subsequently,full-thickness skin defects were induced in the dorsal region of the rats.The ex-periment included 4 groups:normal,model(diabetic refractory wounds),Wenyang-Shengji ointment,and Beifuxin(re-combinant bovine basic fibroblast growth factor gel)groups.The normal and model groups were treated with normal saline after disinfection.In the Wenyang-Shengji ointment and Beifuxin groups,the wounds were topically treated with the re-spective ointments once daily.After 14 d of treatment,wound healing was assessed and quantified using the wound healing rate.Hematoxylin-eosin(HE)staining was employed to examine the micromorphology of the wound tissue.Western blot analysis was performed to measure GRP78,CHOP and caspase-12 levels in the wound tissue.Immunohistochemical analy-sis was used to detect the expression and distribution patterns of GRP78,CHOP and caspase-12 in the wounds.Transmis-sion electron microscopy was used to observe reticulum numbers and swelling.Enzyme-linked immunosorbent assay was used to determine interleukin-1β(IL-1β)level as a pro-inflammatory factor within the wound.RESULTS:Indexes of each group were assessed 14 d after the corresponding intervention.Compared with normal group,the rats in model group exhibited a significant decrease in the wound healing rate(P＜0.01),accompanied by increased inflammatory exudation and poor granulation tissue growth.Additionally,there were increases in the expression levels of GRP78,CHOP and cas-pase-12 proteins(P＜0.01),as well as a significant elevation in the content of inflammatory factor IL-1β(P＜0.01).In contrast,compared with model group,treatment with Wenyang-Shengji ointment resulted in a significant improvement in wound healing rate(P＜0.01),reduction in inflammatory exudation,and enhanced granulation tissue growth(P＜0.01).Furthermore,there was a notable decrease in the protein expression of GRP78/CHOP/caspase-12 within the wound tissue following treatment with Wenyang-Shengji ointment(P＜0.01).The levels of inflammatory factor IL-1β also showed a sig-nificant decrease(P＜0.01).CONCLUSION:Wenyang-Shengji promotes the healing of diabetic refractory wounds,which may be associated with the downregulation of the GRP78/CHOP pathway,inhibition of excessive ERS,and reduc-tion in the level of wound cell apoptosis.

Objective:To conduct visualization analysis,induction and summary for the study status,focus and trend in the dose measurement field of flash radiotherapy(Flash-RT)through bibliometric methods on the basis of the Web of Science Collection(WOS),and analyze the technical bottleneck of Flash-RT dose measurement.Methods:In the WOS database,the("FLASH radiotherapy"or"ultra high dose rate"or"FLASH irradiation")and TS=("dosimetric system"or"dosimeters"or"dosimetry")were used as the theme terms,and all relevant literatures about the study of Flash-RT dose measurement that were included in the Core Collection of WOS database were retrieved.The citation analysis function of WOS and Citespace software(Version 6.2)were used to conduct visualization analysis for the publication trends,sources and research focus of the included literature of Flash-RT dose measurement,and to draw corresponding visualization knowledge maps.Results:The literatures were mainly published during January 2015 and November 2023,and a total of 86 papers were included in the analysis by screening,which included 78 articles and 8 reviews.The top three countries in terms of publication volume were respectively the United States(38 papers),France(19 papers)and Italy(19 papers).The research focuses were respectively Cherenkov,radiotherapy,passive dosimeter,conventional radiation,laser particle acceleration,ionization chamber and proton therapy as cluster analysis.Currently,the study of Flash-RT dose measurement mainly focused on the relevant fields included Flash-RT radiation source,dose rate,and the equipment and method of dose measurement.Conclusion:Flash-RT is a new technology with a key breakthrough in the basic field of radiotherapy,and this technique faces many difficulties and challenges in the clinical translation process of this technique.With the continuous development of science and technique,and deepeningaccumulation of related researchclinical big data,the method and procedure of accurate and efficient dose measurement dosimetry methods and procedures will promote and realize the update and iteration of Flash-RT experiment research and device technique,which will successfully realize the clinical the broader application prospects of this technology.

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

Objective To explore the key points of forensics appraisal of medical disputes in mental hospitals,strengthen the management of mental hospitals,prevent medical disputes and improve medical quality.Methods Using the written judgment of China Judgments Online as materials,the order multi-class Logistic regression analysis was conducted on the common faults and level of responsibility in cases of death resulting from mental hospital treatment.Results Improper nursing,improper management,insufficient knowledge of the disease,unclear information,inadequate rescue,improper medication,unclear diagnosis were the risk factors of the degree of responsibility of medical disputes,and other diseases were protective factors.Conclusion Analyzing the common faults and identification points of death disputes in mental hospitals and rectifying them from two aspects can effectively prevent the occurrence of medical disputes,improve the quality of medical treatment,and achieve a win-win situation for doctors and patients.

ABSTARCT AIM: To investigate the effect of Ginkgo biloba extract (GBE) on kidney injury in rats with chronic renal failure (CRF) and its potential molecular mechanism. METHODS: SD rats were given 5/6 nephrectomy to construct CRF models and divided into model group, GBE group (100 mg /kg), GBE+ Agomir-NC group, and GBE+Agomir-145 group, 12 per group; another 12 were selected as the sham group, with only the kidney exposed and no nephrectomy. Rats in the GBE group were given GBE 100 mg/kg gavage daily, once a day, for 4 consecutive weeks; rats in the GBE+Agomir-NC group and GBE+Agomir-145 group were given GBE 100 mg/kg gavage daily, and then Agomir-NC and Agomir-145 were injected via the tail vein every 3 days for 4 weeks; the sham group and the model group were given the same amount of normal saline by gavage and injection through the tail vein respectively. The general state of the rat was observed, and the renal function indicators [24 h urine microalbumin (24 h UAlb), blood urea nitrogen (BUN), blood creatinine (SCr)] and oxidative stress indicators [malonaldehyde (MDA), Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)] were detected, Masson staining was used to observe the fibrosis of kidney tissue, real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the mRNA expression levels of microRNA-145 (miR-145), transforming growth factor - β1 (TGF - β1) and forkhead box O1 (FOXO1) in renal tissue, Western blot was used to detect the protein levels of TGF - β1 and FOXO1 in kidney tissue. RESULTS: The general state of CRF rats improved significantly after GBE intervention, the body weight, renal tissue SOD and GSH-Px activities, and FOXO1 mRNA and protein levels were significantly higher than those in the model group (P<0.05); the 24 h UAlb, serum BUN, SCr and renal tissue MDA levels, the relative area of renal interstitial fibrosis, and renal tissue miR-145, TGF - β1 mRNA and protein levels were significantly lower than those in the model group (P<0.05); and on the basis of GBE intervention, up-regulating the expression of miR-145 could significantly weaken the protective effect of GBE on renal injury in CRF rats (P<0.05). CONCLUSION: GBE can alleviate kidney damage in CRF rats, and its mechanism of action may be related to down-regulation of miR-145, up-regulation of FOXO1 expression, and inhibition of renal fibrosis.

Objective: To summarize the global research hotspots and trends of family intervention on autism spectrum disorder (ASD), to provide ideas for the development of localized research on family intervention for ASD in China. Methods: This study used the bibliometric software CiteSpace to conduct visual analysis on emerging cutting edge documents in the Web of Science core database in the field of family intervention for autism in the past 20 years (2001-2020). Data collection used 7 subject terms related to family caregiver intervention in February 2021. A total of 2 342 literature was obtained after data sorting. Results: The number of international publications has risen rapidly since 2013. The average annual number of international publications was 29 during 2001- 2012, then 250 during 2013-2020, which increased by 8 times. Among them, the United States ranked the top of publication with 1 295 articles, while publications from two universities in Canada and the United Kingdom showed higher impacts. The high frequency keywords that reflected the international hotspots included children, adolescent, mother, behavior, and stress; the high centrality keywords included follow up, intellectual disability, early recognition, young children and language. Conclusion The research hotspots in the field of ASD family intervention in the past 20 years included targets, strategies and forms, as well as the implementation effects of ASD family interventions. The trends of research in the past five years (2016-2020) mainly focus on the intervention studies of children, adolescents and adults with ASD and the randomized controlled trials of ASD family intervention focusing on caregivers.

Objective:To explore the value of multi-parametric MRI for thyroid gland in differentiating benign and malignant thyroid nodules.Methods:From December 2018 to May 2020, 78 patients with 91 post-surgically pathologically confirmed thyroid nodules were enrolled in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. For each patient, the following MRI findings were obtained including the nodules′ location, size, shape, margin, signal intensity, cystic change, degree and pattern of contrast enhancement, involvement of surrounding structure, and ADC values. The time-intensity curve (TIC) were plotted and subtyped based on dynamic contrast enhancement MRI. The MRI findings between the benign and malignant thyroid nodules were compared using Mann-Whitney U test, χ 2 test or Fisher exact test. Multiple logistic regression analysis was used to select independent predictive variables and build a combined model, and the ROC curve was used to evaluate the diagnostic performance of each MRI finding and the combined model. Results:Between the benign and malignant thyroid nodules, the significant differences were found in size, shape, margin, presence of cystic changes, T 1WI signal intensity, ADC value, enhancement homogeneity, TIC subtypes and presence of thyroid capsule involvement ( P<0.05). Multivariate logistic analysis showed that ill-defined margin (OR=77.61), no presence of cystic changes (OR=36.11) and difference between TIC subtypes (OR=83.41) were independent predictive variables, and the area under the ROC curve (AUC) was 0.879, 0.788, and 0.751, respectively. The AUC, sensitivity and specificity of the combined model were 0.977, 0.986, and 0.904, respectively. Conclusions:Thyroid multi-parametric MRI derived findings can be used for the differential diagnosis of benign and malignant nodules. Combined with the independent risk factors with ill-defined margin, no presence of cystic changes, TIC of type plateau or washout, the diagnostic model has a higher diagnostic efficiency.

Objective: The random forest algorithm was used to construct a rapid screening diagnostic prediction model for children with autism spectrum disorder, to provide the references for early detection, early diagnosis of ASD children, and to reduce the pressure of ASD clinical diagnosis and assessment. Methods: The random forest algorithm of machine learning was applied to build the auxiliary diagnosis model. Totally 346 ASD children and 90 normal children were evaluated by Social Responsiveness Scale and Vineland Adaptive Behavior Scales. ROC curve, and accuracy was used to evaluate the models. Results: Among the models, the accuracy of 13 feature factors and 7 feature factors were above 0.9, the sensitivity was up to 0.927, the specificity was up to 0.936 and the AUC was up to 0.979. The accuracy, sensitivity, specificity and AUC of the model were 0.943,0.959,0.931 and 0.978 respectively. The fitting and generalization effects of the three models were all satisfactory. Conclusion A random forest model based on the SRS Scales and Vineland Adaptive Behavior Scales can be used to diagnose ASD accurately and provide scientific basis for the development of rapid screening and diagnosis tools.

This study aims to review the research progress on the effects of repetitive transcranial magnetic stimulation （rTMS） on cognitive function in generalized anxiety disorder （GAD） with the view of providing references for clinical application. As a common chronic mental disorder， GAD affects the cognitive function， the quality of life and social function of patients. Although first-line treatment is safe and effective for the majority of patients， its effect of improving cognitive function is unclear. As a non-invasive and safe physiotherapy technology， rTMS is expected to provide a new option for the clinical treatment of GAD patients. This review focuses on the characteristics of cognitive function of GAD， the current status of first-line therapy and the treatment of rTMS.

China is a country with high incidence of esophageal cancer. Advanced esophageal cancer not only brings serious threat to the health of patients, but also brings heavy economic burden to their families and society. Early diagnosis and treatment of esophageal cancer are always the hot spot in clinical research, and gastroscopy screening is the key point. The development of artificial intelligence is expected to provide new mean for early diagnosis and treatment of esophageal cancer in the aspects of endoscopy procedure and quality control.Through a brief overview of the concept and development of artificial intelligence in endoscopic diagnosis of superficial esophageal cancer, this study summarizes and reviews the research progress of artificial intelligence in the diagnosis of superficial esophageal carcinoma, and illustrates the importance of its application. This study also discusses the main problems and difficulties of artificial intelligence in the endoscopic diagnosis of esophageal carcinoma. It prospects the application of artificial intelligence in endoscopic esophageal diagnosis in the future.