Algorithmic systems based on artificial intelligence(AI)and machine learning(ML)have undergone rapid advancement in recent years, demonstrating extensive application across diverse ophthalmic disorders. Owing to the public availability of multiple global databases, significant progress has been achieved in the training and development of AI-integrated algorithms utilizing multimodal ophthalmic imaging modalities, including fundus photography and optical coherence tomography(OCT). These advancements have established a foundation for precision medicine and efficient healthcare delivery. The diagnosis of macular diseases relies on the identification of subtle alterations in tissue anatomy, where AI demonstrated exceptional performance in detecting intraocular biomarkers and evaluating anatomical changes during disease progression, with particularly prominent utility in the field of macular pathologies. This article provides a comprehensive review of the current applications of AI in macular diseases, aiming to synthesize existing research achievements and current challenges, while proposing visionary prospects for the broader implementation of AI in ophthalmology and even systemic medicine in the future.

Background Exposure to polycyclic aromatic hydrocarbons (PAHs) is associated with the development of metabolic syndrome (MS). However, the role of amino acids in PAH-induced MS remains unclear. Objective To explore the impact of PAHs exposure on the incidence of MS among coking workers, and to determine potential modifying effect of amino acid on this relationship. Methods Unmatched nested case-control design was adopted and the baseline surveys of coking workers were conducted in two plants in Taiyuan in 2017 and 2019, followed by a 4-year follow-up. The cohort comprised 667 coking workers. A total of 362 participants were included in the study, with 84 newly diagnosed cases of MS identified as the case group and 278 as the control group. Urinary levels of 11 PAH metabolites and plasma levels of 17 amino acids were measured by ultrasensitive performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Logistic regression was used to estimate the association between individual PAH metabolites and MS. Stratified by the median concentration of amino acids, Bayesian kernel machine regression (BKMR) model was employed to assess the mixed effects of PAHs on MS. Due to the skewed data distribution, all PAH metabolites and amino acids in the analysis were converted by natural logarithm ln (expressed as lnv). Results The median age of the 362 participants was 37 years, and 83.2% were male. Compared to the control group, the case group exhibited higher concentrations of urinary 2-hydroxyphenanthrene (2-OHPhe), 9-hydroxyphenanthrene (9-OHPhe), and hydroxyphenanthrene (OHPhe) (P=0.005, P=0.049, and P=0.004, respectively), as well as elevated levels of plasma branched chain amino acid (BCAA) and aromatic amino acid (AAA) (P<0.05). After being adjusted for confounding factors, for every unit increase in lnv_2-OHPhe in urine, the OR (95%CI) of MS was 1.57 (1.11, 2.26), and for every unit increase in lnv_OHPhe, the OR (95%CI) of MS was 1.82 (1.16, 2.90). Tyrosine, leucine, and AAA all presented a significant nonlinear correlation with MS. At low levels, tyrosine, leucine, and AAA did not significantly increase the risk of MS, but at high levels, they increased the risk of MS. In the low amino acid concentration group, as well as in the low BCAA and low AAA concentration groups, it was found that compared to the PAH metabolite levels at the 50th percentile (P₅₀), the log-odds of MS when the PAH metabolite levels was at the 75th percentile (P₇₅) were 0.158 (95%CI: 0.150, 0.166), 0.218 (95%CI: 0.209, 0.227), and 0.262 (95% CI: 0.241, 0.282), respectively, However, no correlation between PAHs and MS was found in the high amino acid concentration group. Conclusion Amino acids modify the effect of PAHs exposure on the incidence of MS. In individuals with low plasma amino acid levels, the risk of developing MS increases with higher concentrations of mixed PAH exposure. This effect is partly due to the low concentrations of BCAA and AAA.

Circular RNAs(circRNAs)are a class of closed-loop non-coding RNAs(ncRNAs)formed by head-to-tail covalent bonds.CircRNAs participate in the development of osteoarthritis by regulating extracellular matrix degrada-tion,inflammatory response and homeostasis of chondrocytes;It regulates the osteogenic differentiation of bone mar-row mesenchymal stem cells,the activity of bone microvascular endothelial cells and angiogenesis to affect femoral head necrosis;It regulates the differentiation of bone marrow stem cells,osteoblasts and osteoclasts to cause osteo-porosis and it affects the invasion,metastasis and drug resistance of osteosarcoma through different pathogenesis.CircRNAs are expected to become a new clinical diagnostic marker in the future.

Objective:To investigate the association of white matter hyperintensities (WMHs) with long-term stroke recurrence in patients with recent subcortical small infarcts (RSSIs).Methods:Consecutive patients admitted to the Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University between January 2019 and August 2022 and met the clinical and imaging manifestations of RSSIs were collected. The demographic characteristics, baseline clinical data, and MRI features were collected. Using stroke recurrence as the endpoint event, the recurrence time was recorded, and Cox regression model was used to analyze relevant factors affecting stroke recurrence in patients with RSSIs.Results:A total of 202 patients were enrolled, including 138 males (68.3%), aged 67.9±10.5 years. Seventy-seven patients (38.1%) were mild WMHs, 64 (31.7%) were moderate WMHs, and 61 (30.2%) were severe WMHs. There were statistically significant differences in age, history of stroke, hypertension, hyperlipidemia, total cholesterol, infarct thickness, and infarct distribution among different WMHs severity groups (all P<0.05). The median follow-up time was 40.5 months (interquartile range, 27.7-49.0 months), and a total of 55 patients (27.2%) had stroke recurrence (ischemic stroke 54, occipital hemorrhage 1). Recurrence rates of stroke in the mild, moderate, and severe WMHs groups were 18.2%, 31.3%, and 34.4%, respectively. Cox regression analysis showed that WMHs were an independent risk factor for stroke recurrence (compared to the mild group, the risk ratio of the severe group was 2.225, 95% confidence interval was 1.116-4.436; P=0.023). Conclusion:The risk of long-term stroke recurrence in patients with RSSI is associated with the severity of WMHs.

Objective To investigate the neurobehavioral effects of long-term mild hypothermia(MHT)combined with compound porcine cerebroside and ganglioside injection(CPCGI)after traumatic brain injury(TBI)in rats and its mechanism.Methods 36 healthy adult male SD rats were randomly divided into model group,MHT group,CPCGI group and MHT+CPCGI group.The TBI model was prepared using an electronically controlled cortical in-jury device.The rats in model group received an intraperitoneal injection of an equal amount of normal saline(NS,2 ml/kg)and were treated at room temperature(37℃)for 48 hours.The rats in MHT group received an intraper-itoneal injection of an equal amount of NS and were treated at a slightly low temperature(33.0±1.0)℃for 48 hours.The rats in CPCGI group received an intraperitoneal injection of an equal amount of CPCGI(0.6 ml/kg)and were treated at room temperature for 48 hours.The rats in MHT+CPCGI group received an intraperitoneal in-jection of an equal amount of CPCGI and were treated at a slightly low temperature for 48 hours.The sensorimotor function of rats was evaluated by modified Neurological Severity Score(mNSS).The motor and spatial memory a-bilities of rats were detected by Morris water maze test,and the motor function of rats was evaluated by beam walk-ing test(BWT)and inclined-grid climbing test.The number of neurons in hippocampus was observed by Nissl stai-ning and immunofluorescence was used to detect the expression of doublecortin(DCX)and neuronal nuclear anti-gen antibody(NeuN).Western blot was used to observe the protein expression of B-cell lymphoma-2(Bcl-2),Bcl-2 associated X protein(Bax)and cysteine proteinase-3(Caspase-3).Results Compared with MHT group and CPCGI group,MHT+CPCGI group had a lower mNNS score,shorter escape latency,higher times across the platform and the percentage of time in the target quadrant,higher BWT score and larger climbing angle,increased numbers of neurons,DCX and NeuN positive cells,increased Bcl-2 expression and decreased expression of Bax and Caspase-3.(P<0.05).Conclusion Long-term mild hypothermia combined with CPCGI can effectively im-prove the neurological deficits of TBI rats by promoting nerve regeneration and inhibiting cell apoptosis,and provide potential strategies and basis for the clinical treatment of TBI.

A retrospective analysis was made on the clinical data and gene mutation characteristics of 2 children admitted to the Children′s Hospital of Zhejiang University School of Medicine for epilepsy without periventricular nodules caused by the ARF1 gene mutation from August 2023 to February 2024, and relevant literature was reviewed.Both patients presented with seizures and psychomotor retardation, and 1 of them was diagnosed with West syndrome.Whole exome sequencing confirmed that the 2 patients carried a missense mutation in the ARF1 gene (c.55C>A, p.R19S).Brain magnetic resonance imaging (MRI) of 2 patients revealed no obvious abnormalities.A summary analysis of 5 cases of ARF1 gene mutations reported in three foreign literatures showed that patients with ARF1 gene mutations usually presented with seizures, developmental delay, hypotonia, mental retardation, and motor stereotypies.MRI showed periventricular nodular heterotopia, corpus callosum dysplasia, subcortical white matter abnormalities, and delayed myelination.This study found for the first time that ARF1-related disorders can occur without significant brain structural malformations, indicating that there are inconsistencies in neuroimaging findings, adding valuable phenotypic information to this gene.The differences in imaging findings may be the result of genetic background or variation in ARF1-interacting proteins, or may be caused by altered regulatory mechanisms of protein activity.

Objective:To investigate the relationship between vaccination doses and the duration of positive nucleic acid or antigen tests in Corona Virus Disease 2019 (COVID-19) patients during omicron epidemic.Methods:A cross-sectional study was conducted from December 26 to December 31, 2022 among COVID-19 patients from all community health service centers in 16 districts of Beijing municipality selected by multi-stage stratified cluster quota sampling method. A questionnaire was used to collect the basic information, vaccination doses, results of nucleic acid or antigen tests of all subjects. The subjects were divided into 5 groups according to the doses of COVID-19 vaccination: the non-vaccination group, the 1, 2, 3 and 4 doses vaccination group. The relationship between vaccination doses and the duration of positive nucleic acid or antigen tests was analyzed by univariate and multivariate logistic regression models.Results:A total of 10 506 COVID-19 cases were included in the study with the age of (43.3±13.7) years. The duration of positive nucleic acid or antigen tests was longer than 7 days in 59.4%(276/465), 51.5%(67/130), 50.6%(355/701), 46.1% (3 464/7 520) and 39.2%(662/1 690) of non-vaccination, and 1, 2, 3, 4 dose vaccination groups, respectively ( P<0.001). Multivariate logistic regression analysis showed that compared with non-vaccination patients, the vaccination dose was an independent protective factor for duration of positive nucleic acid or antigen tests>7 days, and the OR values were 0.7 (95% CI 0.5-0.9, P=0.015), 0.6 (95% CI 0.5-0.8, P<0.001) and 0.5 (95% CI 0.4-0.6, P<0.001) for 2, 3 and 4 doses of vaccination, respectively. Conclusion:The vaccination doses are independently related to the duration of positive nucleic acid or antigen tests in COVID-19 patients and the risk is gradually decreases with the increasing vaccination doses.

Objective:To understand the status of knowledge, attitude and practice of metabolic syndrome(MS) among the elderly in the community and analyze its influencing factors, so as to provide guidance for the prevention and treatment of MS.Methods:From January 2021 to August 2021, permanent residents(residence duration ≥6 months)aged 65 and above with regular health check examination in Fangzhuang Community Health Service Center of Fengtai District, Beijing were investigated using self-designed MS knowledge, attitude and practice questionnaire.After excluding 34 incomplete questionnaires, the 491 valid questionnaires were recycled with questionnaire valid percentage of 93.5%(491/525). The survey results were analyzed by descriptive analysis, Mann-Whitney U test, Kruskal-Wallis H test and multiple linear regression analysis and multiple linear regression.Results:The scores of MS knowledge, attitude and practice of the elderly in the community were 7(5, 10), 9(8, 10)and 19(18, 21)respectively.The correct answer rate of the diagnostic criteria of MS components was less than 50%.The score of knowledge about MS in the elderly was positively correlated with the scores of attitudes( r=0.263)and practice( r=0.134)(all P<0.01). The results of univariate and multiple linear regression analysis showed that gender, attending educational lectures and the prevalence of MS were the influencing factors of MS knowledge score(all P<0.05). Leisure time, attending educational lectures, pre-retirement occupation and regular health check examination were the influencing factors for MS attitude score(all P<0.05); attending educational lectures, leisure time, regular health check examination and pre-retirement occupation were the influencing factors for MS practice score(all P<0.05). Conclusions:The elderly in the community have a low level of knowledge about the components and diagnostic criteria of MS, but have a positive attitude and practice towards the prevention and treatment of MS.The level of knowledge, attitude and practice of MS is affected by health education lectures, occupation, regular health check examination and other factors.Health education on the diagnostic criteria and the awareness of disease prevention for the elderly in the community should be strengthened to improve the levels of the knowledge, attitude and practice of MS.

Objective:To investigate the correlation of fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) and clinical outcome in patients with middle cerebral artery M1 occlusive stroke.Methods:Patients with acute middle cerebral artery M1 occlusive stroke admitted to the Department of Neurology, the Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2019 were enrolled retrospectively. The demographic and clinical data were collected. Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) and FVH score were performed with MRI images. The modified Rankin Scale (MRS) was used to evaluate the clinical outcome at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between FVH and the outcome. Results:A total of 65 patients with acute middle cerebral artery M1 occlusive stroke were enrolled, including 37 males (56.9%). Their age was 64.35±12.13 years. Twenty-nine patients (44.6%) had a good outcome, and 36 (55.4%) had a poor outcome. There were significant differences in triglyceride ( P=0.037), antihypertensive drug treatment ( P=0.037), baseline National Institutes of Health Stroke Scale (NIHSS) score ( P<0.001), DWI-ASPECTS ( P=0.017) and FVH score ( P<0.001) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that FVH score (odds ratio 6.477, 95% confidence interval 1.570-26.716; P=0.010) and NIHSS score (odds ratio 1.869, 95% confidence interval 1.326-2.635; P<0.001) were significantly independently correlated with the poor outcome. However, there was no significant independent correlation between DWI-ASPECTS and the outcome (odds ratio 0.451, 95% confidence interval 0.068-2.988; P=0.410). Conclusions:FVH score is an independent risk factor for poor outcome in patients with acute middle cerebral artery M1 occlusive stroke.

In order to test the practicability and operability of the emergency plan for environmental emergencies of district, the ability of radiation accidents quickly respond, emergency monitoring and disposal of the radiation emergency monitoring team, and to inspect cooperative disposal ability according to the responsibilities stipulated in the plan of police department, health department, and publicity departments, and to further standardize the emergency response procedures for radiation accidents, and carry out radiation accident emergency drills. To describe the radiation accident drill organized by the district and jointly held by environmental protection, police department, health department, publicity and other departments, to analyze the scenario design, emergency equipment, emergency monitoring, on-site disposal, emergency termination, and to summarize and analyze the drill. The drill strictly implemented the emergency response procedures for radiation accidents, and comprehensively verified the nuclear and radiation emergency system in Chang'an District. By relying on the existing national technical force, the drill vigorously coordinated and cooperated to improve the rapid response ability of radiation emergency. The drill is an important way to effectively improve the emergency management ability of radiation accidents, to improve the technical ability of effectively response and emergency disposal of radiation environmental safety, and improve the technical level of the emergency monitoring team. It is also one of the technical means for the effective supervision of radioactive sources. It is suggested to continuously carry out the construction of online supervision capability during the transportation of radioactive sources, to improve the professional qualities and skills of road transport operators and reduce the probability of accidents, and continue to strengthen emergency exercises (drills) and technological innovation.