Fetal growth restriction(FGR)refers to the failure of a fetus to reach the level of growth potential determined by its genetic potential.It is a common obstetric complication,occurring in 5%to 10%of pregnancies.As a major risk factor for perinatal death and adverse neonatal outcomes,early prediction of FGR is crucial for optimizing pregnancy management.Existing evidence suggests that FGR is significantly associated with a variety of adverse pregnancy outcomes,including intrauterine hypoxia,preterm birth,neonatal asphyxia,and even neonatal mortality.It may also affect long-term neurological development and increase the risk of metabolic diseases in adulthood.Its pathogenesis is complex,which may involve placental blood flow perfusion insufficiency and genetic factors.Ultrasound parameters are the main basis for the diagnosis of FGR,among which fetal biological and hemodynamic parameters are of great value.Elevated umbilical artery blood flow resistance index,absent or reversed end-diastolic blood flow,and placental insufficiency are associated with the severity of FGR.However,approximately 10%of fetuses diagnosed by ultrasound as having FGR are later confirmed to be healthy small-for-gestational-age(SGA)infants after birth,and this false positive result may lead to unnecessary clinical interventions.Currently,there is no recognized accurate prediction model for FGR in clinical practice.Future research should focus on establishing unified diagnostic criteria and developing multi-index joint prediction tools based on artificial intelligence(AI).Early prediction and intervention for FGR are of great significance to improve perinatal outcomes.This paper reviewed the predictive value of ultrasound parameters,blood indicators,and their integration with AI for FGR,in order to provide a basis for clinical decision-making.

AIM:This study aimed to investigate the effect of ischemic post-conditioning(I-post-C)on lung ischemia-reperfusion injury(LIRI)in rats and relationship between I-post-C and zinc homeostasis.METHODS:SPF SD rats(6～8 weeks old)were randomly divided into four groups,with eight rats in each group:control group,ischemia/reper-fusion(I/R)group,I-post-C group and I-post-C+zinc ion chelator TPEN group.Inductively coupled plasma mass spec-trometry(ICP-MS)was used to measure the concentration of zinc ions in lung tissues.HE staining,lung wet/dry weight ra-tio(W/D),total lung water content(TLW),and index of quantitative assessment(IQA)of lung injury were used to detect the degree of lung tissue injury in each group.Mitochondrial membrane potential was measured using extraction and JC-1 mitochondrial membrane potential detection kits.TUNEL assay was used to detect the level of apoptosis in lung tissues.Western blot was used to detect the protein expression levels of caspase-3,solute carrier family 39 member 8(SLC39A8/ZIP8),solute carrier family 30 member 9(SLC30A9/ZNT9),and PI3K/AKT/GSK-3β in lung tissues of each group.RT-qPCR was used to detect ZIP8 and ZNT9.RESULTS:Compared to the control group,the I/R group showed significantly aggravated lung tissue injury(P<0.01),decreased zinc ion levels(P<0.01),enhanced cell apoptosis(P<0.05),re-duced mitochondrial membrane potential(P<0.01),decreased PI3K/AKT/GSK-3β phosphorylation levels(P<0.05,P<0.01),increased cleaved caspase-3/pro-caspase-3 ratio(P<0.01),and reduced ZIP8 expression(P<0.05).Compared to the I/R group,the I-post-C group exhibited alleviated injury(P<0.05 or P<0.01),increased zinc ion levels(P<0.01),reduced apoptosis(P<0.01),restored mitochondrial membrane potential(P<0.01),elevated PI3K/AKT/GSK-3β phosphorylation levels(P<0.05,P<0.01),decreased cleaved caspase-3/pro-caspase-3 ratio(P<0.05),and in-creased ZIP8 expression(P<0.05).Compared to the I-post-C group,the I-post-C+TPEN group demonstrated aggravated injury(P<0.01),decreased zinc ion levels(P<0.01),enhanced apoptosis(P<0.01),reduced mitochondrial membrane potential(P<0.05),decreased PI3K/AKT/GSK-3β phosphorylation levels(P<0.05,P<0.01),increased cleaved cas-pase-3/pro-caspase-3 ratio(P<0.05),and reduced ZIP8 expression(P<0.05).ZNT9 expression showed no significant differences among the groups(P>0.05).CONCLUSION:Ischemic postconditioning can improve LIRI by regulating zinc homeostasis,activating PI3K/AKT signaling pathway,inactivating glycogen synthase kinase 3β,inhibiting the de-cline of mitochondrial membrane potential,and antagonizing cell apoptosis in rats.

Objective:To investigate the difference in brain activity intensity between methamphetamine (MA) dependent patients (MA group) and healthy controls (control group) using fractional amplitude of low-frequency fluctuation (fALFF), and to establish a classification model between these two groups using support vector machine (SVM).Methods:From February 2014 to October 2019, a total of 46 male MA-dependent patients and 46 male healthy controls were recruited from the Affiliated Kangning Hospital of Ningbo University. The study collected resting-state functional magnetic resonance imaging (rs-fMRI) data and analyzed the differences in brain functional activity between the two groups. This analysis was conducted using both static and dynamic fractional amplitude of low-frequency fluctuations (d-fALFF). Additionally, the study examined the correlation between fALFF/d-fALFF values in specific brain regions and the total scores, as well as each factor score, of the Brief Psychiatric Rating Scale (BPRS). Furthermore, the relationship between fALFF/d-fALFF values and the age of first use and total dose of MA in the MA group was investigated. Finally, the fALFF map and d-fALFF map of brain regions with significant differences between groups were used as features for constructing classification.Results:Compared to the healthy control group, those dependent on MA showed significantly increased fALFF mainly in the nucleus accumbens, caudate nucleus, thalamus, and amygdala nucleus( t=-5.21--2.72, all P<0.05). The MA group exhibited decreased fALFF in the superior frontal gyrus, middle frontal gyrus, orbital gyrus, and cingulate gyrus( t=3.59-5.00, all P<0.05). Most of the brain regions with decreased d-fALFF overlapped with those exhibiting decreased fALFF( t=3.33-4.87, all P<0.05). The results of the correlation analysis showed that the fALFF value of the right nucleus accumbens was positively correlated with the age of first use of MA ( r=0.537, P<0.001). There is no significant relationship between the abnormal fALFF and d-fALFF values in the MA group and the total scores and each factor scores of BPRS, as well as the total dose of MA taken (after removing outliers). Based on fALFF and d-fALFF values, the SVM classifier achieved accuracies of 90.33%±6.89% and 71.56%±7.80%, respectively. Conclusions:There are significant abnormalities in the low-frequency fluctuation of the resting brain in patients dependent on MA. These abnormalities reflect the rigidity of prefrontal cortex activity, functional impairment, and dysfunction of the anti-reward system. These factors may be one of the causes for MA dependent behavior and repeated episodes. In addition, the fALFF values may be helpful for distinguishing MA dependent individuals from the control group.

AIM:This study aimed to investigate the effect of ischemic post-conditioning(I-post-C)on lung ischemia-reperfusion injury(LIRI)in rats and relationship between I-post-C and zinc homeostasis.METHODS:SPF SD rats(6～8 weeks old)were randomly divided into four groups,with eight rats in each group:control group,ischemia/reper-fusion(I/R)group,I-post-C group and I-post-C+zinc ion chelator TPEN group.Inductively coupled plasma mass spec-trometry(ICP-MS)was used to measure the concentration of zinc ions in lung tissues.HE staining,lung wet/dry weight ra-tio(W/D),total lung water content(TLW),and index of quantitative assessment(IQA)of lung injury were used to detect the degree of lung tissue injury in each group.Mitochondrial membrane potential was measured using extraction and JC-1 mitochondrial membrane potential detection kits.TUNEL assay was used to detect the level of apoptosis in lung tissues.Western blot was used to detect the protein expression levels of caspase-3,solute carrier family 39 member 8(SLC39A8/ZIP8),solute carrier family 30 member 9(SLC30A9/ZNT9),and PI3K/AKT/GSK-3β in lung tissues of each group.RT-qPCR was used to detect ZIP8 and ZNT9.RESULTS:Compared to the control group,the I/R group showed significantly aggravated lung tissue injury(P<0.01),decreased zinc ion levels(P<0.01),enhanced cell apoptosis(P<0.05),re-duced mitochondrial membrane potential(P<0.01),decreased PI3K/AKT/GSK-3β phosphorylation levels(P<0.05,P<0.01),increased cleaved caspase-3/pro-caspase-3 ratio(P<0.01),and reduced ZIP8 expression(P<0.05).Compared to the I/R group,the I-post-C group exhibited alleviated injury(P<0.05 or P<0.01),increased zinc ion levels(P<0.01),reduced apoptosis(P<0.01),restored mitochondrial membrane potential(P<0.01),elevated PI3K/AKT/GSK-3β phosphorylation levels(P<0.05,P<0.01),decreased cleaved caspase-3/pro-caspase-3 ratio(P<0.05),and in-creased ZIP8 expression(P<0.05).Compared to the I-post-C group,the I-post-C+TPEN group demonstrated aggravated injury(P<0.01),decreased zinc ion levels(P<0.01),enhanced apoptosis(P<0.01),reduced mitochondrial membrane potential(P<0.05),decreased PI3K/AKT/GSK-3β phosphorylation levels(P<0.05,P<0.01),increased cleaved cas-pase-3/pro-caspase-3 ratio(P<0.05),and reduced ZIP8 expression(P<0.05).ZNT9 expression showed no significant differences among the groups(P>0.05).CONCLUSION:Ischemic postconditioning can improve LIRI by regulating zinc homeostasis,activating PI3K/AKT signaling pathway,inactivating glycogen synthase kinase 3β,inhibiting the de-cline of mitochondrial membrane potential,and antagonizing cell apoptosis in rats.

AIM:To investigate the protective effect and mechanism of zinc ions on lung ischemia/reperfusion injury(LIRI)in rats.METHODS:SPF SD rats aged 6～8 weeks were divided randomly into 4 groups:control(control)group,ischemia/reperfusion(I/R)group,zinc chloride(ZnCl2)+I/R group,and PI3K inhibitor(LY294002)+ZnCl2+I/R group.Inductively coupled plasma mass spectrometry(ICP-MS)was used to measure the concentration of zinc ions in lung tissues,while the degree of lung tissue injury was assessed by HE staining,the alveolar damage index,and the lung wet/dry weight ratio.qPCR was used to detect the mRNA expression of solute carrier family 39 member 8(SLC39A8/ZIP8),with the TUNEL assay used to determine the level of apoptosis in lung tissue.The phosphorylation levels of caspase3,PI3K,AKT,GSK-3β,ZIP8,and solute carrier family 30 member 9(SLC30A9/ZNT9)were detected by Western blot,while the mitochondrial membrane potential was measured by the mitochondrial extraction kit and JC-1 mitochondrial mem-brane potential detection kit.RESULTS:Compared with the I/R group,the zinc ion level in the ZnCl2+I/R group in-creased(P<0.01),with the qPCR results showing that the expression level of ZIP8 also increased(P<0.01).The West-ern blot results demonstrated that the phosphorylation levels of PI3K/AKT/GSK-3β and cleaved caspase-3/pro were both in-creased(P<0.01 or P<0.05).In addition,the level of caspase-3 was decreased(P<0.01),the ZIP8 level was increased(P<0.05),whereas the level of ZNT9 was not significantly different(P>0.05).The mitochondrial membrane potential was increased(P<0.01)and the level of apoptosis was decreased(P<0.01).The results of HE staining,total lung water(TLW),lung index of quantitative assessment of histology(IQA),and lung tissue wet/dry weight ratio showed that the de-gree of injury was reduced significantly(P<0.05 or P<0.01).Compared with the ZnCl2+I/R group,the LY294002+Zn-Cl2+I/R group had a significant reduction in zinc ion levels(P<0.05),while qPCR showed a significant reduction in ZIP8 expression(P<0.01).Western blot showed that the phosphorylation level of PI3K/AKT/GSK-3β was decreased(P<0.01),the level of caspase-3/pro-caspase-3 was increased(P<0.01)the level of ZIP8 was decreased(P<0.05),al-though there was no significant difference in ZNT9(P>0.05).Measurements of the mitochondrial membrane potential demonstrated a significant decrease(P<0.01),while the TUNEL results showed that the level of apoptosis had increased(P<0.05).HE staining,TLW,IQA and lung tissue wet/dry weight ratio indicated that the degree of injury was aggravated significantly(P<0.05 or P<0.01).CONCLUSION:Administration of zinc chloride in rats has a protective role in lung ischemia/reperfusion injury by activating the PI3K/AKT pathway,leading to inactivation of GSK-3β,stabilization of the mitochondrial membrane potential level,and inhibition of cell apoptosis.

Fetal growth restriction(FGR)refers to the failure of a fetus to reach the level of growth potential determined by its genetic potential.It is a common obstetric complication,occurring in 5%to 10%of pregnancies.As a major risk factor for perinatal death and adverse neonatal outcomes,early prediction of FGR is crucial for optimizing pregnancy management.Existing evidence suggests that FGR is significantly associated with a variety of adverse pregnancy outcomes,including intrauterine hypoxia,preterm birth,neonatal asphyxia,and even neonatal mortality.It may also affect long-term neurological development and increase the risk of metabolic diseases in adulthood.Its pathogenesis is complex,which may involve placental blood flow perfusion insufficiency and genetic factors.Ultrasound parameters are the main basis for the diagnosis of FGR,among which fetal biological and hemodynamic parameters are of great value.Elevated umbilical artery blood flow resistance index,absent or reversed end-diastolic blood flow,and placental insufficiency are associated with the severity of FGR.However,approximately 10%of fetuses diagnosed by ultrasound as having FGR are later confirmed to be healthy small-for-gestational-age(SGA)infants after birth,and this false positive result may lead to unnecessary clinical interventions.Currently,there is no recognized accurate prediction model for FGR in clinical practice.Future research should focus on establishing unified diagnostic criteria and developing multi-index joint prediction tools based on artificial intelligence(AI).Early prediction and intervention for FGR are of great significance to improve perinatal outcomes.This paper reviewed the predictive value of ultrasound parameters,blood indicators,and their integration with AI for FGR,in order to provide a basis for clinical decision-making.

AIM:To investigate the protective effect and mechanism of zinc ions on lung ischemia/reperfusion injury(LIRI)in rats.METHODS:SPF SD rats aged 6～8 weeks were divided randomly into 4 groups:control(control)group,ischemia/reperfusion(I/R)group,zinc chloride(ZnCl2)+I/R group,and PI3K inhibitor(LY294002)+ZnCl2+I/R group.Inductively coupled plasma mass spectrometry(ICP-MS)was used to measure the concentration of zinc ions in lung tissues,while the degree of lung tissue injury was assessed by HE staining,the alveolar damage index,and the lung wet/dry weight ratio.qPCR was used to detect the mRNA expression of solute carrier family 39 member 8(SLC39A8/ZIP8),with the TUNEL assay used to determine the level of apoptosis in lung tissue.The phosphorylation levels of caspase3,PI3K,AKT,GSK-3β,ZIP8,and solute carrier family 30 member 9(SLC30A9/ZNT9)were detected by Western blot,while the mitochondrial membrane potential was measured by the mitochondrial extraction kit and JC-1 mitochondrial mem-brane potential detection kit.RESULTS:Compared with the I/R group,the zinc ion level in the ZnCl2+I/R group in-creased(P<0.01),with the qPCR results showing that the expression level of ZIP8 also increased(P<0.01).The West-ern blot results demonstrated that the phosphorylation levels of PI3K/AKT/GSK-3β and cleaved caspase-3/pro were both in-creased(P<0.01 or P<0.05).In addition,the level of caspase-3 was decreased(P<0.01),the ZIP8 level was increased(P<0.05),whereas the level of ZNT9 was not significantly different(P>0.05).The mitochondrial membrane potential was increased(P<0.01)and the level of apoptosis was decreased(P<0.01).The results of HE staining,total lung water(TLW),lung index of quantitative assessment of histology(IQA),and lung tissue wet/dry weight ratio showed that the de-gree of injury was reduced significantly(P<0.05 or P<0.01).Compared with the ZnCl2+I/R group,the LY294002+Zn-Cl2+I/R group had a significant reduction in zinc ion levels(P<0.05),while qPCR showed a significant reduction in ZIP8 expression(P<0.01).Western blot showed that the phosphorylation level of PI3K/AKT/GSK-3β was decreased(P<0.01),the level of caspase-3/pro-caspase-3 was increased(P<0.01)the level of ZIP8 was decreased(P<0.05),al-though there was no significant difference in ZNT9(P>0.05).Measurements of the mitochondrial membrane potential demonstrated a significant decrease(P<0.01),while the TUNEL results showed that the level of apoptosis had increased(P<0.05).HE staining,TLW,IQA and lung tissue wet/dry weight ratio indicated that the degree of injury was aggravated significantly(P<0.05 or P<0.01).CONCLUSION:Administration of zinc chloride in rats has a protective role in lung ischemia/reperfusion injury by activating the PI3K/AKT pathway,leading to inactivation of GSK-3β,stabilization of the mitochondrial membrane potential level,and inhibition of cell apoptosis.

Objective:To investigate the difference in brain activity intensity between methamphetamine (MA) dependent patients (MA group) and healthy controls (control group) using fractional amplitude of low-frequency fluctuation (fALFF), and to establish a classification model between these two groups using support vector machine (SVM).Methods:From February 2014 to October 2019, a total of 46 male MA-dependent patients and 46 male healthy controls were recruited from the Affiliated Kangning Hospital of Ningbo University. The study collected resting-state functional magnetic resonance imaging (rs-fMRI) data and analyzed the differences in brain functional activity between the two groups. This analysis was conducted using both static and dynamic fractional amplitude of low-frequency fluctuations (d-fALFF). Additionally, the study examined the correlation between fALFF/d-fALFF values in specific brain regions and the total scores, as well as each factor score, of the Brief Psychiatric Rating Scale (BPRS). Furthermore, the relationship between fALFF/d-fALFF values and the age of first use and total dose of MA in the MA group was investigated. Finally, the fALFF map and d-fALFF map of brain regions with significant differences between groups were used as features for constructing classification.Results:Compared to the healthy control group, those dependent on MA showed significantly increased fALFF mainly in the nucleus accumbens, caudate nucleus, thalamus, and amygdala nucleus( t=-5.21--2.72, all P<0.05). The MA group exhibited decreased fALFF in the superior frontal gyrus, middle frontal gyrus, orbital gyrus, and cingulate gyrus( t=3.59-5.00, all P<0.05). Most of the brain regions with decreased d-fALFF overlapped with those exhibiting decreased fALFF( t=3.33-4.87, all P<0.05). The results of the correlation analysis showed that the fALFF value of the right nucleus accumbens was positively correlated with the age of first use of MA ( r=0.537, P<0.001). There is no significant relationship between the abnormal fALFF and d-fALFF values in the MA group and the total scores and each factor scores of BPRS, as well as the total dose of MA taken (after removing outliers). Based on fALFF and d-fALFF values, the SVM classifier achieved accuracies of 90.33%±6.89% and 71.56%±7.80%, respectively. Conclusions:There are significant abnormalities in the low-frequency fluctuation of the resting brain in patients dependent on MA. These abnormalities reflect the rigidity of prefrontal cortex activity, functional impairment, and dysfunction of the anti-reward system. These factors may be one of the causes for MA dependent behavior and repeated episodes. In addition, the fALFF values may be helpful for distinguishing MA dependent individuals from the control group.

AIM: To evaluate the performance of three distinct large language models(LLM), including GPT-3.5, GPT-4, and PaLM2, in responding to queries within the field of ophthalmology, and to compare their performance with three different levels of medical professionals: medical undergraduates, master of medicine, and attending physicians.METHODS: A total of 100 ophthalmic multiple-choice tests, which covered ophthalmic basic knowledge, clinical knowledge, ophthalmic examination and diagnostic methods, and treatment for ocular disease, were conducted on three different kinds of LLM and three different levels of medical professionals(9 undergraduates, 6 postgraduates and 3 attending physicians), respectively. The performance of LLM was comprehensively evaluated from the aspects of mean scores, consistency and confidence of response, and it was compared with human.RESULTS: Notably, each LLM surpassed the average performance of undergraduate medical students(GPT-4:56, GPT-3.5:42, PaLM2:47, undergraduate students:40). Specifically, performance of GPT-3.5 and PaLM2 was slightly lower than those of master's students(51), while GPT-4 exhibited a performance comparable to attending physicians(62). Furthermore, GPT-4 showed significantly higher response consistency and self-confidence compared with GPT-3.5 and PaLM2.CONCLUSION: LLM represented by GPT-4 performs well in the field of ophthalmology, and the LLM model can provide clinical decision-making and teaching aids for clinicians and medical education.

Objective:To introduce the method of using anal fistula endoscope to treat chronic sinus tract leakage at rectal anastomosis site.Methods:We used anal fistula endoscopy to treat a patient with chronic sinus tract leakage after radical resection of rectal cancer, mainly including the following 5 steps: (1) establishing a water injection circulation system through the anus; (2) scraping off purulent coating and mucosa on the surface of the sinus tract with the brush; (3) hemostasis and removal of necrotic tissue with electrocoagulation rods; (4) filling the sinus tract with bioprotein gel; (5) compressing the sinus tract with transanal drainage tube.Results:The patient is a 70 year old male with rectal cancer. After undergoing 3D laparoscopic assisted radical resection of rectal cancer via abdominal anterior resection (Dixon's procedure) and diverting ileostomy surgery for more than 3 months, leakage of the rectal anastomosis was found through colonoscopy and anal iodine water contrast imaging .The patient started eating and flowing juice 6 hours after surgery, got out of bed 24 hours after surgery, and was discharged 48 hours after the removal of the anal canal. Three months after surgery, colonoscopy and transanal iodine hydrography showed that the sinus repair was intact. The diverting ileostomy was reduced 4 months after surgery.Conclusion:Anal fistula endoscope is safe and feasible for the treatment of chronic sinus tract anastomotic leakage in selected patients.