Generative artificial intelligence(Gen-AI), an important branch of artificial intelligence(AI), has attracted increasing attention in medical image analysis and clinical decision support.Different from traditional discriminative models, Gen-AI can generate high-quality and diverse new data by learning the underlying distribution features of data. It exhibits unique advantages in alleviating insufficient training samples, mitigating uneven data distribution, and improving the generalization ability of models. Ophthalmology is highly dependent on multimodal imaging, making it a particularly suitable field for the application of Gen-AI. This review summarizes recent advances in major Gen-AI techniques, including generative adversarial networks, diffusion models, and large language models, and discusses their applications in ophthalmic disease screening and diagnosis, image synthesis and data augmentation, prognostic prediction, and individualized treatment planning. It also analyzes challenges in the course of clinical translation, including data quality, model credibility, ethical supervision and other issues, so as to provide references for its standardized application.

Objective To explore the clinical efficacy of different ligation methods in laparoscopic radi-cal resection of rectal cancer and sigmoid colon cancer and the influencing factors of anastomotic leakage.Methods A total of 82 patients who underwent laparoscopic radical resection of rectal cancer and sigmoid co-lon cancer in this hospital from December 2022 to December 2023 were selected and divided into the low-liga-tion group(n=42)and the high-ligation group(n=40)according to different surgical methods.The inferior mesenteric artery(IMA)classification,IMA length,operation time,intraoperative blood loss,total number of lymph node dissections,number of lymph node dissections in group 253,postoperative hospital stay,exhaust time,incidence of urinary retention,incidence of anastomotic leakage,and incidence of preventive stoma were compared between the two groups.Univariate and multivariate logistic regression analyses were conducted to analyze the influencing factors of anastomotic leakage in patients undergoing radical resection of rectal cancer and sigmoid colon cancer.Results There was no statistically significant difference in IMA length,IMA classi-fication proportion,operation time,intraoperative blood loss,the total number of lymph node dissections,the number of lymph node dissections in group 253,and the postoperative hospital stay between the two groups(P>0.05).Compared with the high-ligation group,the low-ligation group had a shorter exhaust time,lower incidence of anastomotic leakage and preventive ostomy,the differences were statistically significant(P<0.05).Anastomotic leakage occurred in 7 patients.Univariate analysis showed that whether left colic artery(LCA)was preserved,tumor location,presence of underlying diseases,and preventive stoma were associated with anastomotic leakage in patients undergoing radical resection of rectal cancer and sigmoid colon cancer(P<0.05).Multivariate logistics analysis showed that whether LCA was preserved,tumor location,presence of underlying diseases,and presence of preventive stoma were not influencing factors for anastomotic leakage in patients undergoing radical resection of rectal cancer or sigmoid colon cancer(P>0.05).Conclusion In laparoscopic radical resection of rectal and sigmoid colon cancer,the clinical efficacy of preserving LCA is com-parable to that of not preserving LCA,and it can reduce the risk of anastomotic leakage and the probability of preventive stoma,promoting the early recovery of intestinal function.

Objective Compared with patients with insomnia,the clinical characteristics and polysomnography(PSG)results from patients with co-morbid insomnia and obstructive sleep apnea(COMISA)were analyzed.The analysis was conducted to investigate clinical manifestations,sleep physiological characteristics,and related risk factors of COMISA patients.Methods A total of 134 patients with insomnia were enrolled and divided into two groups based on whether their apnea-hypopnea index(AHI)was≥5 events/hour:the COMISA group(69 patients)and the insomnia-only group(65 patients).The COMISA group was further divided into a mild OSA subgroup of 41 cases and a moderate-to-severe OSA subgroup of 28 cases;and then into a mild insomnia subgroup of 37 cases and a moderate-to-severe insomnia subgroup of 32 cases.The demographic characteristics,Pittsburgh sleep quality index(PSQI),self-rating depression scale(SDS),self-rating anxiety scale(SAS),Epworth sleepiness scale(ESS)and PSG results were analyzed.Results Compared with the insomnia-only group,the COMISA group had a higher proportion of men,a higher age,a higher body mass index(BMI),a higher proportion of smoking,a higher proportion of snoring,a lower average blood oxygen saturation and lowest blood oxygen saturation,a higher proportion of N2 stage,and a lower proportion of N3 stage and R stage(P<0.05).Compared with the mild OSA subgroup,the moderate-to-severe OSA subgroup had a higher BMI index,a higher proportion of snoring,a higher SAS score,a lower average blood oxygen saturation and lowest blood oxygen saturation,a higher proportion of N1 stage,and a lower proportion of N3 stage(P<0.05).Compared with the subgroup of mild insomnia,the subgroup of moderate-to-severe insomnia in the COMISA group had a higher proportion of hypnotic drug use(P<0.01),but there was no significant difference between the two groups in PSG results(P>0.05).Logistic regression analysis showed that older age(OR=1.07,P<0.01)and higher BMI(OR=1.41,P<0.01)were risk factors for the co-occurrence of OSA in insomnia patients.Conclusion Patients with COMISA have worse objective sleep quality at night than those with insomnia-only,and patients with more severe OSA have poorer objective sleep quality.In clinical practice,it is important to be aware of the risk of comorbid OSA for patients with insomnia who are older and have a higher BMI.

Metal elements are widely present in people's daily environment. With the increase of industrial activities, people are facing more metal exposures than ever before, and even several metal elements have been detected in follicular fluid. Most people live with environmental background levels of metal exposure rather than occupational long-term exposure. Therefore, the term "environmental metals" in this paper refers specifically to the metals in people's daily background environment. It is important to investigate the potential effects of environmental metal exposure on female fertility. In this paper, we summarize the latest research progress on the effects of environmental metal element exposure on women's reproductive health, discuss the toxicity mechanisms of metal elements, and propose possible detoxification and intervention strategies to provide scientific evidence for the protection of women's reproductive health.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective To investigate the characteristics and differences of congenital endowment in senile dementia population based on the theory of five circuits and six qi.Methods Based on the cross-sectional data of China Health and Retirement Longitudinal Survey(CHARLS)in 2018,the dementia status of the population aged 60 and above in China was evaluated by using the Mini-Mental State Examination(MMSE),and the five-circuit and six-qi features at birth in the senile dementia population were analyzed by descriptive statistics and Chi-square goodness-of-fit test.Results A total of 854 patients with senile dementia were included.The five-circuit and six-qi features at birth in the senile dementia population were as follows:most of them were born at the heavenly stem of Bing while the least at the heavenly stem of Ji and Geng(P＜0.001),most of them were born at the earthly branch of Wei while the least at the earthly branch of Zi(P＜0.001),most of them were born at the yearly circuit of excessive water circuit while the least at the yearly circuit of excessive gold circuit and deficient earth circuit(P＜0.001),and most of the patients were born at sitan of taiyin damp-earth and zaiquan of taiyang cold-water while the least at sitan of jueyin wind-wood and zaiquan of shaoyang ministerial fire;no statistically significant differences were found in the dominant qi and guest qi(P＞0.05);most of the patients were born in the year of combination of circuit and qi being Shunhua while the least in the year of combination of circuit and qi being same celestial correspondence(P＜0.001),and the patients born in the year of Shunhua usually were frequently distributed in heavenly-stem and earthly-branch year of Jiawu(P＜0.001).Conclusion There is a certain relationship between the congenital endowment at birth and the incidence of senile dementia in the population of senile dementia.The circuit-qi features at birth for the prevalence of senile dementia are the yearly circuit of excessive water circuit,sitan of taiyin damp-earth and zaiquan of taiyang cold-water,and the year of the combination of circuit and qi being Shunhua.The population born at the time with the above circuit-qi features are prone to suffer the injury of the kidneys,the heart,and the spleen,and then result into illness.

Objective To investigate the relationship between serum levels of silent information regulator 1(SIRT1)and(sex determining region Y-box protein 2(SOX2)and liver metastasis one year after colorectal cancer surgery.Methods A total of 112 patients who underwent laparoscopic radical operation for colorectal cancer in Southern Theater General Hospital from December 2020 to February 2023 were selected as research objects.Serum SIRT1 and SOX2 levels were detected one day before surgery.Liver metastasis was recorded during one-year follow-up.The patients with liver metastasis were included in the observation group,while patients without liver metastasis were assigned to the control group.The relationship between serum levels of SIRT1 and SOX2 and liver metastasis after colon cancer surgery and the evalution value of both for liver metastasis after surgery in colon cancer patients were analyzed.Results Six patients failed to be followed up,33 patients(31.13%)suffered from liver metastasis one year after surgery(observation group),and the other 73 patients without liver metastasis were included in control group.The observation group had lower SIRT1 and higher SOX2 than the control group(P<0.05).After adjustment of differentiated degree,depth of invasion,and lymph node metastasis,the risk of postoperative liver metastasis in colon cancer patients increased by 1.123 and 1.925 times,respectively(P<0.05),when SIRT1 decreased by 1%and SOX2 increased by 1%,with logit(P)=-1.938-0.754×SIRT1+1.073×SOX2.The area under curve of SIRT1 combined with SOX2 for the evaluation of postoperative liver metastasis in colon cancer patients was greater than SIRT1 and SOX2 alone(Z=2.107,P=0.035;Z=2.481,P=0.013).Conclusion Decreased SIRT1 and increased SOX2 may increase the risk of postoperative liver metastasis in patients with colon cancer.SIRT1 and SOX2 have the potential to serve as predictive indicators for liver metastasis after surgery in colon cancer patients.

Objective:To assess the preliminary efficacy and safety of modified Société Internationale d′Oncologie Pédiatrique Epithelial Liver Tumor Study Group (SIOPEL)-4 protocol for pediatric hepatoblastoma (HB) with lung metastases.Methods:This prospective cohort study enrolled 27 newly diagnosed pediatric HB with lung metastases who received the modified SIOPEL-4 protocol at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children′s Hospital between January 2020 to December 2023. Clinical characteristics, lung response rates to induction chemotherapy, treatment outcomes, prognostic factors and sever chemotherapy toxicities at different stages were analyzed. Survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by Log-Rank test.Results:Of the 27 patients, there were 17 males and 10 females, with the age of 21 (15, 33) months. During the follow-up of 31 (12, 45) months for 17 continuous complete remission patients, 4 cases disease progression (2 cases death) and 6 cases relapse were observed. The 2-year event free survival (EFS) and overall survival (OS) rate was (58±11)% and (89±7)%, respectively. All the 27 patients had response to block 1-3 induction chemotherapy (cisplatin+doxorubicin), with 14 cases (52%) achieving complete response and 13 cases (48%) achieving partial response of lung metastatic lesions, the 2-year EFS rate was (81±12)% and (34±14)%, respectively ( χ 2=6.76, P=0.009), the 2-year OS rate was 100% and (79±13)%, respectively ( χ2=2.12, P=0.145). Patients with caudate lobe tumors or ≥10 pulmonary metastatic nodules had significantly lower EFS rates ( χ2=5.36, 7.84, P=0.021, 0.005, respectively). The incidence of grade 3/4 neutropenia after block 1-3 induction chemotherapy, CD (carboplatin+doxorubicin), and VI (vincristine+irinotecan) consolidation chemotherapy was 90% (73/81), 75% (58/77), and 31% (11/35), respectively. The incidence of grade 3/4 thrombocytopenia was 77% (62/81), 69% (53/77), and 14% (5/35), respectively. The incidence of grade 3/4 infections was 64% (52/81), 25% (19/77), and 20% (7/35), respectively. The differences between the groups were statistically significant ( χ2=43.51, 42.69, 33.00, all P<0.001). Two patients (10%) of the 20 evaluable patients for ototoxicity occurred grade 3 and higher hearing impairment, with 1 patient requiring a hearing aid. Conclusions:The modified SIOPEL-4 regimen shows good preliminary efficacy and safety in treating pediatric HB with lung metastases. The prognosis for patients with residual lesions in the lungs after induction chemotherapy needs to be improved. Attention should be given to the ototoxicity induced by high-dose cisplatin chemotherapy.

Objective To investigate the clinical and CT findings features of nonaneurysmal perimesencephalic subarachnoid hem-orrhage(NAPSAH).Methods A retrospective analysis was conducted on 19 cases of NAPSAH confirmed by clinical treatment and follow-up,and their clinical and CT findings features were summarized.Results All patients exhibited mild clinical symptoms and had a good prognosis without complications.The sites of NAPSAH involved the anterior cistern in 17 cases,the suprasellar cistern in 8 cases,the interpeduncular cistern in 7 cases,the anterior cistern only in 1 case,and the suprasellar cistern only in 1 case;Among them,4 cases had vertebrobasilar dolichoectasia(VBD)and 3 cases had tortuous prolongation of vertebrobasilar artery.Conclusion The incidence of NAPSAH is low,the clinical symptoms are mild and good prognosis.It has typical imaging features.Most of its hemorrhage sites are confined to the anterior cistern,suprasellar cistern and interpeduncular cistern.Combining clinical and CT find-ings helpful to improve the accuracy of diagnosis.

Hepatic ischemia-reperfusion injury （HIRI） is an inevitable major complication during surgical procedures such as liver transplantation and partial hepatectomy， and its prevention and treatment are hotspots and difficulties in clinical practice. This article reviews the mechanism of injury caused by energy metabolism disorders during liver ischemia-reperfusion and related treatment strategies and summarizes the current advances in metabolism-related therapies， in order to provide new ideas for further clarifying the onset mechanism of HIRI and exploring effective clinical prevention and treatment strategies for HIRI.