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.

Obesity is a significant risk factor for cancer and is associated with breast cancer metastasis. Nevertheless, the mechanism by which alterations in systemic metabolism affect tumor microenvironment (TME) and consequently influence tumor metastasis remains inadequately understood. Herein, we found that perturbations in circulating metabolites induced by obesity promote metastasis-like phenotypes in breast cancer. Oleoylcarnitine (OLCarn) concentrations were elevated in the serum of obese mice and humans. Administration of exogenous OLCarn induces metastasis-like characteristics in breast cancer cells. Mechanistically, OLCarn directly interacts with the Arg176 site of adenylate cyclase 10 (ADCY10), leading to the activation of ADCY10 and enhancement of cAMP production. Mutations at Arg176 prevent OLCarn from binding to ADCY10, disrupting the ADCY10-mediated activation of cyclic adenosine monophosphate (cAMP) signaling pathway. This activation promotes transcription factor 4 (TCF4)-dependent kinesin family member C1 (KIFC1) transcription, thereby driving breast cancer metastasis. Conversely, the neutralization of both ADCY10 and KIFC1 through knockdown or pharmacological inhibition abrogates the oncogenic effects mediated by OLCarn. Hence, obesity-induced systemic environmental changes lead to the aberrant accumulation of OLCarn within the TME, making it a potential therapeutic target and biomarker for breast cancer.

ObjectiveTo obtain the gene sequences of major histocompatibility complex (MHC ) Ⅱgenes of Wuzhishan pigs, analyze their genetic information, and explore the biological functions of their MHC system. MethodsSpleen samples were collected from 3 adult male Wuzhishan pigs. Primers were designed according to MHCⅡ gene sequences, and the coding sequences of Wuzhishan pig MHCⅡ genes were amplified by RT-PCR. Sanger sequencing was performed to determine the full-length sequences. Bioinformatics tools were employed to analyze the physicochemical properties, phylogenetic relationships, conserved motifs, structural domains, chromosomal localization, and syntenic relationships of these genes. ResultsEight MHCⅡ genes were identified in Wuzhishan pigs, designated as SLA-DRA, SLA-DQA, SLA-DQB, SLA-DRB, SLA-DOB, SLA-DMB, SLA-DMA and SLA-DOA. The full-length sequences of these genes were determined by Sanger sequencing and subsequently deposited in GenBank under accession numbers PQ182796, PQ182797, PQ182798, PQ182799, PQ182800, PQ182801, PQ182802, and PQ164779. Phylogenetic analysis showed that the six MHCⅡ genes of Wuzhishan pigs clustered separately from their counterparts in Duroc, Meishan, Large White, and Bama pigs, indicating distinct evolutionary trajectories. Bioinformatics analysis demonstrated that most MHC Ⅱ proteins were hydrophobic, with molecular weights ranging from 27 700 to 30 000 Da. Genes within the same subregion shared conserved motifs. Specifically, four MHCⅡ proteins encoded by SLA-DQB, SLA-DRB, SLA-DOB, and SLA-DMB contained the MHCⅡβ conserved domain, while those encoded by the genes SLA-DRA, SLA-DQA, SLA-DMA, and SLA-DOA contained the MHCⅡα conserved domain. The eight MHCⅡ genes were scattered along the long arm of chromosome 7 in the Wuzhishan pigs, exhibiting syntenic relationships with three human genes and five Duroc pig genes. ConclusionThe MHCⅡ genes of Wuzhishan pigs may possess a unique evolutionary origin.

ObjectiveTo obtain the gene sequences of major histocompatibility complex (MHC ) Ⅱgenes of Wuzhishan pigs, analyze their genetic information, and explore the biological functions of their MHC system. MethodsSpleen samples were collected from 3 adult male Wuzhishan pigs. Primers were designed according to MHCⅡ gene sequences, and the coding sequences of Wuzhishan pig MHCⅡ genes were amplified by RT-PCR. Sanger sequencing was performed to determine the full-length sequences. Bioinformatics tools were employed to analyze the physicochemical properties, phylogenetic relationships, conserved motifs, structural domains, chromosomal localization, and syntenic relationships of these genes. ResultsEight MHCⅡ genes were identified in Wuzhishan pigs, designated as SLA-DRA, SLA-DQA, SLA-DQB, SLA-DRB, SLA-DOB, SLA-DMB, SLA-DMA and SLA-DOA. The full-length sequences of these genes were determined by Sanger sequencing and subsequently deposited in GenBank under accession numbers PQ182796, PQ182797, PQ182798, PQ182799, PQ182800, PQ182801, PQ182802, and PQ164779. Phylogenetic analysis showed that the six MHCⅡ genes of Wuzhishan pigs clustered separately from their counterparts in Duroc, Meishan, Large White, and Bama pigs, indicating distinct evolutionary trajectories. Bioinformatics analysis demonstrated that most MHC Ⅱ proteins were hydrophobic, with molecular weights ranging from 27 700 to 30 000 Da. Genes within the same subregion shared conserved motifs. Specifically, four MHCⅡ proteins encoded by SLA-DQB, SLA-DRB, SLA-DOB, and SLA-DMB contained the MHCⅡβ conserved domain, while those encoded by the genes SLA-DRA, SLA-DQA, SLA-DMA, and SLA-DOA contained the MHCⅡα conserved domain. The eight MHCⅡ genes were scattered along the long arm of chromosome 7 in the Wuzhishan pigs, exhibiting syntenic relationships with three human genes and five Duroc pig genes. ConclusionThe MHCⅡ genes of Wuzhishan pigs may possess a unique evolutionary origin.

Objective:To examine the differences in the medical quality of elderly Medicare patients in tertiary public hospitals before and after the implementation of the Diagnosis-related Group Prospective Payment System(DRG-PPS), and to explore the establishment of a long-term quality control mechanism.Methods:A total of 62, 321 inpatient first-page records was collected from Beijing Hospital, including 27, 488 cases from January to December 2019 and 34, 833 cases from January to December 2023.Firstly, the two-sample Kolmogorov-Smirnov test was applied to six sample DRG groups to analyze the statistical differences in the intra-group indicators(average per-case cost, average length of stay)among three age groups(young and middle-aged group: 18-65 years old; early elderly group: 66-79 years old; advanced elderly group: 80-99 years old)before and after the DRG-PPS reform of the medical insurance payment system.Secondly, the two-sample Kruskal-Wallis test was used to analyze the statistical differences in the indicators(total cost, medical cost, nursing cost, medical technology cost, pharmaceutical cost, consumable cost, administrative cost, and length of stay)among the three age groups within the same DRG group.Finally, the Conover test was employed for pairwise comparisons of inter-group indicators between the three groups.Results:Through the intra-group analysis of the total cost and average length of stay indicators of different age groups in the six sample DRG groups( n=6, 248), it was found that the differences were statistically significant.( Z-values for total cost in groups 1-3 was 12.69, 15.73, and 11.45, respectively; Z-values for average length of stay were 8.33, 6.73, and 3.69, respectively; all P<0.05), indicating that the DRG-PPS reform was effective in controlling hospitalization costs and length of stay.The inter-group analysis revealed statistically significant differences in total cost, nursing cost, pharmaceutical cost, consumable cost, administrative cost, and length of stay( H-values were 22.49, 41.86, 15.61, 200.56, 14.73 and 10.73, respectively; all P<0.05; ), suggesting that there were statistically significant differences in cost control among different age groups in the same DRG group.Furthermore, analysis of specific cases revealed that differences in medical costs among different age groups resulted from the combined effects of clinical practice standardization(reflected in the significant reduction of unnecessary examinations and medication)and policy interventions such as volume-based procurement excluding the adverse effects of cost containment on the medical quality of elderly patients in the six sample patient groups.No substantial rise was observed in the 31-day readmission rate, indicating that admission splitting was unlikely to have occurred. Conclusions:The implementation of the DRG-PPS contributed to cost efficiency in the sample hospital.By establishing a long-term quality control mechanism focused on DRG groups with significant cost reductions in elderly patients, abnormal cost-control behaviors can be effectively identified, and high-quality development of the hospital can be achieved while ensuring healthcare quality for elderly patients.

BACKGROUND:Studies have found that massage can reduce blood sugar,promote myogenic factor expression,and increase skeletal muscle content.The extracellular matrix is an important component of skeletal muscle,and association between massage and extracellular matrix and their mechanism of action are still unclear.OBJECTIVE:To explore the effect of massage on extracellular matrix collagen deposition in type 2 diabetic sarcopenia rats.METHODS:Totally 24 Wistar male rats were randomly divided into blank group,model group,and massage group.High-fat diet combined with the streptozotocin method was used to establish a type 2 diabetes mellitus and sarcopenia model.After successful model establishment,the massage group used abdominal massage combined with hind limbs.After 8 weeks of treatment,the fasting blood glucose and serum insulin levels of the rats were measured.The skeletal muscle mass was detected by dual-energy X-ray.The exhaustion time was measured by small animal treadmill.The sliding angle was measured by inclined board test.The pathological changes of skeletal muscle tissue were observed by hematoxylin-eosin staining.The skeletal muscle collagen deposition was observed by Masson staining.The mRNA and protein expressions of type Ⅰ and type Ⅲ collagen in skeletal muscle were detected by qPCR and western blot assay.RESULTS AND CONCLUSION:(1)Compared with the model group,the blood glucose(P＜0.05)and serum insulin(P＜0.01)decreased in the massage group.(2)Compared with the model group,the skeletal muscle mass,running exhaustion time,and the angle of inclined plate experiment were increased in massage group(P＜0.05).(3)Compared with the model group,the skeletal muscles of the massage group were arranged neatly,muscle atrophy was improved,and collagen fiber deposition was reduced.(4)Compared with the model group,the expression levels of type Ⅰ and type Ⅲ collagen mRNA and protein in skeletal muscle were decreased in the massage group(P＜0.05).(5)The results suggest that massage can enhance insulin sensitivity,lower blood sugar,improve skeletal muscle mass,strength and function,and diminish collagen deposition in rats with type 2 diabetes,and may be a potential target for massage to exert its therapeutic effects.

Objective To evaluate the application of an online merge offline mode(OMO)based on an advanced intelligent virtual simulation experimental platform in clinical skills teaching.Methods Two classes were random-ly selected from the clinical medicine major of Hubei Medical University in 2021 and divided into a control group and an experimental group.The control group adopted the traditional lecture-based learning(LBL)teaching mode,while the experimental group adopted the advanced intelligent virtual simulation experimental platform OMO teaching mode for pilot teaching and effect evaluation.Results After implementing the OMO teaching mode of the advanced intelligent virtual simulation experimental platform,the clinical skill operation level,learning efficiency,and teaching effect satisfaction of the experimental group students were higher than those of the control group(P＜0.05).Conclusions Based on the advanced intelligent virtual simulation experimental platform,the OMO teaching mode deeply integrates information technology and clinical skills training,effectively enhances the practical ability and learning efficiency of medical students,and provides a scalable innovative path for the digital transformation of medical education.

Objective To explore the role of meibomian gland massage combined with the ROY adaptation model in nursing of xerophthalmia.Methods The medical records of 286 patients with xerophthalmia admitted from March 2022 to October 2023 were retrospectively included.The patients were divided into conventional group(141 cases)and combined group(145 cases)according to dif-ferent intervention methods.Both groups received optimized pulsed light therapy.The conventional group received meibomian gland massage and routine nursing for xerophthalmia,while the combined group received additional nursing based on the ROY adaptation model.The improvement effects on subjective symptoms(dryness,foreign body sensation,fatigue,photophobia,and burning sensation)as well as psychological status[Symptom Checklist-90(SCL-90)],self-efficacy[General Self-Effica-cy Scale(GSES)],ocular surface status[Ocular Surface Disease Index(OSDI)],and quality of life[the scale of quality of life for diseases with visual impairment(SQOL-DVI)]before and after inter-vention were compared between the two groups.Results The disappearance time of dryness,foreign body sensation,fatigue,photophobia,and burning sensation were shorter in the combined group than those in the conventional group(P＜0.05).After the intervention,the scores of all dimensions and the total score of SCL-90 decreased in both groups compared with those before the intervention,and the scores in the combined group were lower than those in the conventional group(P＜0.05).After the intervention,the scores for facing problems,coping with problems,and the total score increased in both groups compared with those before the intervention,and the scores in the combined group were higher than those in the conventional group(P＜0.05).After the intervention,the scores for ocular symp-toms,visual function,environmental triggers factors,and the total score decreased in both groups compared with those before the intervention,and the scores in the combined group were lower than those in the conventional group(P＜0.05).After the intervention,the scores for general health status,symptoms and visual function,social activities,mental health,and the total score increased in both groups compared with those before the intervention,and the scores in the combined group were higher than those in the conventional group(P＜0.05).Conclusion Meibomian gland mas-sage combined with nursing based on the ROY adaptation model can improve dry eye symptoms,ad-just the ocular surface status,enhance self-efficacy,and improve the quality of life of patients.

Calorie restriction has garnered significant attention in the prevention and treatment of metabolic diseases. During calorie restriction, various appetite-regulating hormones undergo changes, including a decrease in leptin, insulin, and amylin, along with an increase in peptide YY, glucagon-like peptide 1, and pancreatic polypeptide. These hormonal changes play a crucial role in regulating the body's feeding processes, improving glucose and lipid metabolism, and maintaining energy balance. In this paper, we discuss the effects of dietary restriction therapy on appetite-regulating hormones and the mechanisms by which this therapy aids in the treatment of metabolic diseases. Our goal is to provide insights for the prevention and long-term management of metabolic disorders such as obesity and type 2 diabetes.

Objective To observe the efficacy of percutaneous vertebroplasty(PVP)combined with microwave ablation(MWA)for treating vertebral compression fractures(VCF)caused by metastatic cancer.Methods Totally 112 patients with VCF caused by metastatic cancer were retrospectively enrolled,including 77 cases(105 vertebrae)underwent MWA+PVP(group A)and 35 cases(68 vertebrae)who underwent PVP alone(group B).The success rates of the treatments were recorded,and complications were observed.Visual analogue scale(VAS)score of pain,daily morphine consumption(DMC)and Oswestry disability index(ODI)of patients were compared within and between groups after treatments,and local tumor recurrence rates after treatment were observed.Results The success rates of MWA and PVP were both 100%.After treatments,bone cement leakage occurred in 12 cases(12/77,15.58%)in group A and 19 cases(19/35,54.29%)in group B,in group A was lower than in group B(P＜0.001).No other complications occurred.One week and 1,3 and 6 months after treatments,VAS scores of pain,DMC and ODI in group A and B were all lower than those before treatments(all P＜0.001).Three and 6 months after treatments,VAS scores of pain in group A were lower than those in group B(both P＜0.01),while 6 months after treatments,DMC and ODI in group A were lower than those in group B(both P＜0.01).No significant difference of VAS scores of pain,DMC nor ODI was found between groups at the other time points(all P＞0.05).Six months after treatments,local tumor recurrence rate in lesions in group A(17.14%,18/105)was significantly lower than that in group B(32.35%,22/68)(P=0.020).Conclusion For treating VCF caused by metastatic cancer,PVP combined with MWA could reduce incidence of complications,prolong pain relief time and bring better short-term local tumor control effect.