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.

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.

Extracorporeal membrane oxygenation (ECMO) is an important treatment for extracorporeal cardiopulmonary life support for clinically critical patients. Currently, ECMO tubing is commonly fixed by tie-wraps or tourniquets, which have shortcomings such as easy loosening and potential damage to the tubing. Improper fixation of the catheter can lead to a series of adverse events, such as accidental disconnection of the tubing, rupture of the tubing, tubing folding, and air ingress into the tubing. In order to overcome the above problems, the research team of Zhongda Hospital, Southeast University invented a device for ECMO line fixation and obtained a national utility model patent of China (patent number: ZL 2019 2 2282849.3). The tool is mainly composed of several devices, including a line fixation clamp, a clip fixation device, and a base plate, which is uniquely designed and easy to operate. During ECMO therapy, this device ensures effective stabilization of the ECMO tubing, preventing unexpected incidents due to catheter loosening and facilitating the observation of ECMO catheter insertion markings. Pipeline can be effectively fixed to avoid the occurrence of accidents due to the loosening of the catheter, and at the same time, it is convenient to observe the placement scale of the ECMO catheter. The novelty and uniqueness of the fixation device materials also effectively prevent the occurrence of pressure injuries during its use.

Stage T4 colon cancer is divided into two categories:tumor penetrating the visceral peritoneum(T4a)and tumor directly invading or attaching to adjacent organs or structures(T4b).Treatment of T4 colon cancer requires technically demanding surgical procedures,including total resection of adjacent infiltrating organs or structures,and is characterized by a high incidence of postoperative complications and a high rate of positive surgical margin microscopy.It has been found that taking laparoscopic surgery for T4 colon cancer may decrease long-term survival and increase the rate of peritoneal metastasis,but taking laparoscopic surgery for colon cancer also has the potential advantages in increasing perioperative benefits and improving the prognosis.With the upgrade of laparoscopic equipment and the improvement of surgeons'surgical skills,more and more surgeons have adopted laparoscopic surgery to treat T4 colon cancer.Currently,the oncologic safety of laparoscopic surgery for T4 colon cancer has not been effectively evaluated.Therefore,this article reviews the advantages,risks,and the choice of treatment strategies for laparoscopic surgery for T4 colon cancer,taking into account the current status and progress of domestic and international studies.

OBJECTIVE: To study the effect of nano-cerium oxide on the early development of zebrafish embryos. METHODS: The well-developed zebrafish embryos were randomly divided into the control group and the 50, 100, 200, 400 and 800 mg/L dose groups, with 40 embryos in each group. The dose groups were treated with nano-cerium oxide at the corresponding mass concentration for 5 days. The control group received no treatment. The death and malformation of embryos were observed. The heart rate of zebrafish embryos was recorded using confocol microscope. The protein expression of microtubule-associated protein 1 light chain 3(LC3) and cleaved Caspase-3 and were observed by Western blot technology. RESULTS: The death and embryonic malformation rate of zebrafish embryos increased with the increase of doses, showing statistical significance(P<0.01). The heart rate of the 800 mg/L dose group was decreased compared with the control group [(77±8) vs(93±4) beats/min, P<0.01]. There was no statistical significant difference in LC3-Ⅱ protein expression in each groups(P>0.05). The cleaved Caspase-3 protein expression increased in all dose groups compared with the control group(P<0.05). The cleaved Caspase-3 protein expression in the 200 mg/L dose group was higher than that in the 50 mg/L dose group(P<0.05). CONCLUSION: The nano-cerium oxide may induce cell apoptosis, causing toxic effect in early development of zebrafish embryos.

Objective: To investigate the clinicopathological features of long-term tumor-free survival in patients with untreated primary diffuse large B-cell lymphoma (DLBCL) of the tonsil. Methods: The study included 80 consultation cases of primary tonsillar DLBCL from April 2006 to July 2017 in the Department of Pathology, Beijing Friendship Hospital, Capital Medical University. The patients were divided into two groups: experimental groups of 10 untreated patients with long-term tumor-free survival, and 70 patients who had been treated (control group). The clinical data, histopathological features, immunohistochemical staining, and molecular biology test results of the patients were analyzed retrospectively. Results: Patients who had long-term tumor-free survival with untreated primary diffuse large B-cell lymphoma had the disease mostly confined to the tonsil. Biopsy showed that the tonsil structure was only partially effaced and the lesions were relatively "fresh". EBER and FISH test for t (14;18) results were negative. Gene rearrangement detection showed monoclonality. There was statistically significant difference between the age, bcl-2 expression, CMYC protein expression and co-expression of CMYC and bcl-2 between the untreated group and the treated group(P<0.05). Patient gender, tumor site, histological type and clinical stage showed no difference between the untreated group and the treated group (P>0.05); The median overall survival of the untreated group and treated group was 81 months and 20 months, respectively, and the difference was not statistically significant (P>0.05).In patients younger than 40 years of age, the untreated group had a statistically significant difference in primary site and CMYC protein expression compared with the treated group (P<0.05), and there was no statistical significance in other aspects. Conclusions Long-term tumor-free survival patients with untreated tonsillar primary DLBCL have relatively unique clinical characteristics. There is no significant difference in the prognosis between the untreated and treated groups, indicating radiotherapy and chemotherapy may not be required and therefore, avoiding related side effects.

Objective To investigate the clinicopathological features of long?term tumor?free survival in patients with untreated primary diffuse large B?cell lymphoma (DLBCL) of the tonsil. Methods The study included 80 consultation cases of primary tonsillar DLBCL from April 2006 to July 2017 in the Department of Pathology, Beijing Friendship Hospital, Capital Medical University. The patients were divided into two groups: experimental groups of 10 untreated patients with long?term tumor?free survival, and 70 patients who had been treated (control group). The clinical data, histopathological features, immunohistochemical staining, and molecular biology test results of the patients were analyzed retrospectively. Results Patients who had long?term tumor?free survival with untreated primary diffuse large B?cell lymphoma had the disease mostly confined to the tonsil. Biopsy showed that the tonsil structure was only partially effaced and the lesions were relatively "fresh". EBER and FISH test for t (14;18) results were negative. Gene rearrangement detection showed monoclonality. There was statistically significant difference between the age, bcl?2 expression, CMYC protein expression and co?expression of CMYC and bcl?2 between the untreated group and the treated group(P<0.05). Patient gender, tumor site, histological type and clinical stage showed no difference between the untreated group and the treated group (P>0.05);The median overall survival of the untreated group and treated group was 81 months and 20 months, respectively, and the difference was not statistically significant (P>0.05).In patients younger than 40 years of age, the untreated group had a statistically significant difference in primary site and CMYC protein expression compared with the treated group (P<0.05), and there was no statistical significance in other aspects. Conclusions Long?term tumor?free survival patients with untreated tonsillar primary DLBCL have relatively unique clinical characteristics. There is no significant difference in the prognosis between the untreated and treated groups, indicating radiotherapy and chemotherapy may not be required and therefore, avoiding related side effects.

Objective To investigate the application value of sperm nucleoprotein immaturity and sperm DNA damage detection in in vitro fertilization(IVF).Methods From Mar.2015 to Feb.2016,routine sperm analysis,sperm nucleoprotein immaturity and sperm DNA damage detection were performed in 102 patients with infertility,and the correlation between these parameters were analyzed.Results Sperm DNA fragmentation rate was negatively correlated with IVF optimal embryos rate and sperm viability(P<0.05),while was not correlated with IVF fertility rate(P>0.05).Sperm nucleoprotein immaturity rate was not correlated with IVF optimal embryos rate and fertility rate(P>0.05),while was negatively correlated with sperm concentration(P<0.05).Conclusion Sperm DNA fragmentation rate could be closely correlated with IVF optimal embryos rate,which might be with prediction value in IVF treatment.