With the rapid development of artificial intelligence （AI） technology， the ethical governance of AI has gained increasing attention. The Recommendation on the Ethics of Artificial Intelligence was issued by the United Nations Educational， Scientific and Cultural Organization in 2021， which clarified several principles for the ethical governance of AI. In the field of rehabilitation medicine， the research and application of AI technology have significantly improved patients’ quality of life and survival. However， due to the specificity of the service population in rehabilitation medicine， which is mostly for the sick， injured， disabled， and elderly， a series of complex ethical issues have also arisen. This paper analyzed in detail the ethical issues and challenges encountered in the research and application of AI technology in the field of rehabilitation medicine from various aspects， such as informed consent， security of privacy and data， patients’ physical and mental rehabilitation， compliance regulation， protection of specific groups， and promotion of equity. According to the principles of the Recommendation on the Ethics of Artificial Intelligence and others， response strategies were proposed， including multi-party collaboration and interdisciplinary cooperation， improving and refining relevant laws and regulations， strengthening ethical education across society， establishing accountability mechanisms， increasing investment， promoting equity， and other measures， to promote the healthy development of research and application of AI technology in the field of rehabilitation， as well as benefit humanity.

AIM: To explore the factors affecting the whole-eye astigmatism after pterygium excision combined with autologous limbal stem cell transplantation.METHODS: A retrospective analysis was conducted on the medical records of 42 patients(42 eyes)with primary pterygium admitted in the ophthalmology department of Xijing Hospital from January 2023 to October 2023. They underwent pterygium excision combined with autologous limbal stem cell transplantation. The maximum invasion depth of pterygium into the cornea was measured with anterior segment optical coherence tomography(AS-OCT)before operation, the length of the pterygium invading cornea, the width of the limbus and the area of the invading cornea were measured during the operation, and three-dimensional values of corneal astigmatism of anterior segment, index of surface variance(ISV), index of vertical asymmetry(IVA), best corrected visual acuity(BCVA)and whole-eye astigmatism were collected before and at 1 mo after surgery. Patients with astigmatism ≤0.50 D or >0.50 D of the whole eye at 1 mo after surgery were assigned to group A and B, respectively. The differences of clinical data before and at 1 mo after surgery between the two groups, and the correlation between pre-operative clinical indicators and whole-eye astigmatism were analyzed. The decision tree algorithm was performed to explore the influencing factors of whole-eye astigmatism at 1 mo postoperatively.RESULTS: The maximum invasion depth of pterygium in the group A was significantly less than that in the group B [80.00(40.00, 180.00)μm vs 175.00(123.00, 190.00)μm, P=0.002]. Preoperative BCVA(LogMAR), whole-eye astigmatism, cornea astigmatism, ISV, IVA and maximum invasion depth of pterygium were positively correlated with whole-eye astigmatism at 1 mo after surgery(rs=0.317, P=0.041; rs=0.545, P<0.001; rs=0.448, P=0.003; rs=0.389, P=0.011; rs=0.382, P=0.013; rs=0.391, P=0.010). The decision tree algorithm screened out two influential factors: the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. The risk of whole-eye astigmatism >0.50 D at 1 mo after operation was higher with maximum invasion depth of pterygium into the cornea >95 μm than that with ≤95 μm. Among the patients with whole-eye astigmatism >2.63 D before operation, the probability of residual whole-eye astigmatism >0.50 D was 88.9%, and the predictive model AUC was 0.804.CONCLUSION: The whole-eye astigmatism after pterygium resection is mainly affected by the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. When the maximum invasion depth of pterygium into the corneal is >95 μm and the whole-eye stigmatism is >2.63 D before surgery, the patient should receive surgical treatment as soon as possible in order to obtain good clinical benefits.

Objective:This study aims to explore the prevalence of hepatitis E virus (HEV) infection in patients and the screening value of serological indicators for HEV infection patients.Methods:Retrospective analysis was conducted on 97 440 cases of anti-HEV IgM and IgG simultaneously tested in two Beijing hospitals from January 1, 2018 to August 31, 2023. Among them, there were 61 005 males and 36 435 females, with an average age of 51.65±13.05 years old. According to the positivity of anti HEV specific antibodies, they were divided into anti-HEV IgM positive group (3 588 cases), anti-HEV IgG positive group (18 083 cases), and anti-HEV antibody negative group (78 892 cases). Results of HEV RNA, liver function, AFP, PIVKA-Ⅱ and PT were collected, and their basic clinical information were recorded. The prevalence of HEV infection in patients, as well as the relationship between the positivity of anti-HEV specific antibodies and the patient′s age group, HEV RNA, and clinical characteristics were analyzed.Results:Among 97 440 patients who tested anti-HEV IgM and IgG simultaneously, the positivity rate of anti-HEV IgM was 3.68% (3 588/97 440), and was 18.56% for anti-HEV IgG (18 083/97 440). The overall positivity rates of anti-HEV IgM in two Beijing hospitals from 2018 to 2023 were 2.51%, 2.53%, 3.02%, 4.59%, 5.72%, and 4.26% ( χ2=1 401.73, P<0.001), while the positivity rates of anti-HEV IgG were 12.56%, 12.32%, 12.85%, 22.65%, 27.42%, and 26.66% ( χ2=1 058.29, P<0.001). These rates showed a gradual increase until 2023 when a decline was observed. The positivity rates of anti-HEV IgM (2.28%, 3.60%, 4.47%) ( χ2=89.62, P<0.001) and IgG (4.71%, 17.86%, 25.94%) ( χ2=2 017.32, P<0.001) increased with age in patients who aged 1-30, >30-60, and over 60 years old. The age and ALB values of patients in the anti-HEV IgM positive group were lower than the IgG-positive group, while the proportion of males, TBIL, ALT, AFP and PT values were higher than the IgG-positive group, and the differences were statistically significance ( P<0.05). Furthermore, patients in both the anti-HEV IgM and IgG positive groups had higher age, male proportion, TBIL, ALT, AFP, PIVKA-Ⅱ, and PT values than the anti-HEV negative group. Additionally, both groups had lower ALB values than the anti-HEV negative group, all of which were statistically significant ( P<0.05). 2 162 HEV infected patients were grouped based on HEV RNA positivity. The proportion of anti-HEV IgM single positive, IgG single positive, IgM+IgG double positive, and antibody negative patients in the HEV RNA positive group were 5.42% (18/332), 3.62% (12/332), 90.36% (300/332), and 0.60% (2/332), respectively. Among them, the proportion of anti-HEV IgM+IgG double positive patients in the HEV RNA positive group was higher than that in the HEV RNA negative group ( χ2=302.87, P<0.001), while the proportion of anti-HEV IgG single positive ( χ2=174.36, P<0.001) and anti-HEV antibody negative patients ( χ2=59.28, P<0.001) were lower than that in the HEV RNA negative group, both of which were statistically significant ( P<0.001). In addition, the positive rates of HEV RNA in anti-HEV IgM positive, IgG positive, and antibody negative patients were 29.23% (318/1 088), 17.59% (312/1 774), and 0.65% (2/306), respectively. Conclusion:The HEV infection rate among patients declined in 2023. HEV infection is age-related, with older individuals being more susceptible. Abnormal liver function and jaundice were commonly observed during HEV infection. It is crucial to note that the absence of anti-HEV specific antibodies cannot rule out HEV infection; therefore, additional testing for HEV RNA and/or HEV Ag is necessary for accurate diagnosis.

AIM:To investigate the differences in clinical features and therapeutic effects of the tea tree oil wipes combined with deep massages of the meibomian glands for different age groups of patients with demodex blepharitis.METHODS:The clinical data of 146 patients(292 eyes)diagnosed with demodex blepharitis, hospitalized in Department of Ophthalmology, Xijing Hospital from January 2023 to October 2023, was collected in this retrospective study, and the patients were divided into group A(64 cases with 128 eyes)aged ≤45 years old and group B(82 cases with 164 eyes)aged >45 years old according to different ages. The differences in total numbers of binocular mites, Schirmer I tests, symptom and sign scores before, and at 1 and 3 mo after the treatment of the tea tree oil wipes combined with deep massages of the meibomian glands were analyzed between the two groups.RESULTS: Before the treatments, the total number of the mites in the group A [7(6, 8)] was lower than that in the group B [8(7, 9.25); P<0.05]. The dry eye score in the group A [6(6, 7)] was lower than that in the group B [11(10, 12); P<0.001], and the ocular surface irritation symptom score in the group A [10(9, 11)] was higher than that in the group B [6(6, 7); P<0.001]. Both groups experienced a decrease in mite counts and improvement in symptoms and signs scores at 1 mo after treatment, and there was still a degree of improvement in all clinical indicators, with patients in the group B showing a further reduction in mite counts [-1(-3, 0)] even after the treatment was continued for 3 mo.CONCLUSION:The total numbers of mites in patients of older than 45 years old were higher than those in patients of ages younger than 45, and older patients have more serious dry eyes, with less serious symptoms of ocular surface irritation. The treatment can effectively reduce the number of mites in patients of different ages with demodex blepharitis, but the outcomes of Schirmer I tests do not change after the treatment. Longer treatment duration provide sustained clinical benefits.

China is the rank 1st of gastric cancer in the world,and the incidence and mortality of gastric cancer rank the 3rd among various malignant tumors in China.It has been found that tumor cells have their own energy metabolism characteristics.Even in the presence of sufficient oxygen,tumor cells are more inclined to use glycolysis to produce energy,also known as"aerobic glycoly-sis".Aerobic glycolysis can lead to an increase in lactate,promoting the acceleration of tumor cell proliferation and invasiveness,and the key enzyme driving this phenomenon is lactate dehydrogenase(LDH).LDH levels are significantly elevated in patients with gas-tric cancer,and LDH can contribute to the occurrence and development of gastric cancer in many ways.This article will discuss the role of LDH in tumor glycolysis,which is correlated with gastric cancer as well as its clinical application value.It will also discuss the research progress of LDH in targeted therapy for gastric cancer.

Aim To explore the association between insomnia and myocardial infarction(MI)using bidirectional two-sample Mendelian randomization(MR).Methods The summary statistics of MI were obtained from genome-wide association studies(GWAS),and single nucleotide polymorphisms(SNP)associated with insomnia phenotype were select-ed as instrumental variables.Inverse variance weighting(IVW)was used to evaluate the causal relationship between in-somnia and MI.Results MR analysis showed that there was positive relationship between insomnia and MI(IVW:OR=1.015,95％CI 1.004～1.027,P=0.007).There was no horizontal pleiotropy and heterogeneity in instrumental variables.Sensitivity analysis suggested that MR analysis results were stable.Reverse MR analysis showed no causal re-lationship between MI and increased risk of insomnia(IVW:OR=0.725,95％CI 0.466～1.126,P=0.152),and the statistical results were stable after the removal of outliers.Conclusion Insomnia is a risk factor for MI and there was positive relationship between insomnia and MI.However,there was no causal relationship between MI and an increased risk of insomnia.

Objective:To explore the mechanism of EPO on activating receptors of NK cells in rats with diabetic nephropathy based on HMGB1/Beclin-1 signaling pathway.Methods:Forty SPF male SD rats were randomly divided into normal group(A),model group(B),metformin group(C)and EPO group(D),with 10 rats in each group.Diabetic nephropathy modeling was performed on groups B,C and D using high-fat diet and streptozotocin.After successful modeling,group C was given metformin 100 mg/kg by intra-gastric administration,and group D was intraperitoneal injection of EPO 100 U/kg.Group A and B were given normal saline at the same volume by intragastric administration simultaneously.After successful modeling,the remaining 20 rats were randomly divided into group E and group F.Group E was given 30 mg/kg HMGB1 inhibitor by intragastric administration,group F was given 30 mg/kg HMGB1 inhibitor by intragastric administration and 100 U/kg EPO by intraperitoneal injection.HK-2 cells were taken and divided into high glucose+HK-2 cells(HH)group,EPO+high glucose+HK-2 cells(EH)group,glycyrrhizin L+high glucose+HK-2 cells(LH)group,and cultured with glucose for cell experiment.Blood glucose was detected by glucose analyzer,biochemical indexes were de-tected by automatic biochemical analyzer,and renal pathological morphology of rats was detected by PAS staining.Expression of HMGB1/Beclin-1 protein was detected by Western blot,and expressions of NK cell activated receptors were detected by RT-PCR and immunohistochemistry.Results:Compared with group A,blood glucose,24 h urine volume,blood glucose curve,BUN,Scr,UAlb contents in blood and urine,mRNA and protein expressions of NKp30,NKp44,NKp46 in group B were significantly increased(P<0.05),while body weight was significantly decreased(P<0.05).Compared with group B,blood glucose,24 h urine volume,blood glucose curve,BUN,Scr,UAlb contents in blood and urine,mRNA and protein expression of NKp30,NKp44 and NKp46 in group C and group D were significantly decreased(P<0.05),while body weight was significantly increased(P<0.05),renal pathology was also significantly improved,the changes of group D was significantly higher than that of group C(P<0.05).Compared with group A,expression of HMGB1/Beclin-1 protein in renal tissues of rats in group B was significantly increased(P<0.05),and expression of HMGB1/Beclin-1 protein in renal tissues of rats in groups C,D,E and F was significantly decreased(P<0.05),expression of HMGB1/Beclin-1 protein in group D was significantly decreased compared with group C(P<0.05),there was no significant difference between group E and group D,and expression of HMGB1/Beclin-1 protein in group F was significantly decreased compared with group E.HMGB1/Beclin-1 protein expression was positively correlated with NKp30,NKp44 and NKp46 mRNA(P<0.05).Compared with HH group,proliferation rates of EH and LH groups were significantly increased(P<0.05),while apoptosis rate and HMGB1/Beclin-1 protein expression were significantly decreased(P<0.05),there was no significant difference between LH group and EH group(P>0.05).Conclusion:EPO can effectively reduce expressions of NK cell activated receptors and inhibit HMGB1/Beclin-1 signaling path-way in diabetic nephropathy rats,suggesting that EPO may exert its effect by regulating NK cell activated receptors and HMGB1/Beclin-1 signaling pathway.NK cell activation receptors expressions are positively correlated with HMGB1/Beclin-1 signaling pathway.

Objective To analyze the curative effect of acupuncture at Gongsun, Sifeng combined with visceral acupoint tapping in children with mesenteric lymphadenitis (type of gastrointestinal heat accumulation), and its influence on serum intestinal fatty acid-binding protein (I-FABP) and vasoactive intestinal peptide (VIP). Methods A total of 60 children with mesenteric lymphadenitis (type of gastrointestinal heat accumulation) were selected, and were divided into control group (n=30, conventional treatment combined with acupuncture at Gongsun and Sifeng acupoints) and study group (n=30, visceral acupoint tapping on the basis of the control group) according to the random number table method. The clinical efficacy, changes of main symptoms and signs were compared, and the expression levels of serum I-FABP and VIP were detected. Results The total effective rate of the study group was higher than that of the control group(P < 0.05). After 2 weeks of treatment, the serum I-FABP levels of the two groups were lower than that before treatment, and the serum I-FABP level of the study group was lower than that of the control group (P < 0.05). After 2 weeks of treatment, the serum VIP levels of the two groups were higher than that before treatment, and the serum VIP level of the study group was higher than that of the control group (P < 0.05). After 2 weeks of treatment, the improvement of main symptoms and signs in the study group was better than that in the control group (P < 0.05). Conclusion Acupuncture at Gongsun and Sifeng combined with visceral acupoint tapping can be used to treat children with mesenteric lymphadytis (gastrointestinal heat accumulation type), regulate and improve gastrointestinal function, adjust the level of serum I-FABP and VI, and relieve the main symptoms and signs of children, and can be used as an effective therapeutic method.

Objective:To explore the clinical significance of hepatitis B virus (HBV) DNA detection in screening patients with hepatitis B.Methods:Clinical data of 682 331 hepatitis B patients were retrospectively analyzed. The HBV DNA of these patients was detected in the Fifth Medical Center of the PLA General Hospital from January 2017 to December 2021, there were 481 159 males and 201 172 females in this cohort, the average age was (41.34±16.13) years. Patients were divided into HBV DNA positive group (219 879 cases) and HBV DNA negative group (462 452 cases). Clinical characteristics, data of five serologic markers of hepatitis B and hepatitis B surface antigen quantification (HBsAg-QN), liver function, alpha fetoprotein (AFP) and prothrombin time (PT) results were collected and analyzed and compared between the two groups.Results:The positive rate of HBV DNA was 32.22% (219 879/682 331) in this cohort. Among the different age groups, the positive rate of HBV DNA was the highest (40.34%, 128 038/317 380) in young people aged 18-44 years. The proportion of patients was lower among aged <1, 45-59 and ≥60 years patients in HBV DNA positive group than that in HBV DNA negative group, while the proportion of patients was higher among aged 1-17 and 18-44 years patients in HBV DNA positive group than that in HBV DNA negative group (all P<0.001). Among 2 291 <1-year-old infants tested for HBV DNA, 71 infants were HBV DNA positive. The positive rates of HBV DNA from 2017 to 2021 were 4.86% (27/556), 3.68% (14/380), 3.47% (17/490), 1.55% (6/386) and 1.46% (7/479) respectively, showing a downward trend year by year. The positive rate of HBV DNA in acute hepatitis B (AHB) patients was the highest (49.88%, 208/417) among 680 040 patients with hepatitis B. The proportion of AHB patients (0.09%, 208/219 808) and chronic hepatitis B (80.44%, 176 806/219 808) in HBV DNA positive group was higher than that in HBV DNA negative group [0.05% (209/460 232) and 65.45% (301, 216/460 232)], while the proportion of patients with HBV-related liver cirrhosis (11.28%, 24 793/219 808), HBV-related liver cancer (6.72%, 14 775/219 808), liver cancer surgery (1.39%, 3 055/219 808) and liver transplantation (0.08%, 171/219 808) were lower than that in HBV DNA negative group [22.99% (105 813/460 232), 7.25% (33 385/460 232), 3.50% (16 129/460 232) and 0.76% (3 480/460 232)] (all P<0.001). At the same time, positive rate of hepatitis B surface antigen (HbsAg), HBsAg-QN, hepatitis B e antigen (HbeAg), level of total bilirubin, total bilirubin, AFP and PT were higher in HBV DNA positive group than those in HBV DNA negative group, while the age, male ratio and albumin results in HBV DNA positive group were lower than those in HBV DNA negative group (all P<0.01). The HBV DNA loads were higher in HBsAg positive group, hepatitis B surface antibody positive group and HBeAg positive group than those in respective negative groups, while the HBV DNA loads were lower in hepatitis B e antibody positive group and hepatitis B core antibody positive group than those in respective negative groups (all P<0.001). Conclusions:The mother to child transmission rate of<1-year-old infants decreases year by year. HBV DNA is an important factor for the progression of hepatitis B disease. HBV DNA positive hepatitis B patients with higher HBsAg-QN values are more likely to have abnormal serum markers such as liver dysfunction. HBV DNA detection is therefore of clinical importance in screening patients with hepatitis B.

Objective:To determine the long-term efficacy and safety of intra-cervical lymphatic immunotherapy (ICLIT) for adult allergic rhinitis (AR) by comparing it with subcutaneous immunotherapy (SCIT).Methods:A total of 100 adult AR patients with dust mite allergy in Department of Otorhinolaryngology, First People′s Hospital of Foshan from Feb 2018 to Dec 2019 were randomly divided into two groups, 50 in SCIT group [including 42 males and 8 females, aging (32.55±9.72) years] and 50 in ICLIT group [including 45 males and 5 females, aging (31.33±9.84) years]. The changes in total symptom score (total system score, TSS), nasal symptom score (total nasal symptom score, TNSS), eye symptom score (total ocular scoring system, TOSS), drug score (total medication score, TMS), and quality of life score of the two groups of patients were evaluated before and after treatment, and the adverse reactions of all patients during the treatment period were recorded. The changes in the level of dust mite specific IgE (sIgE) in the serum were evaluated. GraphPad Prism 9.0 software was used for statistical analysis.Results:In the SCIT group, 38 patients completed treatment and follow-up, with a dropout rate of 24%. In the ICLIT group, 48 patients completed treatment and follow-up, with a dropout rate of only 4%. The scores of TSS, TNSS, TOSS, TMS, and quality of life in the ICLIT group before treatment were 32.1±3.0, 27.3±3.1, 4.8±2.8, 2.3±0.9, and 68.1±28.7, respectively; After 36 months of treatment, the scores were 21.8±11.4, 18.1±9.4, 3.7±2.9, 1.3±1.1, and 36.0±26.7, respectively, which were significantly lower than those before treatment (all P<0.001). After 36 months of treatment, the TSS of the ICLIT group improved by 10.3±11.2 compared to before, while the TSS of the SCIT group improved significantly by 21.9±11.0 compared to before, with statistically significant differences between the groups ( P<0.001). No serious systemic adverse reactions occurred in both groups of patients. Conclusions:ICLIT treatment for adult AR has long-term efficacy, high safety, and high compliance, but its long-term efficacy is not as good as SCIT. ICLIT can be considered as a new complementary option for AR immunotherapy.