Large language models promise to transform ophthalmic clinical communication but face challenges from factual inaccuracies (hallucinations) and limited domain knowledge. This study introduces EyeRAG, a guideline-grounded GraphRAG system for ophthalmic dialogue that integrates OphthaKG, a domain-specific knowledge graph, constructed exclusively from clinical guidelines. We evaluated EyeRAG across 120 clinical scenarios (40 each for glaucoma, diabetic retinopathy, and cataract), six LLMs (GPT-4o, Gemini 2.5 Flash, Grok 4, Llama 3.3 70B, Claude Sonnet 4, DeepSeek-V2.5), and four RAG configurations, assessing clinical accuracy and patient-centered relevance. Validated by LLM-as-a-judge and board-certified ophthalmologists on internal/external datasets, EyeRAG outperformed Vanilla LLMs and standard RAG. LLM evaluations ranked EyeRAG highest (mean 1.61 ± 1.04 internal/1.72 ± 1.18 external). Experts assigned a mean rank of 1.0, with hallucinations falling to 3.3% (vs. 30% baseline). EyeRAG demonstrates the potential for safe, explainable, and clinically grounded language models to be developed as clinician-supervised aids designed specifically to bridge the communication gap between clinicians and patients. It serves as a tool for patient interpretation rather than clinical decision-making, assisting in patient counselling and tele-ophthalmology by translating complex findings into accessible dialog under professional oversight.
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To describe the clinical presentation, diagnostic challenges, and management of fungal keratitis (FK) caused by Aspergillus spp. presenting with a delayed immune-like ring infiltrate. We report a case describing the clinical course, diagnostic workup, and treatment of a patient with FK initially misdiagnosed as herpes simplex keratitis. A 68-year-old woman presented with a three-week history of decreased vision and ocular pain in the right eye. She had previously been treated with topical chloramphenicol 0.5%, frequent topical betamethasone, and oral acyclovir for presumed herpes simplex keratitis. Despite two weeks of treatment, the corneal findings progressed. At presentation to our center, a yellow-white stromal infiltrate with a surrounding immune-like ring in the inferonasal periphery was observed, along with stromal thinning and signs of impending perforation. Corneal scraping confirmed Aspergillus spp. Topical betamethasone was discontinued, and topical voriconazole 1% with chlorhexidine 0.2% was initiated. Cyanoacrylate glue was applied to manage stromal melting. Following antifungal therapy and withdrawal of topical corticosteroids, the condition stabilized. Immune-like ring formation may be observed in FK due to immune-mediated mechanisms. Despite this immune component, topical corticosteroids should not be used empirically, as they may exacerbate fungal infection and worsen clinical outcomes. It is essential to perform corneal sampling and microbiological confirmation before initiating steroids in cases of immune-like ring lesions. This helps rule out infectious causes, especially FK.
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BackgroundGlutamine-fructose-6-phosphate transaminase 1 (GFPT1) gene variants are a known cause of congenital myasthenic syndrome (CMS), typically presenting with fatigable limb-girdle weakness and characteristic tubular aggregates on muscle biopsy, though recent reports have broadened the clinical spectrum.MethodsWe describe a 5-year-old boy presenting with hypotonia, progressive muscle weakness with head drop, cognitive delay, and visual impairment, found on neuromuscular genetic panel to have a novel homozygous missense variant in GFPT1 (c.1154G>A, p.Arg385Gln).ResultsFurther workup revealed white matter abnormalities with atrophy of corpus callosum and cerebellum on neuroimaging, myopathic motor unit potentials on electromyography, and non-specific changes on the left biceps muscle biopsy with absence of tubular aggregates. Stimulated jitter analysis of the right orbicularis oculi muscle showed increased jitter and blocking indicative of neuromuscular junction (NMJ) transmission defect. Trio whole-exome and trio whole-genome sequencing confirmed autosomal recessive GFPT1-related myasthenia.DiscussionThe muscle-eye-brain (MEB) phenotype of our case was like that of alpha-dystroglycanopathy, a glycosylation-related severe congenital muscular dystrophy. The presence of NMJ abnormalities expands the novel GFPT1 variant genotype-phenotype to include central nervous system features and muscle-eye-brain congenital myasthenic syndrome (MEB-CMS). This case study highlights the role of multiple specialists (neurologist, radiologist, ophthalmologist, pathologist, geneticist) and neurodiagnostic techniques (neuroimaging, electrodiagnostic, muscle pathology) to help deep phenotype symptomatic patients with novel gene variants found on next-generation sequencing.
We present MouseRS-CMD, a murine DNA methylation-based immune cell deconvolution tool. Neutrophils, monocytes, natural killer cells, B cells, CD4 + and CD8 + T cells were purified. DNA methylation was measured with the Illumina Mouse Methylation BeadChip at > 285,000 CpG loci for reference library development and in eye and terminal bleed whole blood with flow cytometry measurements for validation. The IDOL algorithm identified an optimal reference library of 300 CpGs with RMSE < 2.7 for four cell types and < 3.5 for all cell types. MouseRS-CMD enables immune profiling in archival samples and reduces confounding from cell type heterogeneity in molecular studies.
The growing prevalence of realistic AI-generated videos on media platforms increasingly blurs the line between fact and fiction, eroding public trust. Understanding how people watch AI-generated videos offers a human-centered perspective for improving AI detection and guiding advancements in video generation. However, existing studies have not investigated human gaze behavior in response to AI-generated videos of physical scenes. Here, we collect and analyze the eye movements from 40 participants during video understanding and AI detection tasks involving a mix of real-world and AI-generated videos. We find that given the high realism of AI-generated videos, gaze behavior is driven less by the video's actual authenticity and more by the viewer's perception of its authenticity. Our results demonstrate that the mere awareness of potential AI generation may alter media consumption from passive viewing into an active search for anomalies.
The fact that feeding pigs with probiotic-fermented agricultural by-products improves pork quality has been repeatedly demonstrated and widely applied, but the underlying mechanisms remain unclear. This study explored the effects of fermented extruded brewers' spent grain (FEBSG) on meat quality in growing-finishing pigs, as well as its regulatory mechanisms. Sixty Duroc × Landrace × Yorkshire pigs (52.25 ± 2.10 kg) were randomly assigned to five dietary treatments, in which FEBSG replaced 0, 5%, 10%, 15%, and 20% of soybean meal (SBM). The experiment spanned 10 weeks. Compared with the control, 20% FEBSG significantly increased final body weight, average daily feed intake, and average daily gain, while decreasing feed to gain ratio (P < 0.05). Both 15% and 20% FEBSG improved carcass characteristics and meat quality, including higher carcass weight, loin eye area, and intramuscular fat content, along with lower drip loss and shear force (P < 0.05). These treatments also enhanced flavor-related amino acids and unsaturated fatty acids (P < 0.05), and improved umami and sweet taste profiles. Moreover, 20% FEBSG increased muscle fiber density and reduced fiber diameter, upregulated MyHC I, MyHC IIa, PGC-1α, AMPKα1, TFAM, and SDH activity, and downregulated MyHC IIb and LDH activity (P < 0.05). Proteomic analysis identified 69 differentially expressed proteins, with enrichment in AMPK and PPAR signaling pathways. Metagenomic analysis revealed increased abundance of short-chain fatty acid-producing bacteria, including Clostridium, Lactobacillus, Prevotella, and Bartonella. Correlation analysis demonstrated associations between gut microbiota diversity and meat quality traits, as well as between dominant microbial genera and differentially expressed proteins, volatile fatty acids, muscle fiber characteristics, and the AMPK/PGC-1α/TFAM signaling pathway. Partial replacement of SBM with FEBSG positively influenced growth performance and pork quality in pigs, with the underlying mechanisms may involve the activation of the AMPK/PGC-1α/TFAM signaling pathway via the gut-muscle axis, thereby enhancing mitochondrial biogenesis, muscle development, and metabolism.
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Artificial vision systems hold transformative potential for biomedical imaging, diagnostics, and translational research by emulating and extending the capabilities of biological eyes. However, current techniques often face intrinsic trade-offs between spatial resolution, field of view, and depth perception, particularly in compact, biologically relevant settings. Here, we introduce FOLIC, a foveated light-field compound imaging system, which integrates compound-eye-inspired wide angular coverage and chambered-eye-inspired spatial acuity within a unified multiaperture concave architecture. FOLIC naturally generates peripheral, blend, and foveated zones from a single capture, enabling seamless, depth-extended, multiscale visualization from wide-field context down to single-cell lateral resolution. We validate FOLIC across diverse fluorescent and nonfluorescent specimens, including cellular phantoms, tissue sections, and small organisms, demonstrating its versatility and scalability for biomedical research and related translational applications. We anticipate FOLIC to offer a biologically informed design blueprint for future artificial vision systems.
The heart-brain nexus is increasingly recognized as important for human health. Nonetheless, integration of this perspective in research and treatment remains limited in psychiatry, particularly in bipolar disorder (BD). Multisystem vascular imaging may help elucidate mechanisms linking heart and brain health in BD. The ultimate purpose of this review is to inspire and guide integration of vascular imaging more broadly in BD research. An international group of experts reviewed the vascular imaging literature in BD, synthesizing key studies, limitations, and future directions. Findings were organized by organ system (brain, eye, heart, body), including novel methods reported in other psychiatric or neurological disorders that are understudied in BD. Structural and functional vascular differences, reflecting macro- and microvascular health, are reported across the lifespan in BD. State effects are more apparent for functional than structural metrics. BD-related differences in vascular metrics were independent of traditional vascular risk factors in some but not all studies. Accessibility ranged from widespread (e.g., tonometry, retinal imaging) to specialized (e.g., cardiac magnetic resonance imaging [MRI], arterial-spin labeling MRI). Although small BD samples were common, general population cohorts demonstrate feasibility for broader use. BD-related differences in vascular imaging metrics are evident within and beyond the brain. Continued progress is warranted to realize potential implications for brain, heart, and mental health. Larger studies, powered for subgroup analyses and robust covariate modeling, are warranted. Future studies including prospective designs, fluid biomarkers, and lived-experience perspectives would further enhance the relevance of vascular imaging for those with BD.
To report a case of fulminant bilateral multifocal choroiditis as the presenting manifestation of sarcoidosis despite normal serum angiotensin-converting enzyme (ACE) and unremarkable thoracic imaging. An immunocompetent 32-year-old man was admitted with a systemic inflammatory illness and peripheral lymphadenopathy. Given the acute systemic symptoms and recent international travel to Southeast Asia, an infectious cause was initially suspected. Two days after admission, he developed rapidly progressive bilateral central scotomas, floaters, and photophobia. Examination demonstrated bilateral granulomatous keratic precipitates, anterior chamber and vitreous inflammation, and multifocal yellowish deep retinal lesions with indistinct margins involving the posterior pole and midperiphery. Fundus autofluorescence demonstrated hypoautofluorescent lesions with surrounding hyperautofluorescence, and optical coherence tomography (OCT) showed retinal thickening with outer retinal disorganization, subretinal and intraretinal fluid, retinal pigment epithelium (RPE) hyperreflectivity and elevation, and choroidal thickening. Infectious investigations, neuroimaging, serum ACE, and thoracic imaging were unrevealing. Although vision deteriorated despite intensive topical therapy, it improved rapidly after high-dose systemic corticosteroids. Excisional biopsy of a palpable inguinal lymph node showed well-formed non-necrotizing granulomas with negative fungal and mycobacterial stains, findings considered in keeping with sarcoidosis. Methotrexate was commenced as steroid-sparing therapy. Quiescence was achieved within three weeks, and visual acuity recovered to 20/20 bilaterally by two months. Sarcoidosis may present as fulminant bilateral multifocal choroiditis even when serum ACE and thoracic imaging are normal. Careful general examination for peripheral lymphadenopathy, including inguinal nodes, may help identify an accessible extrathoracic biopsy target, facilitating timely tissue confirmation and early immunosuppression.
Patient-specific 3D-printed temporal-bone (PS-TB) models may improve rehearsal, planning and navigation in temporal-bone surgery, yet their optimal use-cases, required fidelity, and desirable enhancements remain undefined from the surgeon's perspective. The purpose is to investigate surgeons' preferred use-cases, physical resemblance requirements, and valuable enhancements for PS-TB models. Otosurgeons from national and international societies were surveyed in the period December 2024-April 2025. Respondents were stratified into either high-volume (HV) surgeons defined as performing ≥50 mastoidectomies per year or low-volume (LV) surgeons. The survey consisted of 88 questions comprising Likert-scale rating (1-5) and free-text responses. Group means were compared with Welch t-tests. Of the 87 participating surgeons, 69 completed the questionnaire (79% response rate; 55 LV/32 HV). PS-TB models were perceived most clinically relevant for pre-operative rehearsal in cases of anatomical malformation (4.14 LV vs 3.62 HV) and least relevant in tympanoplasty and stapes surgical cases. Overall mean perceived pre-operative relevance across procedures was higher for LV than HV surgeons (2.80 vs 2.36; p < 0.01). The same was found for intraoperative use (2.67 vs 2.30; p < 0.05). Critical anatomical landmark structures should have sub-millimeter precision, in particular the facial nerve and lateral semicircular canal (≥4.3). Model enhancements that support visualization of critical structures are rated likely to add clinical value. Otosurgeons perceive PS-TB models as a relevant tool for cases of malformed anatomy or otherwise complex surgery, especially among LV surgeons. However, models need to replicate critical landmarks with sub-millimeter accuracy. These requirements define a trajectory towards improving model value for clinicians.
Current psychiatric diagnoses lack objective criteria, and this study aims to evaluate EEM as a potential tool for improving diagnostic objectivity across psychiatric disorders. The Exploratory Eye Movement (EEM) paradigm was used to analyze eye-movement data from patients with schizophrenia or bipolar disorder and healthy controls. Key metrics included Number of Eye Fixations (NEF), Total Eye Scanning Length (TESL), Mean Eye Scanning Length (MESL), Cognitive Search Score (CSS), and Responsive Search Score (RSS). Group differences were examined with ANOVA and effect sizes, and diagnostic performance was assessed using ROC curves. Feature importance and classification were evaluated with machine learning models using 10-fold cross-validation. Significant age differences were noted between groups, potentially influencing feature selection. NEF and RSS were identified as the most discriminative features, particularly in schizophrenia vs. healthy controls (Cohen's d = -0.79 and -1.12). ROC analysis showed RSS (AUC = 0.84) and NEF (AUC = 0.78) as the top indicators. The SVC model, incorporating demographic features and the top two MI-selected eye movement features (NEF, RSS), achieved an AUC of 0.80 and an F1 score of 0.60, outperforming other models. EEM-based indicators such as RSS, NEF can serve as an adjunctive screening tool to help diagnose but not a stand-alone diagnostic method. Implementing standardized EEM examination procedures in clinical practice is potentially valuable for the early screening of these conditions. Future research could explore integrating EEM with other diagnostic methods to construct an intelligent and comprehensive assessment system.
Sleep disturbances are frequent in the intensive care unit (ICU) and are associated with delirium or delayed mechanical ventilation weaning. Although international guidelines recommend structured screening and non-pharmacological management, their implementation in daily practice is poorly reported. This study aimed to evaluate the prevalence, screening practices, and management strategies for sleep disturbances in French ICUs. This was a secondary analysis of the ESPRIT study, a national, multicenter, cross-sectional study conducted in 128 ICUs. All adult patients admitted on the study day were eligible. Data on unit-level practices and patient-level disturbances were collected. Sleep disturbances were identified by bedside physician. A multivariable multilevel logistic regression identified factors independently associated with sleep disturbances. Among 1,361 patients, 445 (33%) were reported to have sleep disturbances. Only 18% of ICUs conducted routine screening, and no center had implemented a multicomponent protocol. Environmental measures such as light and noise reduction were common, whereas earplugs 51/128 (40%) and eye masks 18/128 (14%) were rarely used. Pharmacological treatments were given to 219 patients (16%), mainly Z-drugs and hydroxyzine. In multivariable analysis, overnight family presence (OR 2.06 [1.12-3.81], p = 0.021) and physical restraints (OR 2.26 [1.39-3.70], p = 0.001) were independently associated with increased risk of sleep disturbances. Optimization of nursing tasks was the only intervention that tended to reduce sleep disturbances (OR 0.57 [0.31-1.04], p = 0.069). Sleep disturbances are common in ICUs, yet routine screening and structured management remain rare. Standardized, nurse-led screening and broader adoption of non-pharmacological protocols are needed to improve sleep quality and patient outcomes.
To compare the clinical and histopathological outcomes of topical Ankaferd Blood Stopper (ABS) combined with autologous blood versus N-butyl-2-cyanoacrylate (NBCA) in the management of experimentally induced corneal perforations with tissue loss. Thirty-four eyes of 29 New Zealand white rabbits were randomly assigned to four groups: ABS combined with autologous blood (n = 10), autologous blood alone (n = 9), NBCA (n = 10), and untreated controls (n = 5). A standardized 1-mm full-thickness central corneal perforation was created using a biopsy punch to simulate tissue loss. Clinical examinations were performed on postoperative days 1, 2, 3, 7, 14, and 21 to assess wound leakage, anterior chamber depth, corneal edema, and inflammation. On day 21, corneal transparency and histopathological findings (stromal fibrosis and inflammatory infiltration) were evaluated. During the first postoperative week, the ABS group showed significantly less wound leakage and anterior chamber shallowing compared to the other groups (p < 0.05). Adhesive dislodgement requiring reapplication was significantly more frequent in the NBCA group (p = 0.012). At the end of the follow-up (day 21), the ABS group demonstrated significantly better corneal transparency (p = 0.027). Histopathologically, stromal fibrosis and inflammatory cell infiltration were significantly reduced in the ABS-treated eyes (p < 0.05). Topical ABS combined with autologous blood provides better clinical stability and more favorable biological healing than NBCA. These findings suggest that ABS may serve as a biologically advantageous alternative for the temporary management of corneal perforations.
To report the first case of chronic papillary conjunctivitis caused by Rickettsia felis infection. A 27-year-old man presented with a four-year history of unilateral papillary conjunctivitis refractory to multiple antibiotic courses. Examination revealed tarsal conjunctival injection, papillary hypertrophy, mucopurulent discharge, and eyelid laxity with entropion. The patient had a history of cat ownership for 5-6 years, suggesting possible exposure to the cat flea, and remained systemically asymptomatic without fever, rash, or lymphadenopathy. Metagenomic next-generation sequencing (mNGS), serology, and histopathology confirmed Rickettsia felis infection. Given the chronic intracellular nature of the infection, the patient received an extended 2-month course of oral doxycycline (100 mg twice daily) combined with topical therapy, with marked improvement observed by week 8 and subsequent entropion repair surgery. This represents the first reported case of chronic, isolated rickettsial conjunctivitis without systemic involvement or Parinaud's oculoglandular syndrome features. This case highlights the importance of considering rickettsial infection in chronic, treatment-refractory conjunctivitis and demonstrates the value of metagenomic sequencing for diagnosis.
Microsurgical procedures demand precise hand-eye coordination, yet the surgeon's hands often remain outside the visual field until instruments enter the microscope view, impairing spatial awareness. We developed the finger-touch approach (FTA) to provide an additional proprioceptive reference point, hypothesizing it would improve safety and confidence without compromising efficiency. A simulation task was designed to replicate microsurgical suture-cutting assistance, one of the most common procedures performed by a microsurgery assistant. Postgraduate-year 1 to 2 junior residents (JR), and plastic surgery residents/fellows (PSF) performed the task using two approaches: a conventional method and the FTA, which involved touching the instrument to the assistant's index finger before entering the microscopic field. The number of unintended contacts, time to reach the microscopic field, and trajectory variability were measured. Microsurgical precision and psychological responses were compared between the methods. Eighteen JRs and five PSFs participated. FTA significantly reduced unintended contacts among JRs compared with the conventional approach (0.1 vs. 0.0, p = 0.003), without affecting the time to reach the field or trajectory variability. In contrast, no significant differences were observed among PSFs. Posttask questionnaire revealed higher positive psychological responses among JRs compared with PSFs in comfort with the FTA (94.4% vs. 40.0%, p = 0.021) and interest in incorporating the technique into actual surgery (100% vs. 60.0%, p = 0.040). FTA improves safety and psychological comfort among novice microsurgical assistants. The technique requires minimal instruction without additional equipment, making it readily implementable in training programs and clinical practices for beginners.
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