Emotional differences based on comments on doctor-patient disputes with varying levels of severity

BACKGROUND The risks associated with negative doctor-patient relationships have seriously hindered the healthy development of medical and healthcare and aroused wide-spread concern in society.The number of public comments on doctor-patient relationship risk events reflects the degree to which the public pays attention to such events.Thirty incidents of doctor-patient disputes were collected from Weibo and TikTok,and 3655 related comments were extracted.The number of comment sentiment words was extracted,and the comment sentiment value was calculated.The Kruskal-Wallis H test was used to compare differences between each variable group at different levels of incidence.Spearman’s correlation analysis was used to examine associations between variables.Regression analysis was used to explore factors influencing scores of comments on incidents.RESULTS The study results showed that public comments on media reports of doctor-patient disputes at all levels are mainly dominated by“good”and“disgust”emotional states.There was a significant difference in the comment scores and the number of partial emotion words between comments on varying levels of severity of doctor-patient disputes.The comment score was positively correlated with the number of emotion words related to positive,good,and happy)and negatively correlated with the number of emotion words related to negative,anger,disgust,fear,and sadness.CONCLUSION The number of emotion words related to negative,anger,disgust,fear,and sadness directly influences comment scores,and the severity of the incident level indirectly influences comment scores.

Ni80A高温合金等温压缩过程中低能孪晶界密度在时空域的分布及演化

调控合金热变形中低能晶界(Σ3^(n)孪晶界)密度是提高合金晶界相关性能的重要手段。为揭示在电热成形过程中孪晶界密度的分布、演化及其与晶粒尺寸和储能相关的内在机制,建立电-热-力多场、宏微观多尺度耦合有限元模型。一系列Ni80A高温合金在等温压缩过程中的模拟结果表明:在加热和保温阶段,孪晶界密度基本不变;在压缩阶段,孪晶界密度先快速增加而后倾向于降低。等温压缩样中孪晶界密度的分布在高温和中等应变速率下更加均匀。与细晶粒尺寸、高储能及高动态再结晶程度相对应的热变形参数区间有助于提高孪晶界密度。

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022)

Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.

玻璃体腔注射康柏西普治疗弥漫性糖尿病性黄斑水肿的眼表改变

目的:探究玻璃体腔注射康柏西普治疗弥漫性糖尿病性黄斑水肿(DDME)的眼表改变。方法:选取2019-01/06于我院眼科被诊断为DDME的患者20例,均为右眼发病,将右眼纳入试验组,左眼(未发生糖尿病性黄斑水肿)纳入对照组,试验组均行3次玻璃体腔注射康柏西普,对照组不采取任何治疗操作。观察治疗前和3次治疗后第1d矫正视力、眼压、浅表点状上皮糜烂情况、泪河高度、眼表症状及体征(OSDI)评分、泪液分泌试验(SⅠt)及角膜荧光素染色(CSF)评分。结果:治疗前,两组眼压、泪河高度、OSDI评分、SⅠt、CSF评分均无差异(P>0.05),且两组均未出现浅表点状上皮糜烂情况,但对照组矫正视力显著优于试验组(0.50±0.20 vs 1.65±0.35,P<0.05)。治疗后,试验组矫正视力、泪河高度、SⅠt明显低于对照组,OSDI和CSF评分明显高于对照组(均P<0.05),眼压升高幅度较对照组更大,但两组无差异(P>0.05),而试验组19眼出现了浅表点状上皮糜烂情况。与治疗前比较,试验组治疗后矫正视力明显改善,泪河高度和SⅠt明显降低,OSDI和CSF评分明显升高(均P<0.05),但眼压无明显变化(P>0.05);对照组各观察指标均无明显变化(P>0.05)。结论:玻璃体腔注射康柏西普治疗弥漫性糖尿病性黄斑水肿会损伤眼表。

非感染性葡萄膜炎的系统治疗进展

葡萄膜炎是发生于眼内组织的炎症反应。其中,非感染性葡萄膜炎是T细胞介导的自身免疫性炎症反应。尽管非感染性葡萄膜炎的系统治疗方案多种多样,但主要原理都是抑制自身免疫反应。在本综述中,我们回顾了非感染性葡萄膜炎系统治疗的历史,详细叙述了系统治疗的现状,总结了各治疗方案的利弊,同时对非感染性葡萄膜炎的系统治疗进行一定的展望。

Rho激酶抑制剂在青光眼治疗中的应用进展

青光眼是以特征性视神经萎缩和视野缺损为共同特征的不可逆性致盲性眼病,高眼压是其最主要的发病机制,而导致高眼压的主要原因是房水传统流出途径中小梁网的病理学改变导致的房水流出阻力增加。Rho激酶抑制剂(ROCKi)是直接作用于小梁网(TM)的降眼压药物,主要通过影响细胞骨架改变TM细胞形态、细胞运动、胞质分裂和平滑肌收缩等,从而增加房水流出、降低眼压,在美国和日本已被批准用于临床;具有改善视网膜血管灌注、促进视神经再生等作用,可能存在视神经保护作用;此外,具有减少滤过泡瘢痕化等作用。因此,ROCKi作为新型抗青光眼药物备受关注,本文将针对Rho/Rho激酶信号通路、ROCKi的作用机制及其临床应用展开综述。

间歇性外斜视眼位控制力评分综述

在间歇性外斜视患者的管理中,眼位控制力至关重要,它是评价手术时机的重要参考指标及监测和判断病情发展严重程度的必要指标之一。因此,眼位控制能力的量化成为间歇性外斜视评估中的重要环节。本文旨在对间歇性外斜视患者眼位控制力评估方法做一综述。

连续性外斜视危险因素和治疗的研究进展

连续性外斜视在临床中并不少见,但国内对该病及其危险因素的研究报道鲜见。本文旨在对内斜视术后继发外斜视的危险因素进行综述,同时讨论了连续性外斜视的治疗,为临床内斜视的术前检查,尤其是连续性外斜视危险因素的评估、降低内斜视过矫的发生率提供重要依据,以期指导内斜视的手术设计和连续性外斜视的诊疗。

Characterization of grain growth behaviors by BP-ANN and Sellars models for nickle-base superalloy and their comparisons

In order to deeply understand the grain growth behaviors of Ni80A superalloy,a series of grain growth experiments were conducted at holding temperatures ranging from 1223 to 1423 K and holding time ranging from 0 to 3600 s.A back-propagation artificial neural network(BP-ANN)model and a Sellars model were solved based on the experimental data.The prediction and generalization capabilities of these two models were evaluated and compared on the basis of four statistical indicators.The results show that the solved BP-ANN model has better performance as it has higher correlation coefficient(r),lower average absolute relative error(AARE),lower absolute values of mean value(μ)and standard deviation(ω).Eventually,a response surface of average grain size to holding temperature and holding time is constructed based on the data expanded by the solved BP-ANN model,and the grain growth behaviors are described.

Correspondence between low-energy twin boundary density and thermal-plastic deformation parameters in nickel-based superalloy

To deeply understand and even describe the evolutions of the low-energy twin boundary density(BLDΣ3n)in a thermal-plastic deformation process,an improved twin density model as a function of average grain size and stored energy is developed.For Nimonic 80A superalloy,the model is solved based on the EBSD statistical results of grain size and BLDΣ3n in the specimens compressed at temperatures of 1273−1423 K and strain rates of 0.001−10 s−1.The corresponding relationships of BLDΣ3n with stored energy and grain size varying with temperature and strain rate are clarified by the superimposed contour plot maps.It is summarized that BLDΣ3n increases with increasing stored energy and decreasing grain size,and higher BLDΣ3n with finer grains corresponds with lower temperatures and higher strain rates.Such relationships are described by the improved twin density model,and the prediction tolerance of the solved model is limited in 2.8%.

Altered spontaneous brain activity patterns in patients with diabetic retinopathy using amplitude of low-frequency fluctuation

BACKGROUND Diabetes mellitus is a metabolic disorder characterized by prolonged elevation of blood glucose due to various causes.Currently,the relationship between diabetic retinopathy(DR)and altered connectivity of brain function is unclear.AIM To investigate the relationship between this brain activity and clinical manifestations and behaviors of DR patients by using the amplitude of low-frequency fluctuation(ALFF)technique.METHODS Twenty-four DR patients and 24 healthy controls(HCs)matched for age and gender were enrolled.We measured and recorded average ALFF values of DR patients and HCs and then classified them using receiver operating characteristic(ROC)curves.RESULTS ALFF values of both left and right posterior cerebellar lobe and right anterior cingulate gyrus were remarkably higher in the DR patients than in the HCs;however,DR patients had lower values in the bilateral calcarine area.ROC curve analysis of different brain regions demonstrated high accuracy in the area under the curve analysis.There was no significant relationship between mean ALFF values for different regions and clinical presentations in DR patients.Neuronal synchronization abnormalities in some brain regions of DR patients were associated with cognitive and visual disorders.CONCLUSION Abnormal spontaneous brain activity was observed in many areas of DR patients’brains,which may suggest a possible link between clinical manifestations and behaviors in DR patients.

Fault tolerant controlled quantum dialogue against collective noise

Quantum system is inevitably affected by the external environment in the real world.Two controlled quantum dialogue protocols are put forward based on logicalχ-type states under collective noise environment.One is against collectivedephasing noise,while the other is against collective-rotation noise.Compared with existing protocols,there exist several outstanding advantages in our proposed protocols:Firstly,theχ-type state is utilized as quantum channels,it possesses better entanglement properties than GHZ state,W state as well as cluster state,which make it difficult to be destroyed by local operations.Secondly,two kinds of logicalχ-type states are constructed by us in theory,which can be perfectly immune to the effects of collective noise.Thirdly,the controller can be offline after quantum distribution and permission announcement,without waiting for all the participants to complete the information coding.Fourthly,the security analysis illuminates that our protocols can not only be free from the information leakage,but also resist against the interceptand-resend attack,the entanglement-and-measure attack,the modification attack,the conspiring attack,and especially the dishonest controller’s attacks.

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy

Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.

Altered regional homogeneity in patients with diabetic vitreous hemorrhage

BACKGROUND Diabetic vitreous hemorrhage(DVH)is a common complication of diabetes.While the diagnostic methods nowadays only concentrate on the eye injury in DVH patients,whether DVH leads to abnormalities of other visual systems,including the eye,the visual cortex,and other brain regions,remains unknown.AIM To explore the potential changes of brain activity in DVH using regional homogeneity(ReHo)and their relationships with clinical features.METHODS Thirty-one DVH patients and 31 matched healthy controls(HCs)were recruited.All subjects were examined by resting-state functional magnetic resonance imaging.The neural homogeneity in the brain region was estimated by ReHo method.Pearson correlation analysis was used to evaluate the relationships between average ReHo values and clinical manifestations in DVH patients.RESULTS Compared with HCs,the ReHo values in the bilateral cerebellar posterior lobes,right superior(RS)/middle occipital gyrus(MOG),and bilateral superior frontal gyrus were significantly increased.In contrast,in the right insula,bilateral medial frontal gyri,and right middle frontal gyrus,the ReHo values were significantly decreased.Furthermore,we found that best-corrected visual acuity of the contralateral eye in patients with DVH presented a positive correlation with the mean ReHo value of the RS/MOG.We also found that depression score of the DVH group presented a negative correlation with the mean ReHo values of the right insula,bilateral medial frontal gyrus,and right middle frontal gyrus.CONCLUSION We found that DVH may cause dysfunction in multiple brain areas,which may benefit the exploration of pathologic mechanisms in DVH patients.

Sonographic features of umbilical vein recanalization for a Rex shunt on cavernous transformation of portal vein in children

BACKGROUND The Rex shunt was widely used as the preferred surgical approach for cavernous transformation of the portal vein(CTPV)in children that creates a bypass between the superior mesenteric vein and the intrahepatic left portal vein(LPV).This procedure can relieve portal hypertension and restore physiological hepatopetal flow.However,the modified procedure is technically demanding because it is difficult to make an end-to-end anastomosis of a bypass to a hypoplastic LPV.Many studies reported using a recanalized umbilical vein as a conduit to resolve this problem.However,the feasibility of umbilical vein recanalization for a Rex shunt has not been fully investigated.AIM To investigate the efficacy of a recanalized umbilical vein as a conduit for a Rex shunt on CTPV in children by ultrasonography.METHODS A total of 47 children who were diagnosed with CTPV with prehepatic portal hypertension in the Second Hospital,Cheeloo College of Medicine,Shandong University,were enrolled in this study.Fifteen children received a recanalized umbilical vein as a conduit for a Rex shunt surgery and were enrolled in group I.Thirty-two children received the classic Rex shunt surgery and were enrolled in group II.The sonographic features of the two groups related to intraoperative and postoperative variation in terms of bypass vessel and the LPV were compared.RESULTS The patency rate of group I(60.0%,9/15)was significantly lower than that of group II(87.5%,28/32)7 d after(on the 8th d)operation(P<0.05).After clinical anticoagulation treatment for 3 mo,there was no significant difference in the patency rate between group I(86.7%,13/15)and group II(90.6%,29/32)(P>0.05).Moreover,3 mo after(at the beginning of the 4th mo)surgery,the inner diameter significantly widened and flow velocity notably increased for the bypass vessels and the sagittal part of the LPV compared to intraoperative values in both shunt groups(P<0.05).However,there was no significant difference between the two surgical groups 3 mo after surgery(P>0.05).CONCLUSION For children with hypoplastic LPV in the Rex recessus,using a recanalized umbilical vein as a conduit for a Rex shunt may be an effective procedure for CTPV treatment.

Compound heterozygous mutations in CYP1B1 gene leads to severe primary congenital glaucoma phenotype

AIM: To identify the novel mutation alleles in the CYP1B1 gene of primary congenital glaucoma(PCG) patients at Shandong Province of China, and investigate their correlation with glaucomatous features.METHODS: The DNA from the peripheral blood of 13 congenital glaucoma patients and 50 ethnically matched healthy controls from the affiliated hospital of Qingdao University were extracted. The coding region of the CYP1B1 gene was amplified by PCR and direct DNA sequencing was performed. Disease causing-variants were analyzed by comparing the sequences and the structures of wild type and mutant CYP1B1 proteins by PyMOL software.RESULTS: Two missense mutations, including A330 F caused by c.988 G>T&c.989 C>T, and R390H caused by c.1169 G>A, were identified in one of the 13 PCG patients analyzed in our study. A330F mutation was observed to be novel in the Chinese Han population, which dramatically altered the protein structure of CYP1B1 gene, including the changes in the ligand-binding pocket. Furthermore, R390H mutation caused the changes in heme-protein binding site of this gene. In addition, the clinical phenotype displayed by PCG patient with these mutations was more pronounced than other PCG patients without these mutations. Multiple surgeries and combined drug treatment were not effective in reducing the elevated intraocular pressure in this patient.CONCLUSION: A novel A330F mutation is identified in the CYP1B1 gene of Chinese PCG patient. Moreover, in combination with other mutation R390H, this PCG patient shows significant difference in the CYP1B1 protein structure, which may specifically contribute to severe glaucomatous phenotype.

Tunable second-order sideband effects in hybrid optomechanical cavity assisted with a Bose-Einstein condensate

We theoretically investigated a second-order optomechanical-induced transparency(OMIT) process of a hybrid optomechanical system(COMS), which a Bose-Einstein condensate(BEC) in the presence of atom-atom interaction trapped inside a cavity with a moving end mirror. The advantage of this hybrid COMS over a bare COMS is that the frequency of the second mode is controlled by the s-wave scattering interaction. Based on the traditional linearization approximation, we derive analytical solutions for the output transmission intensity of the probe field and the dimensionless amplitude of the second-order sideband(SS). The numerical results show that the transmission intensity of the probe field and the dimensionless amplitude of the SS can be controlled by the s-wave scattering frequency. Furthermore, the control field intensities,the effective detuning, the effective coupling strength of the cavity field with the Bogoliubov mode are used to control the transmission intensity of the probe field and the dimensionless amplitude of the SS.

A lithium–tin fluoride anode enabled by ionic/electronic conductive paths for garnet-based solid-state lithium metal batteries

The high energy density and stability of solid-state lithium metal batteries(SSLMBs)have garnered great attention.Garnet-type oxides,especially Li_(6.4)La_(3)Zr_(1.4)Ta_(0.6)O_(12)(LLZTO),with high ionic conductivity,wide electrochemical window,and stability to Li metal anode,are promising solid-state electrolyte(SSEs)materials for SSLMBs.However,Li/LLZTO interface issues including high interface resistance,inhomogeneous Li deposition,and Li dendrite growth have hindered the practical application of SSLMBs.Herein,a multi-functional Li–SnF_(2) composite anode with Li,LiF,and Li-Sn alloy was specifically designed and prepared.The composite anode improves the wettability to LLZTO,constructing an intimate contact interface between it and LLZTO.Meanwhile,ionic/electronic conductive paths in situ formed at the interface can effectively uniform Li deposition and suppress Li dendrite.The solid-state symmetric cell exhibits low interface resistance(11Ω·cm^(2)) and high critical current density(1.3 mA·cm^(−2))at 25℃.The full SSLMB based on LiFePO_(4) or LiNi_(0.5)Co_(0.2)Mn_(0.3)O_(2) cathode also shows stable cycling performance and high rate capability.This work provides a new composite anode strategy for achieving high-energy density and high-safety SSLMBs.

Clinical Practice Guideline on Acupuncture and Moxibustion:Adult Major Depressive Disorder(Mild-Moderate Degree):Determination of clinical questions

Determining clinical questions is fundamental to the development of clinical practice guidelines(CPGs),which bridges the initial phases and the final recommendations.It is essential for evidence retrieval and the formulation of recommendations.The scientific rigor and precision in determination of clinical questions directly influence the future implementation and applicability of guidelines.In 2020,the World Federation of Acupuncture-Moxibustion Societies initiated the project of clinical practice guideline on acupuncture and moxibustion for adult major depressive disorder(mild-moderate degree)to address clinical and medical decision-making issues in acupuncture treatment for adult mild to moderate major depressive disorder.This CPG provides systematic recommendations based on clinical evidence,patient values,and other factors,aiding decision-makers,clinicians,and patients in selecting appropriate interventions.This paper discusses and analyzes the determination process of clinical questions,and the related issues during the development of this guideline,aiming to provide a reference for determining clinical questions and developing CPGs in the field of acupuncture and exploring more scientific tools and methods for determining clinical questions in future CPGs.

Metatranscriptome of human lung microbial communities in a cohort of mechanically ventilated COVID-19 Omicron patients

The Omicron variant of the severe acute respiratory syndrome coronavirus 2(SARS‑CoV‑2)infected a substantial proportion of Chinese population,and understanding the factors underlying the severity of the disease and fatality is valuable for future prevention and clinical treatment.We recruited 64 patients with invasive ventilation for COVID-19 and performed metatranscriptomic sequencing to profile host transcriptomic profiles,plus viral,bacterial,and fungal content,as well as virulence factors and examined their relationships to 28-day mortality were examined.In addition,the bronchoalveolar lavage fluid(BALF)samples from invasive ventilated hospital/community-acquired pneumonia patients(HAP/CAP)sampled in 2019 were included for comparison.Genomic analysis revealed that all Omicron strains belong to BA.5 and BF.7 sub-lineages,with no difference in 28-day mortality between them.Compared to HAP/CAP cohort,invasive ventilated COVID-19 patients have distinct host transcriptomic and microbial signatures in the lower respiratory tract;and in the COVID-19 non-survivors,we found significantly lower gene expressions in pathways related viral processes and positive regulation of protein localization to plasma membrane,higher abundance of opportunistic pathogens including bacterial Alloprevotella,Caulobacter,Escherichia-Shigella,Ralstonia and fungal Aspergillus sydowii and Penicillium rubens.Correlational analysis further revealed significant associations between host immune responses and microbial compositions,besides synergy within viral,bacterial,and fungal pathogens.Our study presents the relationships of lower respiratory tract microbiome and transcriptome in invasive ventilated COVID-19 patients,providing the basis for future clinical treatment and reduction of fatality.