Intravitreal injection practice patterns among Chinese ophthalmologists

AIM:To describe the practice patterns of intravitreal injections(IVIs)among ophthalmologists in China.METHODS:This was a cross-sectional online survey.Ophthalmologists who had performed accumulated more than 100 injections were contacted by the Brightness Center,a hospital-based national network,to complete an anonymous,24-question,internet-based survey.They were surveyed on practices in injection techniques,pre-,and post-injections procedures.RESULTS:A total of 333 ophthalmologists from 28 provinces/municipalities/autonomous regions responded to the survey(50.68%response rate).The 91.29%of the respondents evaluated systemic risk factors by medical history,electrocardiogram(ECG)and blood test.All the respondents used pre-injection prophylactic antibiotics.Most checked intraocular pressure(IOP,99.1%)and blood pressure(96.1%)before injections.A majority of the respondents performed injections in the operating room(98.8%),wore masks(99.7%),gloves(99.4%)and sterile surgical clothing(96.1%),performed topical anesthetics(97.9%),and applied povidone-iodine(95.8%)pre-injection.The 61.26%of the respondents dilated pupil.About half of the respondents(51.05%)performed bilateral injections in the same setting.Superior temporal quadrant(40.54%)was the most frequent site of injection.Around three quarters used 30-gauge needles.Most respondents(97.9%)measured the site of injection from limbus.More than half(53.45%)performed conjunctiva displacement prior to injection.The 32.43%of the respondents checked IOP post-injection and 87.99%physicians checked hand motion(HM)or counting fingers(CF)after injection,while 36.94%observed optic nerve perfusion.All participants used topical antibiotics post-injections.Most physicians(91.89%)reviewed patients on the following day.CONCLUSION:This study provides a description of the real-world practice patterns in IVIs in China and offers critical information regarding education and training of ophthalmologists and amendment of local society guidelines.

Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period:A questionnaire-based study

BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure.Some oculoplastic conditions,like nasolacrimal duct obstruction,have been extensively studied,whereas others,like eyelid malposition and thyroid eye disease,have received minimal or no research.AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.METHODS A cross-sectional survey was disseminated among ophthalmologists all over India.The survey included questions related to pre-operative evaluation,anaesthetic and surgical techniques preferred,post-operative care,the use of adjunctive therapies,and patient follow-up patterns.RESULTS A total of 180 ophthalmologists responded to the survey.Most practitioners(89%)felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised.The most common surgical techniques employed were lacrimal drainage procedures(Dacryocystorhinostomy)(63.3%),eyelid malposition repair(36.9%),and ptosis repair(58.7%).Post-operatively,47.7%of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries.Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.CONCLUSION Approximately 50%of ophthalmologists handle prevalent oculoplastic issues themselves,seeking the expertise of an oculoplastic surgeon under particular conditions.Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery.Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

Diagnostic Method and Adaptability Analysis of Multiple Water Breakthroughs in Horizontal Well in Combined Well Pattern

The combined well pattern has been widely used in reservoir development, with a common pattern being a horizontal well in the center for oil production and multiple vertical wells around for water injection. For this type of well pattern, determining the horizontal well is affected by which injection wells, especially when the injecting water breaks through, accurately determining the direction of water inflow will provide an important basis for targeted water well measures. Based on the production performance data of horizontal wells, the semi logarithmic relationship curves of water-oil ratio, derivative water-oil ratio, and cumulative production were used for the first time to determine the breakthrough problem of water injection in the surrounding water injection wells of horizontal wells based on their response characteristics. The adaptability of this method under different influencing factors was analyzed. Introducing the parameter of cumulative production not only preserves the variation trend of the derivative of water-oil ratio with time, but also facilitates the processing of actual production data.

Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P < 0.05) and aspirin/H2RA(2.82% vs 0.12%,P < 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite > teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide(0.47%),teprenone(0.91%),L-glutamine and sodium gualenate granules(0.92%),gefarnate(0.31%),hydrotalcite(1.00%) and sucralfate oral suspension(0.13%).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide(0.010%),PPI/rebamipide(0.027%),teprenone(0.11%),PPI/teprenone(0.037%),gefarnate(0.017%),and PPI/gefarnate(0.013%).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088(96.6%) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236(60.7%) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin(n = 22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25% for outpatients taking aspirin and 0.5% for outpatients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment

AIM: To assess advanced neuroendocrine tumor (NET) treatment patterns and resource utilization by tumor progression stage and tumor site in the United States. METHODS: United States Physicians meeting eligibility criteria were provided with online data extraction forms to collect patient chart data on recent NET patients. Resource utilization and treatment pattern data were collected over a baseline period (after diagnosis and before tumor progression), as well as initial and secondary progression periods, with progression defined according to measureable radiographic evidence of tumor progression. Resource categories used in the analysis include: Treatments (e.g. , surgery, chemotherapy, radiotherapy, targeted therapies), hospitalizations and physician visits, diagnostic tests (biomarkers, imaging, laboratory tests). Comparisons between categories of resource utilization and tumor progression status were examined using univariate (by tumor site) and multivariate analyses (across all tumor sites). RESULTS: Fifty-five physicians were included in the study and completed online data extraction forms using the charts of 110 patients. The physician sample showed a relatively even distribution for those affiliated with academic versus community hospitals (46% vs 55%). Forty (36.3%) patients were reported to have pancreatic NET (pNET), while 70 (63.6%) patients had gastrointestinal tract (GI)/Lung as the primary NET site. Univariate analysis showed the proportion of patients hospitalized increased from 32.7% during baseline to 42.1% in the progression stages. While surgeries were performed at similar proportions overall at baseline and progression, pNET patients, were more likely than GI/Lung NET patients to have undergone surgery during the baseline (33.3% vs 25.0%) and any progression periods (26.7% vs 23.4%). While peptide-receptor radionuclide and targeted therapy utilization was low across NET types and tumor stages, GI/Lung types exhibited greater utilization of these technologies compared to pNET. Chemotherapy utilization was also greater among GI/Lung types. Multivariate analysis results demonstrated that patients in first progression period were over 3 times more likely to receive chemotherapy when compared to baseline (odds ratio: 3.31; 95%CI: 1.46-7.48, P=0.0041). Further, progression was associated with a greater likelihood of having a study physician visit [relative risk (RR): 1.54; 95%CI: 1.10-2.17, P=0.0117], and an increased frequency of other physician visits (RR: 1.84; 95%CI: 1.10-3.10, P=0.0211). CONCLUSION: Resource utilization in advanced NET in the United States is significant overall and data suggests progression has an impact on resource utilization regardless of NET tumor site.

Understanding practice patterns of glaucoma sub-specialists in India

AIM：To obtain information on the prevailing practice patterns of glaucoma specialists in India.METHODS：Glaucoma specialists attending the Annual Conference of the Glaucoma Society of India（GSI）were surveyed.This survey,conducted in 2013,was based on an interactive audience response system.RESULTS：The information was obtained from 146 glaucoma specialists.Approximately half（n=83;57%）had≥10y of experience in managing glaucoma and were in institutional practice（n=74,51%）.Goldmann applanation tonometry was preferred by 103（72%）specialists whilst n=25（17.4%）used non-contact tonometer.Indentation gonioscopy was favoured by two-thirds（n=90,66%）whereas stereoscopic optic disc examination and visual fields using Humphrey perimeter was performed by a majority of the specialists surveyed（n=115,86%and n=114;83%respectively）.Nearly three quarter specialists（n=96;72%）preferred optical coherence tomography for imaging.The primary choice for treatment of angle closure disease and primary open angle glaucoma was laser（iridotomy,n=117;93%）and medical management（prostaglandin analogue,n=104;78%）,respectively.Approximately only a third of the specialists surveyed（n=37;28%）were performing both trabeculectomy and implantation of a glaucoma drainage device and about half（n=64;47%）were not operating on congenital glaucoma at all.CONCLUSION：This survey has found conformance with preferred practice patterns in several areas of diagnosisand management of glaucoma,but there was diversity in a few areas.The information is a significant step towards improvement of glaucoma care in India,including planning for future strategies.

Laminae combination and shale oil enrichment patterns of Chang 73 sub-member organic-rich shales in the Triassic Yanchang Formation, Ordos Basin, NW China

The Chang 73 sub-member of Triassic Yanchang Formation in the Ordos Basin was taken as an example and the lamina types and combinations,reservoir space features and shale oil enrichment patterns in organic-rich shale strata were investigated using core observation,thin section analysis,XRF element measurement,XRD analysis,SEM,high solution laser Raman spectroscopy analysis,and micro-FTIR spectroscopy analysis,etc.According to the mineral composition and thickness of the laminae,the Chang 73 organic-rich shales have four major types of laminae,tuff-rich lamina,organic-rich lamina,silt-grade feldspar-quartz lamina and clay lamina.They have two kinds of shale oil-bearing layers,"organic-rich lamina+silt-grade feldspar-quartz lamina"and"organic-rich lamina+tuff-rich lamina"layers.In the"organic-rich+silt-grade feldspar-quartz"laminae combination shale strata,oil was characterized by relative high maturation,and always filled in K-feldspar dissolution pores in the silt-grade feldspar-quartz laminae,forming oil generation,migration and accumulation process between laminae inside the organic shales.In the"organic-rich+tuff-rich lamina"binary laminae combination shale strata,however,the reservoir properties were poor in organic-rich shales,the oil maturation was relatively lower,and mainly accumulated in the intergranular pores of interbedded thin-layered sandstones.The oil generation,migration and accumulation mainly occurred between organic-rich shales and interbedded thin-layered sandstones.

On Treatment Patterns for Modeling Medical Treatment Processes in Clinical Practice Guidelines

Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.

Analytical Treatment of the Evolutionary (1 + 1)-Dimensional Combined KdV-mKdV Equation via the Novel (G'/G)-Expansion Method

The novel (G'/G)-expansion method is a powerful and simple technique for finding exact traveling wave solutions to nonlinear evolution equations (NLEEs). In this article, we study explicit exact traveling wave solutions for the (1 + 1)-dimensional combined KdV-mKdV equation by using the novel (G'/G)-expansion method. Consequently, various traveling wave solutions patterns including solitary wave solutions, periodic solutions, and kinks are detected and exhibited.

THE COMBINED HOUGH TRANSFORM

On the basis of researching the generalized Hough transform and its im-provements,this paper presents a combined Hough transform(CHT)for recognizing arbi-trary shapes.The combined Hough transform introduces the idea of the adaptive Houghtransform(AHT)into the double Hough transform(DHT).It not only maintains the de-sirable features of the DHT,but also improves the speed of execution and resistanceagainst disturbance,and reduces the memory requirements greatly.The CHT canaccurately recognize objects,partially occluded in complex background.Therefore,it ispossible to implement the CHT in real-time application.

Characterization of subunits encoded by Sn RK1 and dissection of combinations among these subunits in sorghum(Sorghum bicolor L.)

Sucrose nonfermenting-related protein kinase 1(SnRK1)is one of the critical serine/threonine protein kinases.It commonly mediates plant growth and development,cross-talks with metabolism processes and physiological responses to biotic or abiotic stresses.It plays a key role in distributing carbohydrates and sugar signal transporting.In the present study,eight SnRK1 coding genes were identified in sorghum(Sorghum bicolor L.)via sequences alignment,with three forαsubunits(SnRK1α1 to SnRK1α3),three forβ(SnRK1β1 to SnRK1β3),and one for bothγ(SnRK1γ)andβγ(SnRK1βγ).These eight corresponding genes located on five chromosomes(Chr)of Chr1–3,Chr7,and Chr9 and presented collinearities to SnRK1s from maize and rice,exhibiting highly conserved domains within the same subunits from the three kinds of cereals.Expression results via qRT-PCR showed that different coding genes of SnRK1s in sorghum possessed similar expression patterns except for SnRK1α3 with a low expression level in grains and SnRK1β2 with a relatively high expression level in inflorescences.Results of subcellular localization in sorghum leaf protoplast showed that SnRK1α1/α2/α3/γmainly located on organelles,while the rest four of SnRK1β1/β2/β3/βγlocated on both membranes and some organelles.Besides,three combinations were discovered among eight SnRK1 subunits in sorghum through yeast two hybrid,includingα1-β2-βγ,α2-β3-γ,andα3-β3-γ.These results provide informative references for the following functional dissection of SnRK1 subunits in sorghum.

Under-forest Breeding Pattern and the Practice Form

Through the development in recent years, China's under-forest breeding pattern can be divided into four kinds of practice form of under-forest breeding pattern (the pattern of breeding driven by leading enterprises; the pattern of breeding driven by intermediary economic organizations; the pattern of breeding driven by the professional wholesale market; the pattern of breeding driven by the modern animal husbandry demonstration areas), according to difference in the main body participating in signing the operation contract in breeding pattern. In the production practice of under-forest breeding pattern, the most widely used and successful pattern is the pattern of breeding driven by leading enterprises and its derivative forms.

Property combination patterns of traditional Chinese medicines

Objective:In this study,the property combinations(PCs)of single herbs,two-herb combinations,and multi-herb prescriptions were studied to determine that the propertycombination patterns will be associated with these three levels.Method:By calculating the prescription PC weight,we analyzed the PCs of the single herb coptis rhizome,the two-herb combination of coptis rhizome and scutellaria root,and the classic prescriptions Coptis Decoction to Resolve Toxicity,White Tiger Decoction to Resolve Toxicity,and Peony Decoction,all three of which contain coptis and scutellaria.Results:Calculated results show that cold-bitter-lung,cold-bitter-heart,and cold-bitterstomach are present in both Coptis Decoction and White Tiger Decoction and have the highest PC weights.The weights of coptis and scutellaria in Peony Decoction differs from in their weights in Coptis Decoction and White Tiger Decoction,in that the PCs of highest weights in Peony Decoction are cold-bitter-spleen,cold-bitter-liver,cold-bitter-large intestine,coldsour-liver,and cold-sour-spleen.Conclusion:This novel method for exploring the properties and compatibilities of traditional Chinese herbs helps validate the combination theories of herbs.Application of this method may be valuable in designing new efficacious herbal prescriptions.

Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns

Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.

Research on organizational performance in human resource management practices

In this paper, we analyzed the status of human resource management practices in western China state-owned and state holding enterprises azld private enterprises, and found that there are differences in the nature of the business combination of different patterns of human resource management practices.

Adjuvant therapy for hormone receptor-positive breast cancer: Perspective from a survey on breast cancer physicians' acceptance of practice-changing data

A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.

基于基础与专业相融合的研究型实验教学方法探索

以卓越工程师教育为背景,针对创新型、实践型工程技术人才培养目标,该文将笔者多年课堂教学、实验教学和相关科研工作的经验融入到实验教学中,探索基础与专业相融合的研究型实验教学方法。方法注重学生对基础知识与专业应用的融合训练,基于基础实验系统和综合开放式实验平台,通过对学生在基础电路测试、知识分解、电路独立设计与测试方面的训练,帮助学生创新性和科学研究素养的培养。该文方法在教学实践中进行应用,并起到较好的效果。

“国潮”背景下文创产品的设计思路

目的分析“国潮”文化元素的特征,探究“国潮”文化元素在文创产品设计中的应用策略,为设计师提供更多的思路,从而提高文创产品设计水平,增强文化自信。方法采用文献资料法和案例法进行研究,在文化主题、形式风格和表现手法这三个方面探讨了“国潮”文化元素在文创产品设计中的应用,同时也论述了“国潮”应用的几点原则。结论文创产品设计师应该充分认识到传统文化的重要价值,在文化主题、形式风格和表现手法这三个方面借鉴“国潮”文化元素,并遵循实用性原则、时尚性原则和艺术性原则,从而提升文创产品的生命力。

新时期我国结核病防治服务体系建设及展望

中国结核病防治服务体系是随着疫情水平的变化和经济社会的发展不断调整变化的。自2011年,中国逐步推行新型结核病防治服务体系。进入新时代,如何更好地健全和完善结核病防治服务体系,是结核病防治工作面临的重大问题。作者系统总结了中国结核病防治服务体系的演变沿革,阐述了结核病防治服务体系运行现状,分析了其中存在的问题和挑战,对结核病防治服务体系建设提出了工作意见和建议,并展示了未来发展前景。