Effect of a cervical collar on optic nerve sheath diameter in trauma patients

BACKGROUND:As advocated in advanced trauma life support and prehospital trauma life support protocols,cervical immobilization is applied until cervical spine injury is excluded.This study aimed to show the difference in optic nerve sheath diameter(ONSD)between patients with and without a cervical collar using computed tomography(CT).METHODS:This was a single-center,retrospective study examining trauma patients who presented to the emergency department between January 1,2021,and December 31,2021.The ONSD on brain CT of the trauma patients was measured and analyzed to determine whether there was a difference between the ONSD with and without the cervical collar.RESULTS:The study population consisted of 169 patients.On CT imaging of patients with(n=66)and without(n=103)cervical collars,the mean ONSD in the axial plane were 5.43±0.50 mm and 5.04±0.46 mm respectively for the right eye and 5.50±0.52 mm and 5.11±0.46 mm respectively for the left eye.The results revealed an association between the presence of a cervical collar and the mean ONSD,which was statistically significant(P<0.001)for both the right and left eyes.CONCLUSION:A cervical collar may be associated with increased ONSD.The effect of this increase in the ONSD on clinical outcomes needs to be investigated,and the actual need for cervical collar in the emergency department should be evaluated on a case-by-case basis.

Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis

BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.

Simulation of Haloxylon Ammodendron Stand Basic Diameter Structure Based on Fuzzy Distribution Function

Based on the investigation data of 12 Haloxylon ammodendron plots in the south edge of Gurbantunggut Desert, Fuzzy distribution was introduced into the study of Haloxylon ammodendron base diameter structure fitting according to the consistency between the characteristics of Fuzzy distribution function and the distribution series of cumulative percentage of stand base diameter, and the fitting precision and effect of Fuzzy distribution function were discussed. The root mean square error RMSE and determination coefficient R2 values showed that Fuzzy-Γ1, Fuzzy-Γ2, Fuzzy-Γ3, Fuzzy-Γ4 had good fitting performance, among which Fuzzy-Γ1 had relatively high fitting precision, and its parameters were closely related to stand age and density, Fuzzy-Γ2 distribution function was the second, and Fuzzy-Γ4 distribution function had the worst fitting effect. By introducing a parameter c from the similarity of four distribution function formulas, a generalized Fuzzy distribution function Fuzzy-Γ5 is obtained. This function shows the highest fitting accuracy. Most of the values of parameter c are near 1 or 2, which shows that the diameter distribution is mainly approximate to Fuzzy-Γ1 and Fuzzy-Γ2.

Increased retinal venule diameter as a prognostic indicator for recurrent cerebrovascular events:a prospective observational study

Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations.However,the ability of retinal vasculature changes,specifically focusing on retinal vessel diameter,to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively.While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events,they have not incorporated this information into a predictive model.Therefore,this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke.Additionally,we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors.We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University.All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years.We found that,after adjusting for related risk factors,patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin(MAD_(0.5-1.0DD))of≥74.14μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin(MVD_(0.5-1.0DD))of≥83.91μm tended to experience recurrent cerebrovascular events.We established three multivariate Cox proportional hazard regression models:model 1 included traditional risk factors,model 2 added MAD_(0.5-1.0DD)to model 1,and model 3 added MVD0.5-1.0DD to model 1.Model 3 had the greatest potential to predict subsequent cerebrovascular events,followed by model 2,and finally model 1.These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke,and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.

One-year results for myopia control of orthokeratology with different back optic zone diameters: a randomized trial using a novel multispectral-based topographer

AIM:To present the 1-year results of a prospective cohort study investigating the efficacy,potential mechanism,and safety of orthokeratology(ortho-k)with different back optic zone diameters(BOZD)for myopia control in children.METHODS:This randomized clinical study was performed between Dec.2020 and Dec.2021.Participants were randomly assigned to three groups wearing ortho-k:5 mm BOZD(5-MM group),5.5 mm BOZD(5.5-MM group),and 6 mm BOZD(6-MM group).The 1-year data were recorded,including axial length,relative peripheral refraction(RPR,measured by multispectral refractive topography,MRT),and visual quality.The contrast sensitivity(CS)was evaluated by CSV-1000 instrument with spatial frequencies of 3,6,12,and 18 cycles/degree(c/d);the corneal higher-order aberrations(HOAs)were measured by iTrace aberration analyzer.The one-way ANOVA was performed to assess the differences between the three groups.The correlation between the change in AL and RPR was calculated by Pearson’s correlation coefficient.RESULTS:The 1-year results of 20,21,and 21 subjects in the 5-MM,5.5-MM,and 6-MM groups,respectively,were presented.There were no statistical differences in baseline age,sex,or ocular parameters between the three groups(all P>0.05).At the 1-year visit,the 5-MM group had lower axial elongation than the 6-MM group(0.07±0.09 vs 0.18±0.11 mm,P=0.001).The 5-MM group had more myopic total RPR(TRPR,P=0.014),with RPR in the 15°–30°(RPR 15–30,P=0.015),30°–45°(RPR 30–45,P=0.011),temporal(RPR-T,P=0.008),and nasal area(RPR-N,P<0.001)than the 6-MM group.RPR 15–30 in the 5.5-MM group was more myopic than that in the 6-MM group(P=0.002),and RPR-N in the 5-MM group was more myopic than that in the 5.5-MM group(P<0.001).There were positive correlations between the axial elongation and the change in TRPR(r=0.756,P<0.001),RPR 15–30(r=0.364,P=0.004),RPR 30–45(r=0.306,P=0.016),and RPR-N(r=0.253,P=0.047).The CS decreased at 3 c/d(P<0.001),and the corneal HOAs increased in the 5-MM group(P=0.030).CONCLUSION:Ortho-k with 5 mm BOZD can control myopia progression more effectively.The mechanism may be associated with greater myopic shifts in RPR.

Study of the Characteristics of Large-Diameter Iron Bars Obtained by Rolling at the ODHAV Foundry in the Republic of Guinea

This work consists of evaluating the quality of the mechanical parameters of large-diameter steels, i.e. 20, 25, 28 and 32, through a process of recycling scrap metal that fills garages, rubbish dumps, gutters and other abandoned sites, as well as imported concrete reinforcing steel sold in the Republic of Guinea. To carry out this important work, a number of mechanical tensile and bending tests and a microscopic analysis combining two devices, an electron microscope and a photographic camera, were carried out. The samples were taken from sampling areas in the major communes of Conakry, namely: Casse Sonfonia, Matoto and Kagbélen. The tensile strength values of the large dimensions 20, 25, 28 and 32 are given in the tables.

Sub-stand diameter distribution types vary along an old-growth Douglas-fir chronosequence into the horizontal diversification development stage

Managing mature Douglas-fir[Pseudotsuga menziesii(Mirb.)Franco]stands to emulate the structural complexity of natural old-growth forest requires identifying structural targets at the sub-stand level at which neighborhood dynamics and patchy disturbance shape structure.We therefore sought to describe the archetypal shapes of predominant sub-stand diameter distribution types(DDTs)observed in natural tree neighborhoods in stands comprising a chronosequence(ca.120-450+yrs)encompassing mature,vertical diversification,and horizontal diversification development stages.The ten 1.0 ha stands are located in the southcentral Oregon Cascades,USA.Building on the known spatial position of each tree,natural tree neighborhoods were identified using the floating neighborhood approach based on spatial tessellation connecting neighboring trees at the first-(mean 61 m2)through fifth-(mean 2058 m2)order scales.Cluster analysis was then used to objectively identify the most predominant DDTs among the relative tree size distributions observed in the trans-scale neighborhoods within each stand.Repeated measures regression was used to classify each DDT to one of six observed archetypal shapes:negative exponential,unimodal,rotated sigmoid,bimodal,concave,or multi-modal.Only three of the 81 observed DDTs deviated by<10%from the stand average,while every stand had at least one DDT that deviated by>50%(maximum 83%).Within each stand,five to ten predominant DDTs were observed,which deviated from the stand average by 30-48%and were characterized by two to five different archetypal shapes.Consequently,in some stands the majority of tree neighborhoods were best characterized by a different shape from that assigned at the stand level.Deviation from the stand average increased from the youngest stand in the mature development stage through the middle stands in the vertical diversification stage to the oldest stands in the horizontal diversification stage.The complexity of DDT shapes tended to increase along the chronosequence(from negative exponential and uniform toward concave and multi-modal),with shape richness highest mid-sequence and evenness peaking in the oldest stands.The high diversity of sub-stand structural complexity reduces the utility of standlevel diameter distributions as old-growth restoration targets.However,the presence in early-sequence stands of sub-stand diameter distributions common to later-sequence stands may facilitate active management at the neighborhood level to promote future old-growth condition.Restoration of substand diameter structures would likely require combining spatial perspectives,such as by augmenting tree-level croptree management with diameter distribution targets for the resulting tree neighborhoods.

Alternative expressions for stand diameter in complex forests

Quadratic mean diameter is the most frequently reported descriptor of the diameter distribution of forests.As such,it is often used as an indicator of forest stand structure,developmental stage,and ecological and economic potential.However,quadratic mean diameter can be heavily influenced by the presence or absence of large numbers of small stems in lower canopy strata,and it is also sensitive to left-truncation of the diameter distribution,making its interpretation across inventories with different protocols challenging.Here,we examine three alternative expressions of stand diameter:the arithmetic and quadratic mean diameter of the thickest 100 trees per hectare,and the basal area-weighted mean diameter.Using data from the United States Forest Inventory and Analysis program for New York and New England,these alternative expressions showed closer correlation with multiple stand structural variables than did quadratic mean diameter,including merchantable cubic and board foot volume per hectare,aboveground live tree carbon per hectare,and total number of live and dead standing trees greater than 40 cm diameter at breast height per hectare(previously proposed as an index of old-growth structure).Arithmetic and quadratic mean diameter of the thickest 100 trees per hectare showed nearly identical performance,and the strongest correlations across the board.We develop closed-form expressions for these variables when the diameter distribution is a Weibull,and illustrate their behavior relative to quadratic mean diameter for that situation.While the reasons for prevalence of quadratic mean diameter as an indicator remain valid,we suggest that these alternative measures should be more widely reported and analyzed to give a more informative depiction of stand structure and development in complex forests.

Measuring tree stem diameters and straightness with depth-image computer vision

Current techniques of forest inventory rely on manual measurements and are slow and labor intensive.Recent developments in computer vision and depth sensing can produce accurate measurement data at significantly reduced time and labor costs.We developed the ForSense system to measure the diameters of trees at various points along the stem as well as stem straightness.Time use,mean absolute error(MAE),and root mean squared error(RMSE)metrics were used to compare the system against manual methods,and to compare the system against itself(reproducibility).Depth-derived diameter measurements of the stems at the heights of 0.3,1.4,and 2.7 m achieved RMSE of 1.7,1.5,and 2.7 cm,respectively.The ForSense system produced straightness measurement data that was highly correlated with straightness ratings by trained foresters.The ForSense system was also consistent,achieving sub-centimeter diameter difference with subsequent measures and less than 4%difference in straightness value between runs.This method of forest inventory,which is based on depth-image computer vision,is time efficient compared to manual methods and less computationally and technologically intensive compared to Structure-from-Motion(SFM)photogrammetry and ground-based LiDAR or terrestrial laser scanning(TLS).

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

基于MLWE和MSIS的可验证解密方案

两方安全计算中涉及的可验证解密技术可以应用在医疗研究数据共享、机构间合作进行模型训练等有隐私保护需求的现实场景中,有助于进一步打破数据孤岛、保障数据安全。但是目前已有的为基于格密码或其他后量子加密方案正确解密所构造的零知识证明的效率不高。面对这一现状,文中针对Kyber提出了一个基于模容错学习问题(MLWE)和模小整数解问题(MSIS)的可验证解密方案。首先,根据Kyber的加解密特性,在利用证明者和验证者所持数据构造相等关系时存在差异,该方案提出了一种利用误差估计结合Kyber的压缩函数,使证明者提供给验证者一部分所持数据的信息,从而消除差异的方法,进而提供可以用于验证的相等关系,把该关系与Dilithium签名方案无公钥压缩版本的框架相结合,构造非交互式零知识证明,将可验证解密问题转变为证明环中短向量满足的线性关系。其次,在理论上分析了方案的正确性、安全性、通信开销和计算复杂度,将方案的合理性和零知识性规约到MSIS困难假设,并提供了2组不同安全等级的建议参数设置。最后,通过编写C语言程序测试了所提方案的正确性和效率。实验结果与理论分析结果基本一致,与现有方案相比,所提方案在对单个密文的证明大小和证明时间上有显著优势,更加简洁、高效。

Diameter distributions in Pinus sylvestris L.stands:evaluating modelling approaches including a machine learning technique

The diameter distribution of trees in a stand provides the basis for determining the stand’s ecological and economic value,its structure and stability and appropriate management practices.Scots pine(Pinus sylvestris L.)is one of the most common and important conifers in Turkey,so a well-planned management schedule is critical.Diameter distribution models to accurately describe the stand structure help improve management strategies,but developing reliable models requires a deep understanding of the growth,output and constraints of the forests.The most important information derived by diameter distribution models is primary data on horizontal stand structure for each diameter class of trees:basal area and volume per unit area.These predictions are required to estimate the range of products and predicted volume and yield from a forest stand.Here,to construct an accurate,reliable diameter distribution model for natural Scots pine stands in the Türkmen Mountain region,we used Johnson’s SBdistribution to represent the empirical diameter distributions of the stands using ground-based measurements from 55 sample plots that included1219 trees in natural distribution zones of the forests.As an alternative,nonparametric approach,which does not require any predefined function,an artificial intelligence model was constructed based on support vector machine methodology.An error index was calculated to evaluate the results.Overall,both Johnson’s SB probability density function with a three-parameter recovery approach and the support vector regression methodology provided reliable estimates of the diameter distribution of these stands.

Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neurocritically ill patients

BACKGROUND Delay in treatment of raised intracranial pressure(ICP)leads to poor clinical outcomes.Optic nerve sheath diameter(ONSD)by ultrasonography(US-ONSD)has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP.However,there is a dearth of data in neuro-medical intensive care unit(ICU)where the spectrum of disease is different.AIM To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients.METHODS We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ICU.US-ONSD was performed according to ALARA principles.A cut-off more than 5.7 mm was taken as significantly raised.Raised ONSD was corelated with raised ICP on radiological imaging.Clinical history,general and systemic examination findings,SOFA and APACHE 2 score and patient outcomes were recorded.RESULTS There was significant association between raised ONSD and raised ICP on imaging(P<0.001).The sensitivity,specificity,positive and negative predictive value at this cut-off was 77.55%,89.06%,84.44% and 83.82% respectively.The positive and negative likelihood ratio was 7.09 and 0.25.The area under the receiver operating characteristic curves was 0.844.Using Youden’s index the best cut off value for ONSD was 5.75 mm.Raised ONSD was associated with lower age(P=0.007),poorer Glasgow Coma Scale(P=0.009)and greater need for surgical intervention(P=0.006)whereas no statistically significant association was found between raised ONSD and SOFA score,APACHE II score or ICU mortality.Our limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre-and post-treatment or procedures for raised ICP.CONCLUSION ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised ICP.ONSD can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.

基于CL加密的改进分布式解密系统

近些年,无线医疗传感器网络(Wireless Medicine Sensor Networks,WMSNs)得到了广泛的应用。WMSNs提高了患者护理质量,但同时也存在许多安全隐患。为了保护患者数据的隐私安全,Yi等人提出了一个基于Paillier密码系统的分布式ElGamal密码系统。然而,Rao分析了他们的方案并展示了一种可行的攻击,该攻击允许攻击者获取密钥。因此,是否可以将具有加法同态性质的密码系统修改为安全的分布式解密系统,以实现更简单的分布式密钥生成和更高效的分布式解密仍然是一个挑战。针对上述挑战,该文提出了一种基于Castagnos和Laguillaumie(CL)加密的改进分布式解密系统,并对未知阶群G上的离散对数关系给出了有效的零知识证明。与其他分布式解密系统相比,基于CL加密的改进分布式系统具有良好的性能、更可靠的设置、更高的安全级别。

基于SM9的密钥策略属性基加密及快速解密

属性基加密是一种通过指定访问策略实现数据共享的公钥加密技术,分为密钥策略属性基加密和密文策略属性基加密两种.在属性基加密中,数据拥有者通过指定一个访问策略(属性集合)对数据进行加密,被授权的接收者使用与属性集合(访问策略)相关联的解密密钥访问数据.与传统"一对一"的数据共享模式相比,属性基加密是一种更为精细的数据共享机制,可以提供"一对多"的数据共享模式,适用于区块链、云计算等信息系统中的多用户数据安全共享应用.SM9标识加密是我国设计的标识密码算法,用于保障数据的机密性,于2021年成为国际标准.但是,SM9标识加密仅提供"一对一"的数据共享模式.本文在SM9标识加密的基础上,结合经典密钥策略属性基加密的构造思路,构造了一种基于SM9的密钥策略属性基加密方案.所提方案中的密钥/密文结构与SM9标识加密算法中的密钥/密文结构相似,可与现有使用SM9的信息系统有效融合.在此基础上,提出基于SM9的密钥策略属性基加密快速解密方法.新方法具有以下特点:(1)通过增加密钥长度,将解密时使用的双线性运算数量由原来的2|I|个降低至2个,其中|I|表示解密时使用的线性秘密生成矩阵中的行数;(2)使用聚合技术,将密文中的群元素个数由原来的(2+|S|)个降低至3个,其中S表示加密时使用的属性集合;(3)新方法具有动态自适应性,用户可以根据实际需求在密钥长度和解密时间之间进行个性化权衡.这些特性使得所提新方法更适用于计算、带宽和存储资源受限的轻量级设备.最后,性能分析表明,该方案在实际应用中是可行的.

机关涉密档案解密管理工作研究

在机关档案管理中,涉密档案的安全管理是一项重要的工作。在涉密档案的解密降密管理方面,还存在诸多难点和安全风险点,文章以此为切入点进行论述,分析在管理过程中存在的风险和隐患,探讨有效的解决措施,提高涉密档案管理质量。

基于不经意多项式估值的SM4协同加解密方案

协同加解密是安全多方计算中的重要研究方向,它可以安全高效地实现数据保护、隐私保护。为解决现有SM4协同加解密方案离线计算阶段计算复杂度偏高的问题,提出一种基于不经意多项式估值的SM4协同加解密方案。方案利用预计算的多项式集合和多项式值集合来完成在线阶段的S盒协同计算,从而提高在线计算阶段的性能。其证明了所提方案的正确性和安全性,同时与四种不同的方案进行对比,结果表明,所提方案计算效率明显高于其他方案,说明所提方案能安全高效地完成SM4协同加解密。

《各级国家档案馆馆藏档案解密和划分控制使用范围的暂行规定》的内容、意义及修订建议

《各级国家档案馆馆藏档案解密和划分控制使用范围的暂行规定》是国家档案局和国家保密局于1991年联合印发的部门规章,是各级国家档案馆开展馆藏档案解密和开放审核工作的重要制度依据和工作指南。论文在对其主要内容和历史意义进行梳理和分析的基础上,结合新修订的《中华人民共和国档案法》和《中华人民共和国保守国家秘密法》及其相关法规制度,提出定义不明、权责不清、工作流程与标准有待补充等问题,并有针对性地提出修订建议。

一种SSD主控芯片数据加解密模块的设计与验证

为了增强固态硬盘(Solid State Disk,SSD)的数据安全,介绍了SSD主控芯片中一种满足《安全芯片密码检测准则》二级要求设计的数据SM4加解密模块。另外,为了验证模块设计的正确性,介绍了基于通用验证方法学(Universal Verification Methodology,UVM)设计的自动化验证平台,以设计功能点和代码覆盖率为衡量指标,数据加解密模块被该验证平台较充分地验证,最终达到片上系统(System on Chip,SoC)的流片交付标准。

保密管理视角下国防科研院所档案解密问题初探

本文从保密与档案的法律法规层面和国防系统对涉密档案解密要求入手,分析涉密档案解密势在必行,结合笔者单位开展的涉密档案解密和到期档案鉴定,分析国防科研院所关于涉密档案解密的现状及存在的问题,提出可践行意见。