Objective To explore the effect of virtual reality technology combined with self-made spe-cial masks on preoperative anxiety and general anesthesia induction in children.Methods A total of 180 chil-dren with adenoid hypertrophy who underwent surgical treatment in this hospital from 2021 to 2023 were se-lected as the research subjects and divided into the control group,the experiment group 1 and 2 according to the random number table method,with 60 cases in each group.After the children entered the anesthesia induc-tion room,the control group was accompanied by one nurse to play with toys and read books to relieve anxie-ty.The experiment group 1 and 2 wore the PICO 4 VR all-in-one machine.In the control group and the experi-ment group 1,the masks were connected to the anesthesia machine for inhalation of sevoflurane.The children lost consciousness and completed the peripheral venous puncture operation and were sent to the operating room.They were assisted with intravenous anesthetics and tracheal intubation was completed.The experiment group 2 completed anesthesia induction by connecting a special mask to an anesthesia machine and a negative pressure suction tube on the basis of the experiment group 1.The simplified Modified Yale Preoperative Anxi-ety Scale(mYPAS-SF)scores of the three groups were compared at the time of entering the anesthesia induc-tion room(T0),10 min after entering the anesthesia induction room(T1),before the start of anesthesia induc-tion(T2),as well as the anesthesia induction time and the incidence of postoperative anesthesia adverse reac-tions.Results The comparison results among the three groups of mYPAS-SF scores showed that at T1 and T2,the scores of the experiment group 1 and 2 were decreased compared with the control group(P<0.05).The mYPAS-SF scores in the three groups showed that the scores at T0,T1,and T2 were significantly higher than those at admission(P<0.05).The levels in the experiment group 1 and 2 gradually were decreased over time(P<0.05),while there was no significant change in the control group(P>0.05).There was a statisti-cally significant difference in the anesthesia induction time among the three groups(P<0.05),and it was gradually decreased(P<0.05).There was a statistically significant difference in the incidence of choking cough,stridor and restlessness among the three groups(P<0.05),both the experiment group 1 and 2 were lower than the control group(P<0.05),and the incidence of choking cough in the experiment group 2 was lower than that in the experiment group 1(P<0.05).Conclusion Virtual reality technology combined with special masks for the induction of general anesthesia can reduce preoperative anxiety in children,shorten the induction time of anesthesia,and reduce adverse reactions of anesthesia.

Objective To evaluate the effect of comprehensive warming measures on reducing the inci-dence of inadvertent perioperative hypothermia(IPH)in patients with extensive burns.Methods A total of 82 patients with extensive burns who underwent escharectomy between January 2020 and January 2024 were selected as the study subjects.They were randomly divided into a control group and an observation group,with 41 patients in each group.The control group received conventional warming measures,while the observation group received comprehensive warming measures in addition to the conventional measures.Body temperature was monitored at the following time points:preoperatively,at the start of anesthesia,at the start of surgery,60 minutes after surgery,120 minutes after surgery,and at the end of surgery.The time to anesthesia recovery,intraoperative fluid infusion volume,blood transfusion volume,urine output,incidence of postoperative shive-ring,and length of hospital stay were recorded.Hemoglobin(HB),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),and blood lactate levels were measured before and after surgery.Results Statistically significant differences were observed between the two groups in intraoperative blood transfusion volume,postoperative blood lactate levels,incidence of IPH,incidence of postoperative shive-ring,and length of hospital stay(P＜0.05).No statistically significant differences were found in intraopera-tive fluid infusion volume,urine output,time to anesthesia recovery,or postoperative levels of HB,PLT,PT,and APTT(P＞0.05).The body temperature of patients in both groups showed a decreasing trend as surgery progressed.The body temperature in the control group was significantly lower than that in the observation group at 60 minutes after surgery,120 minutes after surgery,and at the end of surgery(P＜0.05).Conclusion Comprehensive perioperative warming measures can reduce the incidence of intraoperative hypothermia and decrease intraop-erative bleeding in patients with extensive burns.

Objective With the complex evolution of the social system,patients experience varying degrees of delay in obtaining medical and health services under the combined drive of internal and external environment.In order to alleviate the dilemma of seeking medical treatment in crisis situations,it analyzes the causes of the public's use behavior of Internet medical and health services after delayed medical treatment and the ways to improve it.Methods It employs the method of QCA analysis to explore the crisis management strategies adopted by 183 public.Based on Anderson medical treatment model as the theoretical guidance,conditional variables were constructed.Through deductive logic,it analyzes the complex linkage effect of seven variables,including accessibility level,traumatic life events,panic mood and satisfaction with Internet medical use,on the use of Internet medical services.Results it found that panic has a decisive role in promoting the public's use of Internet medical services.Five behavioural models of Internet medical use are proposed to reveal the potential driving mechanism of the public's adoption of Internet medical strategies.Conclusion By analyzing the synergistic effects between variables,it proposes comprehensive strategies,providing a new perspective for public health emergency management,and offering empirical evidence for policymakers to optimize smart medical services.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Diabetic Retinopathy (DR) is a chronic, progressive and potentially harmful retinal microvascular disease that is associated with persistent hyperglycemia.Without timely and effective treatment, it will seriously damage the vision of patients and bring great inconvenience to their lives.The development of DR involves various mechanisms such as blood-retinal barrier damage, inflammation and neurodegeneration.Intraocular fluids, including aqueous humor and vitreous fluid, can directly reflect the changes in the intraocular environment and have a good indication of the progress of intraocular lesions.In recent years, the changes of various cytokines in intraocular fluid during the occurrence of DR and their influence on the disease course and their changes after treatment have been widely studied.This article focuses on the changes in angiogenesis-related cytokines such as vascular endothelial growth factor, placental growth factor, galectin-1, angiotensin 1 (Ang1), Ang2 and inflammation-related cytokines such as tumor necrosis factor-α, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, monocyte chemoattractant protein-1, transforming growth factor-β, interleukin (IL)-1β, IL-6, IL-8, IL-10 in the intraocular fluid of DR patients, and the changes of these cytokines and the significance after treatment in patients with diabetic macular edema and proliferative DR to provide potential targets for exploring new and personalized clinical treatment and theoretical basis to improve the prognosis of patients with DR.

Objective With the complex evolution of the social system,patients experience varying degrees of delay in obtaining medical and health services under the combined drive of internal and external environment.In order to alleviate the dilemma of seeking medical treatment in crisis situations,it analyzes the causes of the public's use behavior of Internet medical and health services after delayed medical treatment and the ways to improve it.Methods It employs the method of QCA analysis to explore the crisis management strategies adopted by 183 public.Based on Anderson medical treatment model as the theoretical guidance,conditional variables were constructed.Through deductive logic,it analyzes the complex linkage effect of seven variables,including accessibility level,traumatic life events,panic mood and satisfaction with Internet medical use,on the use of Internet medical services.Results it found that panic has a decisive role in promoting the public's use of Internet medical services.Five behavioural models of Internet medical use are proposed to reveal the potential driving mechanism of the public's adoption of Internet medical strategies.Conclusion By analyzing the synergistic effects between variables,it proposes comprehensive strategies,providing a new perspective for public health emergency management,and offering empirical evidence for policymakers to optimize smart medical services.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Chronic inflammation is critical in the onset and progression of atherosclerosis (AS). The lipopolysaccharide (LPS) level in the circulation system is elevated in AS patients and animal models, which is correlated with the severity of AS. Inspired by the underlying mechanism that LPS could drive the polarization of macrophages toward the M1 phenotype, aggravate inflammation, and ultimately contribute to the exacerbation of AS, LPS in the circulation system was supposed to be the therapeutic target for AS treatment. In the present study, polymyxin (PMB) covalently conjugated to PEGylated liposomes (PLPs) were formulated to adsorb LPS through specific interactions between PMB and LPS. In vitro, the experiments demonstrated that PLPs could adsorb LPS, reduce the polarization of macrophages to M1 phenotype and inhibit the formation of foam cells. In vivo, the study revealed that PLPs treatment reduced the serum levels of LPS and pro-inflammatory cytokines, decreased the proportion of M1-type macrophages in AS plaque, stabilized AS plaque, and downsized the plaque burdens in arteries, which eventually attenuated the progression of AS. Our study highlighted LPS in the circulation system as the therapeutic target for AS and provided an alternative strategy for AS treatment.

Objective:To compare the effect of uPWS R15 software based on deep learning with MIM-Maestro 6.9 software based on atlas library to automatically delineate the organs at risk of prostate cancer in order to provide a reference for clinical application.Methods:The CT data of 90 prostate cancer patients admitted to the Department of Oncology Radiotherapy of the Affiliated Hospital of North Sichuan Medical College from 2018 to 2022 were retrospectively selected. Based on the uPWS R15 software developed by Shanghai United Imaging Medical Technology Company and the MIM-Maestro 6.9 software developed by Beijing Mingwei Vision Medical Software Company, the effects of uPWS and MIM software on automatic delineation of organs at risk were evaluated according to five parameters, including delineation time (T), Dice similarity coefficient (DSC), Jaccard similarity coefficient (JSC), Hausdorff distance (HD) and the mean distance to agreement (MDA).Results:The sketching time of uPWS software was less than that of MIM software. There were no significant differences in the sketching effect of femoral head and skin between the two software (all P>0.05). The delineation of right kidney ( tMDA=-3.43, zDSC=-4.03, zJSC=-4.16, P<0.05), left kidney ( tMDA=-3.87, zDSC=-4.18, zJSC=-4.41, P<0.05), small intestine ( tMDA=-8.57, zDSC=-9.99, tJSC=14.21, P<0.05) and rectum ( zMDA=-4.00, tDSC=-9.98, tJSC= 9.72, P< 0.05) except HD, was statistically different. The bladder ( z=-7.88, -9.00, -8.17, -8.74, P<0.05) and spinalcord ( z=-3.87, -4.43, 4.03, 3.05, P<0.05) were also delineated with significant differences. The DSC automatically delineated by uPWS software was >0.7, while the DSC automatically delineated by MIM software was >0.7 for all other organs at risk except small intestine and rectum. In addition, the HD, MDA and JSC values of the organs at risk (bilateral femoral head, bilateral kidneys, spinal cord, bladder, skin, rectum and small intestine) automatically delineated by uPWS software were generally better than those with MIM software. Conclusions:The uPWS software outlines better than the MIM software, but the MIM software can also be used clinically with modifications to the small bowel and rectum, saving a great deal of time in preparation for radiation therapy.

ObjectiveTo explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients. MethodsFrom January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE. ResultsThere was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P < 0.001) and left process of interventricular septum (OR = 3.641, P = 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874). ConclusionCTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.