Objective:To explore the application value of Holo-Hilbert spectral analysis (HHSA) in the analysis of tremor in Parkinson′s disease (PD) and essential tremor (ET).Methods:A total of 59 patients with PD with motor symptoms and 46 patients with ET were selected from the patients visiting the Department of Neurology, Qilu Hospital of Shandong University (Qingdao) between January 2022 and April 2024, and the original tremor information and myoelectric activity were recorded by accelerometer and electromyography under the condition of no weight bearing and 1 000 g weight bearing. Fourier transform (FT) and HHSA were used to convert the original data, and the effectiveness of HHSA for tremor analysis was verified by comparing the tremor characteristics under the two conversion methods.Results:The tremor data of 59 PD patients and 46 ET patients were converted by HHSA, and the amplitude modulation frequency-carrier frequency spectrum was obtained; and compared with FT, the noise-related spectrum and insignificant peaks were eliminated, and the uniqueness of tremor was maintained. And the tremor peak frequencies of PD patients under the two methods were similar, both being 4-6 Hz; the tremor peak frequencies of ET patients under the two methods were also similar, both being 6-12 Hz. The tremor peak frequencies of FT and HHSA transform in the upper limb resting state of PD patients were (4.93±0.73) Hz and (4.83±0.93) Hz, respectively, with no statistically significant difference between the two groups ( t=0.371, P=0.695). The tremor peak frequencies of FT and HHSA transform in the left upper limbs of ET patients were (8.59±2.23) Hz and (8.57±2.29) Hz, respectively ( t=0.273, P=0.968), in the right upper limbs were (8.09±1.87) Hz and (8.20±2.11) Hz, respectively ( t=0.141, P=0.890), both with no statistically significant differences. There were no significant differences in the tremor peak frequencies of the two methods in the same limb and the same state. PD patients and ET patients who showed harmonics under FT did not show harmonics after HHSA transform. Conclusions:The effectiveness and accuracy of HHSA and FT in the analysis of tremor in PD and ET patients are similar. HHSA is an effective tool for analyzing tremor and the problem of harmonics can be solved by HHSA, and the amplitude modulation frequency-carrier frequency spectrum can be used to analyze the relationship between accelerometer and electromyographic data, providing a possible way to study the mechanism of tremor.

Objective To explore the positive distribution of antinuclear antibody(ANA)and antinuclear antibody spectrum(ANAs)specific antibody detection in patients with chronic kidney disease(CKD)and its clinical application.Methods Indirect immunofluorescence(IIF)and line immunoassay(LIA)were used to detect ANA and ANAs in the sera of 3 968 CKD patients.Results The positive rate of IIF-ANA was 14.34％,that of LIA-ANAs was 26.84％,and the coincidence rate of the two detection results was 74.65％.In IIF-ANA,the distribution of nuclear patterns showed that the highest proportion was the nuclear speckled type(38.87％),followed by the cytoplasmic speckled type(20.06％).In LIA-ANAs,anti-SSB antibody showed the highest positive rate(13.40％),followed by anti-SSA antibody(13.33％).Additionally,the positive rates of IIF-ANA and LIA-ANAs were 20.44％and 30.35％respectively in females,significantly higher than those of males at 9.98％and 24.33％(P＜0.05),and also showed a relatively high positive rate in patients under 20 years old at 46.15％and 38.46％(P＜0.05).Among patients with stage 5 CKD(CKD5),the positive detection rate of ANA was the highest at 15.30％,and the specific antibody indicators with relatively high detection rates in stages 1 to 5 mainly included anti-SSB antibody(average 5.12％)and anti-SSA antibody(average 5.09％).Conclusion The positive detection rates and consistent coincidence rates of autoantibodies in CKD patients,detected by IIF and LIA,are relatively high,especially in young women,middle-aged and elderly women,and patients who have progressed to stage 5.The positive rate of IIF-ANA increases with the progression of the disease.Therefore,routine detection of autoantibodies in patients is of great value and significance for the early identification of autoimmune diseases and can provide assistance for the treatment and prevention of CKD.

Objective To explore the positive distribution of antinuclear antibody(ANA)and antinuclear antibody spectrum(ANAs)specific antibody detection in patients with chronic kidney disease(CKD)and its clinical application.Methods Indirect immunofluorescence(IIF)and line immunoassay(LIA)were used to detect ANA and ANAs in the sera of 3 968 CKD patients.Results The positive rate of IIF-ANA was 14.34％,that of LIA-ANAs was 26.84％,and the coincidence rate of the two detection results was 74.65％.In IIF-ANA,the distribution of nuclear patterns showed that the highest proportion was the nuclear speckled type(38.87％),followed by the cytoplasmic speckled type(20.06％).In LIA-ANAs,anti-SSB antibody showed the highest positive rate(13.40％),followed by anti-SSA antibody(13.33％).Additionally,the positive rates of IIF-ANA and LIA-ANAs were 20.44％and 30.35％respectively in females,significantly higher than those of males at 9.98％and 24.33％(P＜0.05),and also showed a relatively high positive rate in patients under 20 years old at 46.15％and 38.46％(P＜0.05).Among patients with stage 5 CKD(CKD5),the positive detection rate of ANA was the highest at 15.30％,and the specific antibody indicators with relatively high detection rates in stages 1 to 5 mainly included anti-SSB antibody(average 5.12％)and anti-SSA antibody(average 5.09％).Conclusion The positive detection rates and consistent coincidence rates of autoantibodies in CKD patients,detected by IIF and LIA,are relatively high,especially in young women,middle-aged and elderly women,and patients who have progressed to stage 5.The positive rate of IIF-ANA increases with the progression of the disease.Therefore,routine detection of autoantibodies in patients is of great value and significance for the early identification of autoimmune diseases and can provide assistance for the treatment and prevention of CKD.

Objective:To explore the application value of Holo-Hilbert spectral analysis (HHSA) in the analysis of tremor in Parkinson′s disease (PD) and essential tremor (ET).Methods:A total of 59 patients with PD with motor symptoms and 46 patients with ET were selected from the patients visiting the Department of Neurology, Qilu Hospital of Shandong University (Qingdao) between January 2022 and April 2024, and the original tremor information and myoelectric activity were recorded by accelerometer and electromyography under the condition of no weight bearing and 1 000 g weight bearing. Fourier transform (FT) and HHSA were used to convert the original data, and the effectiveness of HHSA for tremor analysis was verified by comparing the tremor characteristics under the two conversion methods.Results:The tremor data of 59 PD patients and 46 ET patients were converted by HHSA, and the amplitude modulation frequency-carrier frequency spectrum was obtained; and compared with FT, the noise-related spectrum and insignificant peaks were eliminated, and the uniqueness of tremor was maintained. And the tremor peak frequencies of PD patients under the two methods were similar, both being 4-6 Hz; the tremor peak frequencies of ET patients under the two methods were also similar, both being 6-12 Hz. The tremor peak frequencies of FT and HHSA transform in the upper limb resting state of PD patients were (4.93±0.73) Hz and (4.83±0.93) Hz, respectively, with no statistically significant difference between the two groups ( t=0.371, P=0.695). The tremor peak frequencies of FT and HHSA transform in the left upper limbs of ET patients were (8.59±2.23) Hz and (8.57±2.29) Hz, respectively ( t=0.273, P=0.968), in the right upper limbs were (8.09±1.87) Hz and (8.20±2.11) Hz, respectively ( t=0.141, P=0.890), both with no statistically significant differences. There were no significant differences in the tremor peak frequencies of the two methods in the same limb and the same state. PD patients and ET patients who showed harmonics under FT did not show harmonics after HHSA transform. Conclusions:The effectiveness and accuracy of HHSA and FT in the analysis of tremor in PD and ET patients are similar. HHSA is an effective tool for analyzing tremor and the problem of harmonics can be solved by HHSA, and the amplitude modulation frequency-carrier frequency spectrum can be used to analyze the relationship between accelerometer and electromyographic data, providing a possible way to study the mechanism of tremor.

Colorectal cancer(CRC)is one of the common malignant tumors,and its incidence rate and mortality rate in China are rising.As a high-incidence malignant tumor,in the process of screening,diagnosis,and treatment,CRC not only has universal ethical issues similar to other diseases,but also has its unique ethical problems,including the accessibility of CRC screening and medical insurance reimbursement,privacy exposure and the materialization of doctor-patient relationship during consultation and physical examination,the balance between"killing"and"nurturing"of cancer cells in excessive diagnosis and treatment,as well as the physiological and psychological issues of patients caused by enterostomy.This paper summarized and analyzed the special ethical issues in the diagnosis and treatment of CRC,and proposed corresponding countermeasures and suggestions.

High-risk procedures in general surgery usually carry high risks and uncertainties,and patients may face significant changes in their living and health conditions,which can easily lead to doctor-patient disputes.This paper summarized the obstacles to implementing joint decision-making of doctors and patients in high-risk procedures in general surgery,as well as explored the best way to incorporate joint decision-making into clinical practice.In the decision-making process,general surgeons and patients need to work together to overcome ethical dilemmas such as lack of communication and decision-making abilities,inadequate informed consent and cognitive abilities,as well as institutional and cultural issues.To help patients choose the most suitable treatment method and truly make decisions about high-risk procedures,it is recommended that China strengthen communication skills training for general surgeons,develop and utilize decision-making support tools,and simultaneously supported multiple parties,to provide a good incubation soil for the implementation of joint decision-making of doctors and patients in general surgery.

Due to the particularity of mental diseases, doctor-patient relationship in psychiatric medicine is a subject that needs to be paid attention to. This paper focused on the discussion of the model of doctor-patient relationship in psychiatric medicine from the perspective of constructing a harmonious doctor-patient relationship. Based on the Szasz & Hollender’s Model of Doctor-patient Relationship and combined with the characteristics of psychiatric medicine, this paper discussed the applicable doctor-patient relationship models, namely, the shared participation model, the guidance-cooperation model, the active-passive model, and the protective-constraint model. The specific application of the shared participation model, the guidance-cooperation model, and the active-passive model in the psychiatric medicine context were introduced in detail, and the reasons and characteristics of the protective-constraint model added on the basis of Szasz & Hollender’s Model of Doctor-patient Relationship were elaborated. Meanwhile, the realization paths of the protective-constraint model in clinical practice were further explored, which included evaluating the behavioral capacity and consciousness state of patients with mental disorders, obtaining informed consent, and standardizing the use of intervention rights and withdrawal mechanisms. The discussion of this model will promote the improvement of doctor-patient relationship and the development of psychiatric medicine.

Objective:This study aims to analyze the relationship between the effect of induction chemotherapy and the timing of radiotherapy in limited-disease or limited-stage small-cell lung cancer (LSCLC). Methods: Data from 148 LSCLC patients who re-ceived induction chemotherapy and radiotherapy between January 2009 and December 2012 were retrospectively analyzed. The effect of two to three cycles of induction chemotherapy was evaluated according to the RECIST version 1.1, which includes complete re-sponse (CR), partial response (PR), stable disease, and progressive disease. CR and PR were used to calculate response rate. The pa-tients were divided into early and late groups based on immediate radiotherapy after two to three cycles of induction chemotherapy. The survival rate was analyzed using the Kaplan-Meier method. Log-rank test and Cox regression model were used to evaluate the influenc-ing factors of the survival rate. Results: The median overall survival (OS) and progression-free survival (PFS) were 22.8 and 13.0 months, respectively. The early and late radiotherapy groups exhibited OS of 34.0 and 18.0 months, respectively, and corresponding PFS of 16.8 and 10.9 months. In the subgroup analysis, for the patients who responded to the induction chemotherapy, the early and late radiotherapy groups showed median OS of 18.0 and 19.5 months, respectively, and corresponding PFS of 19.4 and 11.7 months. For the patients who had no response to the induction chemotherapy, the early and late radiotherapy groups exhibited median OS of 18.0 and 9.5 months, respectively, and corresponding PFS of 12.4 and 10.3 months. Conclusion:All LSCLC patients who received two to three cycles of induction chemotherapy should receive radiotherapy as soon as possible after chemotherapy, regardless of their response to the induction chemotherapy.

Based on the health service delivery system and its performance, it shows the major issues faced by Indonesian health system, including heavy disease burden of NCD, imbalance allocation of medical care and resources, poor access to health service in rural area, low level of government health budget and so on. Presently, the reform in Indonesian health system is in the direction of equity and self-government, via participation of community, private sector or civil society, availability of comprehensive, equitable health care and health resource, to enhance health system and improve population health.

Objective:To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical re-section and determine relevant prognostic factors. Methods:A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial sur-gery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treat-ed with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator. Results:The median survival period after recurrence was 14.3 months (95%CI=12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P=0.032). Univariate analysis results showed the following prognostic factors:tumor location before surgery;operation mode;whether or not recurrence was detected with distant metastases;and therapy af-ter recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor. Conclu-sion:Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant me-tastases treated with chemotherapy may initially benefit from a longer survival rate.