In order to further understand the cognitive attitude of different groups towards the rank of rights and interests in medical decision-making and its influencing factors, and provide theoretical reference for the practice of medical decision-making, this study conducted convenience sampling through the questionnaire star enterprise edition. The collected data were descriptive statistical analysis with SPSS 21.0 software and joint hypothesis testing. The results showed that there were differences in the cognition of religious beliefs on the same individual’s rights and interests rank among the sample population (P<0.05). There were differences in the cognition of professional title, working years and institution level on the attitude of rights and interests rank in the group of medical institutions (P<0.05). In the ranking of the importance of individual rights usually involved in medical activities, the rights to life, health and equality were the most important. Most people can rationally view the rights and interests of doctors, patients and stakeholders. In medical decision-making, we should adhere to the principle of right rank, give priority to safeguarding the right to life and give consideration to fairness and justice. In the face of conflicts of interest, we should do a good job in value evaluation, safeguard the reasonable interests of patients and give consideration to the demands of family members.

Cardiovascular diseases is the leading cause of threat to human life and health worldwide. Early risk assessment, timely diagnosis, and prognosis evaluation are critical to the treatment of cardiovascular diseases. Currently, the evaluation of diagnosis and prognosis of cardiovascular diseases mainly relies on imaging examinations such as coronary CT and coronary angiography, which are expensive, time-consuming, partly invasive, and require high professional competence of the operator, making it difficult to promote in the community or in areas where medical resources are scarce. The fundus microcirculation is a part of the human microcirculation and has similar embryological origins and physiopathological features to cardiovascular circulation. Several studies have revealed fundus imaging biomarkers associated with cardiovascular diseases, and developed and validated intelligent diagnosis and treatment models for cardiovascular diseases based on fundus imaging data. Fundus imaging is expected to be an important adjunct to cardiovascular disease diagnosis and treatment given its noninvasive and convenient nature. The purpose of this review is to summarize the current research status, challenges, and future prospects of the application of artificial intelligence based on multimodal fundus imaging data in cardiovascular disease diagnosis and treatment.

Previously, the diagnosis of schizophrenia was empirical since it relied on the patient′s subjective symptoms and the practitioner′s clinical experience. There is an urgent need for objective and reproducible assessment tools to aid its diagnosis. Changes in brain structure and function are closely related to the development of schizophrenia. The retina, a part of the central nervous system, is highly similar to the brain morphologically and neurophysiologically and can be assessed by a non-invasive and convenient fundus examination. There have been studies using optical coherence tomography, fundus photography, optical coherence tomography angiography, and electroretinography to identify significant changes in the structure and function of the fundus in patients with schizophrenia. However, there is still a lack of generalization in these studies. This article summarises and discusses the findings in this area and presents a vision for future studies to explore the application value of fundus in the management of schizophrenia.

Previously, the diagnosis of schizophrenia was empirical since it relied on the patient′s subjective symptoms and the practitioner′s clinical experience. There is an urgent need for objective and reproducible assessment tools to aid its diagnosis. Changes in brain structure and function are closely related to the development of schizophrenia. The retina, a part of the central nervous system, is highly similar to the brain morphologically and neurophysiologically and can be assessed by a non-invasive and convenient fundus examination. There have been studies using optical coherence tomography, fundus photography, optical coherence tomography angiography, and electroretinography to identify significant changes in the structure and function of the fundus in patients with schizophrenia. However, there is still a lack of generalization in these studies. This article summarises and discusses the findings in this area and presents a vision for future studies to explore the application value of fundus in the management of schizophrenia.

In order to further understand the cognitive attitude of different groups towards the rank of rights and interests in medical decision-making and its influencing factors, and provide theoretical reference for the practice of medical decision-making, this study conducted convenience sampling through the questionnaire star enterprise edition. The collected data were descriptive statistical analysis with SPSS 21.0 software and joint hypothesis testing. The results showed that there were differences in the cognition of religious beliefs on the same individual’s rights and interests rank among the sample population (P<0.05). There were differences in the cognition of professional title, working years and institution level on the attitude of rights and interests rank in the group of medical institutions (P<0.05). In the ranking of the importance of individual rights usually involved in medical activities, the rights to life, health and equality were the most important. Most people can rationally view the rights and interests of doctors, patients and stakeholders. In medical decision-making, we should adhere to the principle of right rank, give priority to safeguarding the right to life and give consideration to fairness and justice. In the face of conflicts of interest, we should do a good job in value evaluation, safeguard the reasonable interests of patients and give consideration to the demands of family members.

Majority of type 2 diabetes mellitus (T2DM) patients are highly susceptible to several forms of cognitive impairments, particularly dementia. However, the underlying neural mechanism of these cognitive impairments remains unclear. We aimed to investigate the correlation between whole brain resting state functional connections (RSFCs) and the cognitive status in 95 patients with T2DM. We constructed an elastic net model to estimate the Montreal Cognitive Assessment (MoCA) scores, which served as an index of the cognitive status of the patients, and to select the RSFCs for further prediction. Subsequently, we utilized a machine learning technique to evaluate the discriminative ability of the connectivity pattern associated with the selected RSFCs. The estimated and chronological MoCA scores were significantly correlated with R= 0.81 and the mean absolute error (MAE) =1.20. Additionally, cognitive impairments of patients with T2DM can be identified using the RSFC pattern with classification accuracy of 90.54％ and the area under the receiver operating characteristic (ROC) curve (AUC) of 0.9737. This connectivity pattern not only included the connections between regions within the default mode network (DMN), but also the functional connectivity between the task-positive networks and the DMN, as well as those within the task-positive networks. The results suggest that an RSFC pattern could be regarded as a potential biomarker to identify the cognitive status of patients with T2DM.

Objective To investigate the effect of nutritional intervention upon the clinical efficacy of chemoradiotherapy in patients diagnosed with esophageal carcinoma. Methods A total of 46 patients who were diagnosed with esophageal cancer in Anhui Cancer Hospital from November 2016 to August 2017 were enrolled in this prospective study. All patients were randomly and evenly divided into the nutritional intervention (NI) and routine treatment (RT) groups. The changes in body mass index (BMI),PG-SGA, serum albumin ( ALB), hemoglobin ( HB), white blood cell ( WBC) and other objective nutritional parameters and the incidence of chemoradiotherapy-induced complications were recorded before and after chemoradiotherapy. Results Prior to chemoradiotherapy,age,sex,BMI,ALB,PLT and clinical staging did not significantly differ between two groups (all P>0. 05).In the NI group,the BMI was (21.52±2. 67) after chemoradiotherapy,significantly higher than (21.13±2. 73) before radiotherapy (P= 0. 000).Moreover,the PG-SGA score after chemoradiotherapy was significantly lower compared with that before chemoradiotherapy (P= 0. 000).In the RT group,the BMI,Hb,ALB,PLT and WBC after chemoradiotherapy were significantly lower than those before radiotherapy, and thePG-SGA score was worse after chemoradiotherapy ( all P<0. 05).In the NI group, the incidence of grade 3 myelosuppression was 4. 34％, significantly lower than 8. 68％ in the RT group ( P= 0. 000 ). Conclusions Patients with esophageal cancer treated with chemoradiotherapy have a high nutritional risk. Nutritional intervention can improve the nutritional status, reduce the incidence of chemoradiotherapy-induced complications,and probably improve the quality of life and clinical prognosis.

Objective To investigate the significance of computed tomography(CT)and 3.0 T magnetic resonance imaging(MRI)in intensity-modulated radiotherapy(IMRT)for esophageal carcinoma. Methods Thirty-five patients newly diagnosed with esophageal carcinoma who received radical radiotherapy in our hospital from November 2013 to April 2015 were enrolled as subjects. Target volume was delineated on the CT images and MRI images(T2-weighted and diffusion-weighted fusion images). The MRI-and CT-based IMRT plans were designed using the same dose prescription and dose constraints for organs at risk(OAR). The target volume,prescribed dose,and doses for OAR were compared between the two plans. Results In the two plans, dose distribution and planning parameters met the clinical requirement. The length of lesion,gross tumor volume (GTV),and planning target volume(PTV)defined by 3.0 T MRI were significantly smaller than those defined by CT(P=0.00,0.03,0.03). There were no significant differences in the D 2%,D 98%,D 50%,homogeneity index,or conformity index for primary GTV(PGTV)and PTV-PGTV between the two plans(all P>0.05). Compared with the CT-based plan,the 3.0 T MRI-based plan had a significantly smaller mean dose to the lungs and an insignificantly smaller actual dose to the lungs(P=0.00;P>0.05).There were no significant differences in maximum doses tolerated by the spinal cord or heart between the two plans. Conclusions In terms of target volume delineation and dosimetric parameters, both CT-and 3.0 T MRI-based plans meet the clinical requirement. The 3.0 T MRI-based plan may provide potential benefits for some OAR due to a smaller target volume compared with the CT-based plan.

OBJECTIVE: To investigate the clinical value of detection of preoperative urinary soluble Fas (sFas) expression in predicting the recurrence of non-muscle invasive bladder cancer (NMIBC).
 METHODS: We performed a prospective research, which included 128 cases with NMIBC from January 2008 to April 2011. Expression levels of sFas in urine, which was saved at the first morning from preoperative NMIBC patients, were analyzed by ELISA. Clinical and pathological data, European Organization for Research and Treatment of Cancer (EORTC) risk group category, follow-up data and urinary sFas values were collected from each patient, and each prognostic outcome was evaluated by statistical analysis of non-parametric test. Urinary sFas values and recurrence-free probabilities were estimated by the Kaplan-Meier method and compared by the log rank test. Cox proportional hazards regression models were performed to determine the independent predictors of NMIBC recurrence. The prognosis index (PI) was established.
 RESULTS: The urinary sFas level was significantly elevated in the NMIBC cases with a higher stage or grade or high-risk EORTC group category than in those with a lower stage or grade or low-risk EORTC group category (each P<0.05), regardless of age or gender (P>0.05). Kaplan-Meier analysis revealed a significant increase in incidence of recurrence in the NMIBC patients with high sFas levels in the urine (P<0.001). According to Cox regression analysis, the urinary sFas level and EORTC risk group category (each P<0.05) were the independent predictors of NMIBC recurrence. Based on the outcome of Cox regression, the formula of PI=(0.004×sFas value+1.179×EORTC score) was established.
 CONCLUSION Our study indicates that urinary sFas test may help to identify NMIBC patients at risk of tumor recurrence and it deserves further research.
Disease Progression ; Humans ; Kaplan-Meier Estimate ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Urinary Bladder Neoplasms ; pathology ; urine ; fas Receptor ; urine

Objective To investigate the clinical efficacy of endoscopic surgery for extensive osteoradionecrosis (ORN) of skull base in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.Methods Seventeen patients diagnosed as ORN of skull base after radiotherapy for NPC and underwent endoscopic surgery were retrospectively studied with their clinic data.Results Based on the CT and endoscopic examination,all patients had large skull base defects with bone defects averaged 7.02 cm2 (range,3.60-14.19 cm2).Excepting for curetting the sequestra,endoscopic surgery was also used to repair the wound or to protect the internal carotid artery with flap in 12 patients.No bone reconstructions were conducted in all patients with the bone defects of skull base.CT examinations were taken after endoscopic surgery when required.The postoperative follow-up ranged from 8 months to 6 years (average,14 months).Aside from 1 patient with delayed cerebrospinal fluid (CSF),others had no related complications.Conclusions The patients with extensive ORN can be treated with endoscopic surgery to curette the necrotic bone of skull base,and endoscopic reconstruction provides an alternative technique.It may not be necessary to reconstruct the bone defects at skull base,however,the exposed important structures of skull base,such as internal carotid artery,need to repair with soft tissue such as flap.