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Purpose To reduce the total clinic visit duration among retina providers in an academic ophthalmology department. Methods All patient encounters across all providers in the department were analyzed to determine baseline clinic visit duration time, defined as the elapsed time between appointment time and checkout. To increase photography capacity, a major bottleneck identified through root cause analysis, four interventions were implemented: training ophthalmic technicians to perform fundus photography in addition to optical coherence tomographies, relocating photography equipment to be adjacent to examination rooms, procuring three additional Optos widefield retinal photography units, and shifting staff schedules to better align with that of the providers. These interventions were implemented in the clinics of two retina providers. Results The average baseline visit duration for all patients across all providers was 87 minutes (19,550 patient visits). The previous average visit duration was 80 minutes for Provider 1 (557 patient visits) and 81 minutes for Provider 2 (1,246 patient visits). In the 4 weeks after interventions were implemented, the average visit duration decreased to 60 minutes for Provider 1 and 57 minutes for Provider 2. Conclusion A systematic approach and a multidisciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations.

To examine the diagnostic yield of exome sequencing (ES) in singleton pregnancies with isolated fetal clubfoot.Clinical data from singleton pregnancies with a sonographic diagnosis of isolated clubfoot and ES results between 2018 and 2021 were retrospectively obtained from a single referral medical center. The recorded data include maternal age, gestational age at sonographic diagnosis, the indication for genetic testing, ES results, and pregnancy outcomes.During the study period, 38 fetuses were prenatally diagnosed with isolated clubfoot by ultrasound and underwent ES after the copy number variant analysis was non-diagnostic. Through the trio-ES analysis, pathogenic or likely pathogenic variants were detected in 4 of 38 (10.5%) with the following genes: BRPF1, ANKRD17, FLNA, and KIF1A. All are de novo with three of autosomal dominant inheritance and one of X-linked recessive inheritance.Sonographic diagnosis of clubfoot, even isolated, increases the risk for monogenic syndromes. Exome sequencing should be an option for genetic investigation for such pregnancies.

To present both our center's and previously reported experience of prenatal diagnosis of Coffin-Siris syndrome (CSS) with regard to the laboratory testing and fetal features of this syndrome.This was a retrospective study of eight pregnancies with fetal CSS identified by prenatal or postnatal genetic testing. Clinical and laboratory data were collected and reviewed for these cases, including maternal demographics, prenatal sonographic findings, chromosomal microarray and exome sequencing (ES) results, and pregnancy outcomes.A total of eight cases of fetal CSS based on molecular testing were detected. Two cases presented with an increased nuchal translucency (NT) in the first trimester. The remaining six were identified at the second trimester scan. Agenesis of the corpus callosum (ACC) was the most common sonographic finding, accounting for 5/7 (71.4%) cases in which a second trimester sonogram was performed: four had ACC as an isolated finding, and one had additional features of cerebellar hypoplasia and left congenital diaphragmatic hernia.CSS should be included in the differential diagnosis when ACC is found by prenatal ultrasound. Both chromosomal microarray and ES should be options when counseling patients with a structurally anomalous fetus.

To observe the effect on motor function, spasticity degree, muscle strength and the relevant parameters of three-dimensional gait analysis in the patients with post-stroke spasticity in the lower limbs treated with the combined therapy of electroacupuncture (EA) and muscle electricity biofeedback or the simple muscle electricity biofeedback therapy on the base of rehabilitation medicine.A total of 60 patients with post-stroke spasticity in the lower limbs were randomized into an EA + biofeedback group, a biofeedback group and a rehabilitation group, 20 cases in each one. In the rehabilitation group, the basic rehabilitation training was provided, 45 min each time. In the biofeedback group, on the base of the treatment as the rehabilitation group, the biofeedback therapy was added, 30 min each time. In the EA + biofeedback group, besides the treatment as the biofeedback group, acupuncture was supplemented at Futu (ST 32), Liangqiu (ST 34), Zusanli (ST 36) and Fenglong (ST 40), etc, and EA was applid at Zusanli (ST 36) and Taichong (LR 3) with continuous wave and 5 Hz in frequency. In each group, the treatment was given once daily, 5 times a week, for 6 weeks totally. Separately, before and after treatment, the score of Fugle-Meyer assessment (FMA), the score of clinical spasticity index (CSI) in the lower limbs and the strength of the anterior tibial muscle on the affected side were assessed, and the spatial-temporal parameters (step frequency and steep speed) in the three-dimensional gait analysis and the kinematic parameters (maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side) were measured in the patients of three groups.After treatment, FMA score was increased as compared with that before treatment in all of three groups (On the base of rehabilitation treatment, the combined regimen of EA and muscle electricity biofeedback therapy and the simple muscle electricity biofeedback therapy all effectively strengthen the motor functions and reduce spasticity as well as improve step frequency, step speed and the range of motion of ankle joint in the patients with post-stroke spasticity in the lower limbs. Regarding the gait improvement, the combined regimen of EA and muscle electricity biofeedback is better than the simple muscle electricity biofeedback.

The functional movement screen (FMS) is commonly used to evaluate sports injury risks, but no study has been reported for Wushu athletes. The aim of this study was to identify optimal FMS cut-off points for previously injured Wushu athletes and to examine the associations with other possible factors. In this study, a total of 84 Chinese Wushu athletes (15.1 &plusmn, 4.5 years old, 51% male) with a minimum of two years of professional training background in either Taiji, Changquan, or Nanquan were assessed by the FMS. Video recordings were used to confirm the scoring criteria, and previous injuries were assessed based on face-to-face interviews. An optimal cut-off of the FMS score was investigated by receiver operating characteristic curves with sensitivity and specificity. We found that FMS score of less than 16 (sensitivity = 80%, specificity = 56%) was related to an increased occurrence of injuries (odds ratio = 5.096, 95%CI: 1.679&ndash, 15.465) for the current study sample. The training type and training levels were related with FMS scores. More than half of the athletes (58%) had FMS asymmetry and 21% of athletes reported pain while performing the FMS protocol. Future prospective studies are recommended to use FMS with cut-off of 16 points in Wushu athletes.

To understand the iron stores of the plateletpheresis donors, so as to provide some new experimental data for further exploration and more perfect health examination criteria of the plateletpheresis donors.A total of 297 plateletheresis donors conformed to standard in October 2018 were selected by the cross sectional study. The related factors affecting iron stores were analyzed; the effect of plateletpheresis times of donation on the levels of the hemoglobin(Hb) and serum ferritin(SF) as well as the iron deficency rate in the blood donors was also analyzed; the iron stores in the blood donors was evaluated.The SF level in plateletpheresis donors negatively correlated with annual plateletphersis times of donation（r=-0.416, P＜0.001）; The SF level decreased with the increase of annual times of donation（P＜0.05）; The iron deficiency rate in plateletpheresis donors showed the increase trend with the increase of annual times of donation. The iron deficiency rate in male and femal with 18-23 times of donation was 12.5%(8/64) and 40%(6/15) respectively.The blood center should reduce recruitment frequency and increase the testing of SF for regularly plateletpheresis donors.单采血小板献血者铁储备状况的分析.了解单采血小板献血者体内铁储备状况，为研究和制定更细致和更完善的单采血小板献血者健康检查标准提供有力的实验依据.采用横断面调查，选取2018年10月符合标准的297例单采血小板献血者样本，分析影响铁储备指标的相关性因子，从年度单采血小板次数方面，探讨其对献血者体内血红蛋白（Hb）、血清铁蛋白（SF）及铁缺乏率的影响，全面调查献血者的铁储备状况.单采血小板献血者SF水平与年度单采血小板次数呈负相关（r=-0.416，P＜0.01）；随着年度献血次数的增加，SF水平不断下降，差异具有统计学意义（P＜0.05）；随着年度献血次数增加，单采血小板献血者铁缺乏比率有增加的趋势。男性18-23次组铁缺乏比率为 12.5%(8/64) ，女性18-23次组的铁缺乏比率为40%(6/15).采供血机构对重复单采血小板献血者可适当减少招募次数，有必要增加SF的检测.

The implementation of expressway toll-free policy during holidays in China has caused serious congestion and frequent accidents on expressways. Many studies have explored the policy’s macroscopic outcome and its countermeasures for policy managers, while limited attention has been paid to the influence mechanism of the policy on the individuals’ travel behavior, especially the mode choice behavior. More insight into the dynamic effects of individuals reacting to policy measure is needed. This study aims at analyzing the adaption progress of the individual’s mode choice behavior and estimating the time-varying influence of the traffic policy on the mode split. With assumptions travelers’ adapting behavior conform to the inertia and myopia principles, a Logit dynamic evolutionary model for mode choice is proposed. A unique globally stable equilibrium state for the model is derived with the strict mathematical analysis. As an application, the influence of the expressway toll-free policy on mode split is evaluated. The travel cost structure, the sensitivity of the travel distance and traffic supply, and the evolutionary dynamics of the mode split are analyzed in scenarios with and without the expressway toll-free policy. The result indicates that travel distance and network’s total supply amount remarkably affect the implementation effect of the policy.

This paper refers to Nissan Tino series models as the research object, the power source of the vehicle makes reasonable distribution by a kind of optimization control strategy of the energy, in order to improving the efficiency of the energy conservation. The experimental data was compared by the advisor software simulation to control strategy, it is verified the effectiveness of the energy saving efficiency.

Through the study of the traditional vascular contour extraction algorithm, in this paper the means that vascular contour extraction of MRS regional morphology algorithm based on Sobel Operator is proposed. This method comprehensively applying regional growth algorithm and morphologic detection algorithm, and combining with Sobel operator through the correction and contrast enhanced, the result of vascular contour is more accurate and more continuous on this basis, which plays a decisive role. Experiments show that this method not only can effectively extract vascular outline and vascular contour positioning accuracy is higher, but also can effectively reduce the interference of noise to the image , Thereby this method improve the anti-interference ability of contour extraction for image

Metal smelting process all kinds of element content directly influence the metal performance index and smelting process control .The amount of carbon become mainly alloy index for divided type and number. LIPS using high power laser ablation material produce plasma, in plasma radiation spectrum analysis; it could be used in the composition of solid, liquid and gas composition and concentration measurement. But the results of the measurement will be affected by some factors, this article through some experiments, that show the Influence factors for the measured results such as the delay time，the different environment of gas and the laser pulse energy and analyzed them.

Using LIBS (laser-induced-breakdown-spectroscopy)technology, element percent in ferroalloy can be measured. High energy laser beam focus on high temperature plasma of ferroalloy surface, using fiber spectrometer detected plasma emission spectral lines in the cooling process to determine the type and content in the ferroalloy elements. In the application of quantitative analysis internal standard method in ferroalloy C content, according to the measuring principle built experimental platform, according to Fe for internal standard elements, setting up the calibration curve of C content, and using the curves to ferroalloy samples in a quantitative analysis on the C element. The results show, LIBS internal standard method to determine the relative error of the ferroalloy C content for no more than 10%, verifying the internal standard method used in the determination of the elements in ferroalloy feasibility.

By studying the conventional algorithm of contour extraction, a new method of contour extraction in blood vessel of brain is proposed based on the MOC maximum optimization cost. First of all, the theory computes the gray differential of the image by conventional differential method to build the cost space. Then, by using dynamic programming theory, the maximum optimization cost curve in the space is extracted to serve as the specific cerebrovascular profile. The experiments show that this method ensures high efficiency in extracting cerebrovascular contour and a high accuracy in positioning cerebrovascular contour, and it diminishes the target image ambiguity caused by noise to improve the anti-interference ability of Contour extraction.

Spectrum signal may contain many peaks or mutations and noise also is not smooth white noise, to this kind of signal analysis, must do signal pretreatment, remove part of signal and extract useful part of signal.Based on the data of blood glucose near-infrared spectrum as the research object to explore the application of wavelet transform in the near infrared spectrum signal denoising, and through the simulation results show that using wavelet analysis of near infrared spectral data pretreatment than the traditional Fourier method can be higher precision of prediction.

According to supercritical CO2Extraction and characteristics of tiller onion crush the processing, we have established a differential mass conservation model, Extraction rate was accurately obtained in the differential mass conservation model based on the characteristics of the BP neural network. Through further training, we got the network training and simulation figures. Finally, the differential mass conservation model was solved.

CYP21A2 gene mutations in a child with congenital adrenal hyperplasia (CAH), and the child's parents, were detected in the study. The clinical features, treatment monitoring and molecular genetic mechanism of CAH are reviewed. In the study, DNA was extracted from peripheral blood samples using the QIAGEN Blood DNA Mini Kit; a highly specific PCR primer for CYP21A2 gene was designed according to the sequence difference between CYP2lA2 gene and its pseudogene; the whole CYP2lA2 gene was amplified with PrimeSTAR DNA polymerase (Takara), and the amplification product was directly sequenced to detect and analyze CYP2lA2 gene mutation. The child was clinically diagnosed with CAH (21-hydroxylase deficiency, 21-OHD) at the age of 36 days, and the case was confirmed by genetic diagnosis at the age of 1.5 years. The proband had a homozygous mutation at c.293-13C in the second intron of CYP21 gene, while the parents had heterozygous mutations. Early diagnosis and standard treatment of CAH (21-OHD) should be performed to prevent salt-wasting crisis and reduce mortality; bone aging should be avoided to increase final adult height (FAH), and reproductive dysfunction due to oligospermia in adulthood should be avoided. These factors are helpful for improving prognosis and increasing FAH. Investigating the molecular genetic mechanism of CAH can improve recognition and optimize diagnosis of this disease. In addition, carrier diagnosis and genetic counseling for the proband family are of great significance.

To evaluate the value of serum brain natriuretic peptide (BNP) in the diagnosis of hyperthyroid heart disease in children.Fifty-eight children with hyperthyroidism were assigned to two groups according to their cardiac functions: hyperthyroid heart disease (n=28) and hyperthyroidism alone (n=30). Thirty healthy children served as the control group. Serum BNP level, left ventricular ejection fraction (LVEE) and E/A ratio were measured before and after treatment. The diagnostic value of BNP was evaluated in children with hyperthyroid heart disease.The serum BNP level in the hyperthyroid heart disease and the hyperthyroidism alone groups before treatment was significantly higher than that in the control group (P0.05), while the LVEF and the E/A ratio were significantly lower than those in the control group (P0.05). Serum BNP level was positively correlated with the TT3 (r=0.801, P0.05) and TT4 levels (r=0.578, P0.05) and negatively with the LVEF (r=-0.48, P0.05) and the E/A ratio (r=-0.35, P0.05) in the hyperthyroid heart disease group. The serum BNP, TT3 and TT4 levels in the hyperthyroid heart disease and the hyperthyroidism alone groups were reduced and the LVEF and the E/A ratio increased significantly three months after treatment (P0.05). When serum BNP level of323.62 pg/mL was proposed as a cutoff point, the sensitivity, specificity, positive predictive value and negative predictive value were 92.86%, 90.00%, 89.66% and 93.10% respectively for the diagnosis of hyperthyroid heart disease.BNP may serve as a reliable marker for the diagnosis of hyperthyroid heart disease in children. Serum BNP level along with the LVEF and the E/A ratio may be useful in the evaluation of the severity and the cardiac function in children with this disease.

Luminescent 20-nm silicon dioxide nanoparticles containing dibromofluorescein (D; particles denoted D-SiO(2)) were synthesized by the sol-gel method. In the presence of Pb(Ac)(2) as a heavy atom perturber, the particle can emit the intense and stable room temperature phosphorescence(RTP) signal on a polyamide membrane at the wavelength of lambdaex(max)/lambdaem(max) = 460/623 nm for D. Our research indicates that the specific immune reaction between goat-anti-human IgG antibody labeled with D-SiO(2) and human IgG can be carried out quantitatively on a polyamide membrane, and the phosphorescence intensity was evidently enhanced after the immunoreaction. Thus a new solid substrate-room temperature phosphorescence immunoassay (SS-RTP-IA) for determination of human IgG was established. The linear range of this method is 0.0624-20.0 pg spot(-1) of human IgG (corresponding to a concentration range of 0.156-50.0 ng ml(-1), sample volume: 0.40 microl spot(-1)). The regression equation of the working curve is DeltaIp = 94.39 + 17.00 m IgG (pg spot(-1)) (460/623 nm, r = 0.9998). Detection limit calculated as 3 Sb/k is 0.015 pg spot(-1). After elevenfold replicate measurement, RSD are 3.2% and 2.4% for samples containing 0.156 and 50.0 ng l(-1) IgG, respectively. This method is sensitive, accurate, and of high precision. And it has been applied to the determination of IgG in human serum with satisfactory results. Meanwhile, the mechanism of SS-RTP-IA based on an antibody labeled with nanoparticles containing dibromofluorescein luminescent molecules was discussed.