Prophylactic Effect of Gossypin Against Percutaneously Administered Sulfur Mustard

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青少年自我伤害行为影响因素与情绪管理对策-社会心理学论文-社会学论文

青少年自我伤害行为影响因素与情绪管理对策-社会心理学论文-社会学论文——文章均为WORD文档，下载后可直接编辑使用亦可打印——心理学情绪管理论文第五篇：青少年自我伤害行为影响因素与情绪管理对策摘要：自我伤害行为是应对负性情绪的常用策略, 普遍存在于冲动型、情绪管理薄弱的青少年群体中, 严重影响其身心健康和发展, 是重要的疾病负担之一, 应引起广大学者和学校卫生工作者的关注和重视。

作者对自我伤害行为的概念和界定、流行病学和危害、影响因素进行了文献研究和分析, 并提出以培养青少年情绪管理能力为重点的预防和干预策略。

关键词：情绪; 自我伤害行为; 精神卫生; 青少年;Emotional regulation and self-injury behavior among adolescentsTANG JieDepartment of Preventive Medicine, School of Public Health, Guangzhou Medical UniversityAbstract：Self-injury behavior, a common strategy for coping with negative emotions, is widespread among adolescents with impulsive and emotional dysregulation. Self-injury behavior severely impacts an adolescents mental and physical well-being, and has become one of the important disease burdens, which deserves much attention from both scholars and school health care providers. Based on literature review, the definition, epidemiology and influencing factors of self-injury,as well as proposed prevention and intervention strategies for self-injury focusing on emotional regulation, were provided.自我伤害行为(self-harm behavior, SB) 是一个宽泛的概念, 其核心内涵指个体故意伤害自己的身体组织。

尖孢镰刀菌对秀丽隐杆线虫生物学特性及表达转录组的影响

华南农业大学学报 Journal of South China Agricultural University 2024, 45(3): 381-389DOI: 10.7671/j.issn.1001-411X.202308007易杏盈, 肖月, 张东华, 等. 尖孢镰刀菌对秀丽隐杆线虫生物学特性及表达转录组的影响[J]. 华南农业大学学报, 2024, 45(3): 381-389.YI Xingying, XIAO Yue, ZHANG Donghua, et al. Effects of Fusarium oxysporum on the biological characteristics and expression transcriptome of Caenorhabditis elegans[J]. Journal of South China Agricultural University, 2024, 45(3): 381-389.尖孢镰刀菌对秀丽隐杆线虫生物学特性及表达转录组的影响易杏盈1，肖　月1，张东华1，刘　丽1，闫晓慧1，伍建榕1,2(1 西南林业大学生物多样性保护学院/云南省高校森林灾害预警控制重点实验室, 云南昆明 650224；2 西南林业大学林学院/西南地区生物多样性保育国家林业局重点实验室, 云南昆明 650224)摘要: 【目的】探讨尖孢镰刀菌Fusarium oxvsporum对秀丽隐杆线虫Caenorhabditis elegans生物学特征的影响，明确线虫响应尖孢镰刀菌侵染的关键通路。

【方法】将尖孢镰刀菌活性孢子和灭活孢子分别与秀丽隐杆线虫共培养，测定C. elegans寿命、体长、运动能力、繁殖力以及咽泵运动速率等基本生物学特征；进行全基因组测序，通过GO和KEGG分析明确线虫响应尖孢镰刀菌侵染的关键通路和生物学功能。

【结果】尖孢镰刀菌活性分生孢子与线虫共培养可导致线虫寿命下降，虫体显著缩短，线虫繁殖力显著降低；但共培养并未对线虫的咽泵运动速率及运动能力产生明显影响。

光谱法研究药物小分子与蛋白质大分子的相互作用的英文

Spectroscopic Study of the Interaction between Small Molecules and Large Proteins1. IntroductionThe study of drug-protein interactions is of great importance in drug discovery and development. Understanding how small molecules interact with proteins at the molecular level is crucial for the design of new and more effective drugs. Spectroscopic techniques have proven to be valuable tools in the investigation of these interactions, providing det本人led information about the binding affinity, mode of binding, and structural changes that occur upon binding.2. Spectroscopic Techniques2.1. Fluorescence SpectroscopyFluorescence spectroscopy is widely used in the study of drug-protein interactions due to its high sensitivity and selectivity. By monitoring the changes in the fluorescence emission of either the drug or the protein upon binding, valuable information about the binding affinity and the binding site can be obt本人ned. Additionally, fluorescence quenching studies can provide insights into the proximity and accessibility of specific amino acid residues in the protein's binding site.2.2. UV-Visible SpectroscopyUV-Visible spectroscopy is another powerful tool for the investigation of drug-protein interactions. This technique can be used to monitor changes in the absorption spectra of either the drug or the protein upon binding, providing information about the binding affinity and the stoichiometry of the interaction. Moreover, UV-Visible spectroscopy can be used to study the conformational changes that occur in the protein upon binding to the drug.2.3. Circular Dichroism SpectroscopyCircular dichroism spectroscopy is widely used to investigate the secondary structure of proteins and to monitor conformational changes upon ligand binding. By analyzing the changes in the CD spectra of the protein in the presence of the drug, valuable information about the structural changes induced by the binding can be obt本人ned.2.4. Nuclear Magnetic Resonance SpectroscopyNMR spectroscopy is a powerful technique for the investigation of drug-protein interactions at the atomic level. By analyzing the chemical shifts and the NOE signals of the protein in thepresence of the drug, det本人led information about the binding site and the mode of binding can be obt本人ned. Additionally, NMR can provide insights into the dynamics of the protein upon binding to the drug.3. Applications3.1. Drug DiscoverySpectroscopic studies of drug-protein interactions play a crucial role in drug discovery, providing valuable information about the binding affinity, selectivity, and mode of action of potential drug candidates. By understanding how small molecules interact with their target proteins, researchers can design more potent and specific drugs with fewer side effects.3.2. Protein EngineeringSpectroscopic techniques can also be used to study the effects of mutations and modifications on the binding affinity and specificity of proteins. By analyzing the binding of small molecules to wild-type and mutant proteins, valuable insights into the structure-function relationship of proteins can be obt本人ned.3.3. Biophysical StudiesSpectroscopic studies of drug-protein interactions are also valuable for the characterization of protein-ligandplexes, providing insights into the thermodynamics and kinetics of the binding process. Additionally, these studies can be used to investigate the effects of environmental factors, such as pH, temperature, and ionic strength, on the stability and binding affinity of theplexes.4. Challenges and Future DirectionsWhile spectroscopic techniques have greatly contributed to our understanding of drug-protein interactions, there are still challenges that need to be addressed. For instance, the study of membrane proteins and protein-protein interactions using spectroscopic techniques rem本人ns challenging due to theplexity and heterogeneity of these systems. Additionally, the development of new spectroscopic methods and the integration of spectroscopy with other biophysical andputational approaches will further advance our understanding of drug-protein interactions.In conclusion, spectroscopic studies of drug-protein interactions have greatly contributed to our understanding of how small molecules interact with proteins at the molecular level. Byproviding det本人led information about the binding affinity, mode of binding, and structural changes that occur upon binding, spectroscopic techniques have be valuable tools in drug discovery, protein engineering, and biophysical studies. As technology continues to advance, spectroscopy will play an increasingly important role in the study of drug-protein interactions, leading to the development of more effective and targeted therapeutics.。

《PlantPhysiology》双语教学教案

《Plant Physiology》（双语）教学教案任课教师：王晓峰教授单位：生命科学学院植物学系授课班级：生科丁颖班、农学丁颖班等Introduction计划学时：2 h一.教学目的了解植物生理学的对象、内容、产生和发展及发展趋势。

二.教学重点植物生理学的内容及发展趋势，植物生理学与分子生物学的关系。

三.教学难点植物生理学的发展趋势四.教学方法采用以多媒体教学法为主。

五.教学用具多媒体硬件支持。

六.教学过程●Introduction of my research work briefly (5 min)●Concept of plant physiology and main contents and chapters of this course (20 min) ●Tasks of plant physiology（20 min）Some examples: Photoperiod, Solution culture, Water culture, Senescence, Ethylene, Tissue culture, Plant growth substance, Photomorphogenesis, Etiolation.●Establishment and development of plant physiology（30 min）In ancient China and western countries→Experimentally/scientifically→J.von Liebig’s work→Modern plant physiology. Establishment and development of plant physiology in China.●Perspectives of plant physiology（10 min）Five problems of human beings : Food, Energy, Environment, Resources, Population ●Summary of the contents of introduction（5 min）Chapter 1 Water Metabolism教学章节：植物对水分的需要、植物细胞对水分的吸收、植物根系对水分的吸收、蒸腾作用、植物体内水分的运输、合理灌溉的生理基础计划学时：3 h一、教学目的通过本章学习，主要了解植物对水分吸收、运输及蒸腾作用的基本原理，认识维持植物水分平衡的重要性，为合理灌溉提供理论基础。

ECIL3_Antifungal_prophylaxis_update_2009

Antifungal prophylaxis in leukemia patients 2009 update of the ECIL-1 and 2 guidelinesObjectivesMethods1.QuestionnaireSummer 2005Do you Use Antifungal Prophylaxis?(N= 38)908070605040302010Yes Allo Auto InductionDo you Use Antifungal Prophylaxis?(N= 38)Allo Auto Induction Fluco57.157.155 Itra caps7.19.55Itra sol21.414.320 Itra iv 3.6 4.85 Vorico 3.6 4.85 Ambisome 3.6--Nystatin10.714.315 Non-abs amphoB17.919.025 AmphoB aerosol7.1--2. Literature ReviewPopulation Dose Effect RefAllogeneic 400 mg qd Proven 18 →7%Slavin 1995, Marr 2000Autologous400 mg qdUnknown Goodman 1992 (52% auto)AML w/o SCT 400 mg qdNoneSchaffner 1995400 mg qdProven/probable 24 →7%Rotstein 1999In allogeneic SCT fluconazole 400 mg qd to reduce the incidence of IFI AI In autologous SCT fluconazole 400 mg qd to reduce the incidence of IFI CIII In AML w/o SCT fluconazole 400 mg qd to reduce the incidence od IFIAIDoes Fluconazole Prophylaxis Reduce theIncidence of IFI?Reduce Attributable Mortality?Population Dose Effect RefAllogenic400 mg qd21% →13%Slavin1995, Marr2000 Autologous400 mg qd 5.6% →0.6%Goodman 1992 (52%auto)AML w/o SCT400 mg qd None Schaffner 1995400 mg qd 4.5% →0.7%Rotstein 1999In allogeneic SCT fluconazole400 mg qd to reduce attributable mortality AI In autologous SCT fluconazole400 mg qd to reduce attributable mortality AI In AML w/o SCT fluconazole400 mg qd to reduce attributable mortality CIIIReduce Overall Mortality?Population Dose Effect RefAllogeneic400 mg qd55% →28%Slavin1995, Marr2000 Autologous400 mg qd None Goodman 1992 (52%auto)AML w/o SCT400 mg qd None Schaffner 1995400 mg qd None Rotstein 1999In allogeneic SCT fluconazole400 mg qd to reduce overall mortality AI In autologous SCT fluconazole400 mg qd to reduce overall mortality CIII In AML w/o SCT fluconazole400 mg qd to reduce overall mortality CIIIPopulation Dose EffectRefAllogeneic 400 mg qd Days until empiric antifungals 18 →21Slavin 1995, Marr 2000Autologous400 mg qdUnknownGoodman 1992 (52% auto)AML w/o SCT 400 mgqdEmpiric antifungals 33% →48%Schaffner 1995400 mg qdEmpiric antifungals 50% →57%Rotstein 1999In allogeneic SCT fluconazole 400 mg qd to reduce empiric antifungals AI (?)In autologous SCT fluconazole 400 mg qd to reduce empiric antifungals CIII In AML w/o SCT fluconazole 400 mg qd to reduce empiric antifungalsEIDoes Fluconazole Prophylaxis Reduce the Use of Empirical Antifungal Therapy?Population Dose ResultRef Allogeneic Various Relapse rate 33%univariate risk factor analysis Offner 1998Autologous???AML w/o SCT VariousRelapse rate 16%multivariate risk factor analysisCornely 2003In allogeneic SCT secondary prophylaxis to reduce BT-IFI C III In autologous SCT secondary prophylaxis to reduce BT-IFI C III In AML w/o SCT secondary prophylaxis to reduce BT-IFIC IIIDoes Secondary Prophylaxis Reduce theIncidence of Breakthrough IFI?Itraconazole: meta-analysisN Os/IV IFI IAI FI-MorGotzsche& Johansen 310.510.27-0.96--Bow530.610.38-0.890.910.44-1.180.780.38-1.60Glasmacher136/20.600.43-0.890.670.41-1.100.650.43-0.98Efficacy of itraconazole correlates closely with the dose: oral solution at 400 mg/day or iv formulation at 200 mg/day (supported by in vitro studies and animal models)Menichetti Os vs. placebo Mixed~75% AL Double-blind201/205Morgenstern Os vs. fluco Mixed~1/3 auto’sOpen218/227Harousseau Os vs. amphoB Mixed~70% AL Double-blind281/276Lass-Flörl Os vs. amphoB Mixed Open52/54 Marr Itra* vs. fluco Allogeneic Tx Open151/148 Winston Itra vs. fluco Allogeneic Tx Open71/67Invasive fungalinfections Proven deep fungalOverallmortalityAttributablemortalityEmpirictherapyToxicity24 % vs33 % (0.035) 2.5 vs4.4 % (ns)7% vs9%(ns)1 vs5(ns)ns(for AL)ns10 vs13 (ns) 6 vs1 (0.06)-7 vs0(0.024)*34 vs52Itra> flucoIA: 1.8 % vs3.3 % (ns) 2.8 % vs4.7 % (ns)6 % vs8 %(ns)1 vs5ns ns1 vs4 5.7 % vs5.5 %(ns)--ns7 % vs15 % (0.03)Mold: 5 % vs12 % (0.03)(ns) -ns Itra> fluco9 % vs25 % (0.01) IA: 4 % vs12 % (ns)45 % vs42 %(ns)9 % vs18 %(ns)-Itra> flucoItraconazole for allo BMTPosaconazoleDesign and Treatment DesignPopulationsTreatmentregimenDuration oftreatmentFollow upIncidence of Proven/Probable IFIsWhile on Treatment*2%1%8%6%7/29122/28817/2883/291P = .0038P = .00132%1%8%7%7/30425/29820/2982/304P = .0009P = .0001Incidence of Proven/Probable IFIsDuring Fixed Time Period*5%2%9%7%16/30127/29921/2997/301P = .0740P = .00595%1%11%9%14/30433/29826/2984/304P = .0031P <.0001HSCT + GVHDFluconazole(AI) vs. posaconazole(AI) inAllogeneic HSCTPrimary prophylaxis with Primary prophylaxis with voriconazole voriconazole inallogeneic hematopoietic stem cell transplant recipients recipients : Two trials analyzed1-Wingard J et al. 2 –Marks D et alStudy Overview•••––––UPDATE ECIL-3 2009WingardJ et al. 2007UPDATE ECIL-3 2009Study Endpoints•––••Primary endpoint: fungal-free survival (FFS) at 180 days –•–Wingard J et al. 2007Patient CharacteristicsFLU N=295VORI N=305Age (median)43 years43 years% 18 years or above92%91% DiseaseAML101 (34%)133 (44%) ALL64 (22%)58 (19%) CML60 (20%)43 (14%) MDS49 (17%)49 (16%) NHL21 (7%)22 (7%) Disease risk status = good263 (89%)283 (93%) Donor source = related169 (57%)168 (55%)UPDATE ECIL-3 2009Wingard J et al. 2007SafetyToxicities (Grades 3Toxicities (Grades 3--5)*FLU N = 295VORI N = 305Liver 18%15%Confusion 5%6%Photopsia 0%1%Psychosis 4%2%Renal 11%9%Hypoxia22%18%UPDATE ECIL-3 2009Wingard J et al. 2007Fungal-free SurvivalFluconazole (N=295) 75% at 180 Days Voriconazole (N=305) 78% at 180 DaysII II I I I II I I I I II I II I I III I III I I I II I I II I I I I I IIII II I II I I I I I I I I II I II I I I II I I I II I I I I I I I I p=0.72UPDATE ECIL-3 2009Wingard J et al. 2007Microbiologically Documented Proven/Probable Fungal Infections Through Day 180Fungal Genus FLU VORI •Aspergillus*16*7*•Candida33•Zygomycetes32•Other11Totals**23**13***p = 0.05** p = 0.11Wingard J et al. 2007Voriconazole(VOR) versus itraconazole(ITR) for primary prophylaxis of invasive fungal infections in allogeneic HSCT recipients Marks et al. ICAAC 2009, San Francisco, M-1249aMarks D et al. 2009UPDATE ECIL-3 2009 Antifungal prophylaxis in allogeneic SCTProposed changes onlyNeutropenia w/o GvHDFluconazole* 400 mg/d AIPosaconazole No data Voriconazole200 mg bid Provisional AI GvHD> grade IFluconazole400 mg/d CIPosaconazole200 mg tid AIVoriconazole200 mg bid Provisional AIEchinocandinsVan Burik J et al. Clin Infect Dis 2004Few patients, not exclusively high-riskpatients, few proven FIUPDATE ECIL-2 2007 Caspofungin versus itraconazole in patients with hematologic malignanciesMattiuzzi et al. AAC 2006; 50: 14355 (52%)44(51%)7 (6%) 5 (6%)40 (37%)29 (34%)Insufficient data to propose recommendationdue to design and statisticsOral and IV PolyenesLiposomal amphotericin B in BMTrecipientsFalagas& Vardakas, Am J Hematol2006Low-dose liposomal amphotericin B in prolonged neutropeniaPenack et al. Ann Oncol2006; 17: 13065 (4.6%)22 (20.2%)5/75 (6.7%)20/57 (35%)6282464210Aerosolized Aerosolized amphotericin amphotericin BSchwartz et al. Blood 1999; 93: 3654-3661Rijnders et al. Clin Infect Dis 2008; 46: 1401-8UPDATE ECIL-3 2009Liposomal AmB Placebon=139n=132Aerosolized liposomal amphotericin B plus fluconazole during prolonged neutropeniaRijnders et al. Clin Infect Dis 2008; 46: 1401-8ResultsRijnders et al. Clin Infect Dis2008; 46: 1401-8ResultsFluconazole(dose?) was given to all patientsDiscontinuation of inhalation therapy for at least one weekReasons for discontinuationRijnders et al. Clin Infect Dis2008; 46: 1401-8Aerosolized liposomal amphotericin B plus fluconazole during prolonged neutropenia•ECIL-3 recommendationPrimary antifungal Prophylaxis in Cancer Patients: Fluco v. Drug with Anti-mold Activity: Meta-analysisAnti--mould Relative Outcome Fluconazole Antirisk*Robenshtok et al. J Clin Oncol2007; 25 (34)Inclusion criteria should provide a high enough incidence of IFI (> 10%?) to warrant PAC•Double-blind•Study end points–Incidence of proven and probable invasive yeast and mould infections(EORTC/MSG criteria): requires adherence to diagnostic protocol–Overall mortality and fungus-attributable mortality–(superficial and mucosal infections)–Toxicity–Colonization and resistanceIncrease of microbial shift and induction of resistance during antifungal prophylaxis!These findings may reflect, at least, partly,antifungal selection pressure caused byantifungals in high-risk patientsAzole resistant yeasts in patients receivingantifungal prophylaxisMain results ReferencesPeriod NopatientsMarr 2002 1994-1997655FLU increased colonisations with non albicans species (53%) mostly C. glabrataand C krusei, 5.3% of C. albicans were FLU resistant1988-1992474FLU-prophylaxis was directly associated with fungemia by C. krusei(OR=27.07)Abi-Said 1997and C. glabrata(5.08)1993253No increase in infections and colonisation in patients receiving FLU Winston 19931994-1995300No significant increase in breakthrough infections Slavin19951989-1990463Significant increase in C. krusei infections and colonisation by C. krusei(41%) Wingard19911989-1996234 C. krusei fungemia increased significantly (doubled from 5-to 10%) in patientsAbbas2000with FLU1994-1995274Colonisation by non C. albicans increased in both study arms, FLU and placebo Laverdiere20001991365No differences were found between the study groups Goodman 19921996-1999395Increased infection with C glabrata and C krusei were observed Martino 2002Martino 19941999-2001304No difference in the incidence of IFI during the study period (FLU 16%, vs ITRA13%)1999-2000882Breakthrough infections for MICA and FLU were 1.6% and 2.4%. C. glabrataVan Burik2004colonisation in the FLU and C. albicans in the MICA-arm increasedsignificantlyDrug monitoring of itraconazoleConclusions : Drug monitoringrecommended for oral formulationfrequency not well defined, probablyweeklyDuration of antifungal prophylaxisN (%)Drug Duration15 (50)Flu 400mg q.d.Neutrophil count ≥500/µl6 (19)Flu 100-200mg q.d.End of immunesuppression4 (12)Itra200 mg b.i.d.d 30 (1)end of immunesuppression(3)4 (12)Amph Bconv. 0,5 mg/kg q.d. (1) lipid 1-3mg/kg q.d. (3)Neutrophil count ≥500/µl => Flu till end ofimmunesuppression2 (6)No prophylaxis3. Evidence-Based RecommendationsUPDATE ECIL-3 2009: Summary slide Primary antifungal prophylaxis in leukemia patients •Induction chemotherapy of acute leukemia。

无导线起搏与传统起搏对三尖瓣反流短期影响的对比研究

㊃心脏电生理学专题㊃无导线起搏与传统起搏对三尖瓣反流短期影响的对比研究郭雨龙㊀付明鹏㊀刘晨㊀乔宇㊀郭金锐㊀刘可㊀郭涛650102昆明,云南省阜外心血管病医院心律失常中心通信作者:郭雨龙,电子信箱:kktury8859@DOI:10.3969/j.issn.1007-5410.2023.04.004㊀㊀ʌ摘要ɔ㊀目的㊀比较无导线起搏与传统起搏患者的短期三尖瓣反流变化情况,并分析三尖瓣反流的相关因素㊂㊀方法㊀回顾性纳入2020年1月至2022年11月在云南省阜外心血管病医院就诊的新植入起搏器94例患者,分为无导线起搏组(47例)和传统起搏组(47例),通过经胸超声心动图评估术前㊁术后6月内的三尖瓣反流程度及恶化情况,比较两组三尖瓣反流恶化的发生率㊂Logistic回归分析发生三尖瓣反流的相关因素㊂㊀结果㊀发生三尖瓣反流恶化者共29例(30.9%),无导线起搏组和传统起搏组的发生风险相似(14例比15例,29.8%比31.9%),差异无统计学意义(χ2=0.050,P=0.823)㊂二元logistic回归分析结果显示,单腔起搏器是发生三尖瓣中㊁大量反流的独立影响因素(χ2=10.031,P=0.010)㊂㊀结论㊀与传统起搏器相比,无导线起搏器可能并不减少术后短期发生三尖瓣反流的风险㊂ʌ关键词ɔ㊀无导线起搏;㊀心脏起搏;㊀三尖瓣反流;㊀三尖瓣瓣下复合体基金项目:云南省临床医学中心项目;云南省卫生健康委员会医学后备人才培养计划(H-2018037);云南省阜外心血管病医院院级科研基金项目(2019YFKT-04)Comparison of the short-term effects of leadless pacing and traditional pacing on tricuspidregurgitation㊀Guo Yulong,Fu Mingpeng,Liu Chen,Qiao Yu,Guo Jinrui,Liu Ke,Guo TaoDepartment of Arrhythmia,Fuwai Yunnan Cardiovascular Hospital,Kunming650102,ChinaCorresponding author:Guo Yulong,Email:kktury8859@.ʌAbstractɔ㊀Objective㊀To compare the short-term risk of tricuspid regurgitation in patients treatedwith leadless pacemaker or traditional pacemaker,and to determine its related factors.㊀Methods㊀A totalof94patients who were newly implanted leadless or traditional pacemakers in Fuwai Yunnan CardiovascularHospital from January2020to November2022were retrospectively enrolled.All were divided into theleadless pacemaker group(n=47)and the tranditional pacemaker group(n=47).The transthoracic echocardiography was used to evaluate the severity and deterioration of tricuspid regurgitation before and6months after operation.Logistic regression analyses was used to assess its related factors.㊀Results㊀A totalof29(30.9%)patients had tricuspid regurgitation deterioration.There was no significant difference in therisk of tricuspid regurgitation deterioration between the leadless and tranditional pacemaker groups(14casesvs.15cases,29.8%vs.31.9%,χ2=0.050,P=0.823).Binary logistic regression analyses resultindicated that single-chamber pacemaker was an independent factor of moderate to massive tricuspid regurgitation(χ2=10.031,P=0.010).㊀Conclusions㊀Compared with traditional pacemaker,leadless pacemaker probably cannot reduce the short-term risk of tricuspid regurgitation after operation.ʌKey wordsɔ㊀Leadless pacemaker;㊀Cardiac pacing;㊀Tricuspid regurgitation;㊀Tricuspid subvalvular apparatusFund program:Yunnan Provincial Clinical Medical Center Project;Yunnan Provincial Health Commission Medical Reserve Talent Training Plan(H-2018037);Yunnan Fuwai Cardiovascular DiseaseHospital Hospital-Level Research Fund Project(2019YFKT-04)㊀㊀心脏起搏是严重心动过缓最有效的治疗方式㊂传统心脏起搏器由脉冲发生器及相连接的电极导线构成,电极导线一般通过上腔静脉途径植入心腔内,右心室起搏电极导线跨过三尖瓣进入右室内固定㊂但是在以机械机制为主的多种机制介导下,传统心脏起搏会有加重恶化三尖瓣反流风险㊂无导线起搏是近年来最新的心脏起搏技术,与传统起搏器不同,无导线起搏器体积仅有胶囊大小,可通过特殊的输送装置,经下腔静脉途径植入右心室内,植入成功后输送装置可完全撤除,具有创伤小㊁恢复快,以及避免了囊袋并发症等特点㊂其心腔内留存的无导线起搏器仅在右心室内,不会遗留跨三尖瓣的电极导线㊂但是,无导线起搏对患者三尖瓣反流影响的临床研究数据较少,且尚无直接比较无导线起搏与传统起搏的报道㊂因此,我们通过纳入无导线起搏与匹配的传统起搏患者,在术前与术后短期通过经胸超声心动图评估三尖瓣反流情况,比较两组之间三尖瓣反流恶化的发生率,以此评估无导线起搏对三尖瓣反流的影响,希望能为无导线起搏的进一步推广应用提供有价值的临床信息㊂1㊀对象和方法1.1㊀研究对象回顾性队列研究㊂纳入2020年1月至2022年11月在云南省阜外心血管病医院新植入起搏器患者,分为无导线起搏组和传统起搏组㊂纳入标准: (1)无导线起搏组符合无导线起搏适应证,且成功完成无导线起搏器植入手术者;(2)传统起搏组按照年龄㊁性别进行1ʒ1匹配,纳入同期就诊的符合传统起搏适应证且成功完成植入者㊂排除标准: (1)因传统起搏感染㊁电极故障或电池耗竭而转用无导线起搏者;(2)仅植入心房电极单腔起搏器者;(3)原有起搏器更换或升级者㊂本研究符合医学研究伦理学要求(编号:2022-94)㊂所有患者均知情同意㊂1.2㊀方法1.2.1㊀无导线起搏器植入手术㊀采用美敦力无导线起搏器(型号Micra TM MC1VR01或Micra TM AV MC1AVR1),所有操作均在导管室血管造影机透视指导下完成㊂穿刺右股静脉,置入导引钢丝,逐级扩张;若右股静脉穿刺或置入导丝不顺则换用左股静脉,沿导引钢丝置入输送装置,应用输送装置将无导线起搏器送至右心室内;多体位投照(至少三个体位:右前斜30ʎ㊁左前斜45ʎ及正位)确认跨过三尖瓣到达右心室中下间隔部,造影确认与心肌贴靠情况满意后,施加一定压力推送输送系统,并释放无导线起搏器,稍微回退输送鞘管,通过牵拉试验证实无导线起搏器头端勾挂满意,且测试阈值㊁阻抗㊁感知等参数满意后方可剪断拉绳;若不满意,则回收后重新定位释放㊂整个手术过程中,静脉推注3000U肝素,输送鞘管持续肝素盐水冲洗,最后撤除输送装置㊁缝合伤口,最后加压包扎㊂1.2.2㊀传统起搏器植入手术㊀采用传统起搏器,所有操作均在导管室血管造影机透视指导下完成㊂穿刺左锁骨下静脉或腋静脉,置入导引钢丝,若穿刺或置入导丝不顺则改为右侧植入,沿锁骨下做4~ 5cm皮肤切口,逐层分离至深筋膜层,制作合适大小的皮下囊袋,应用可撕开鞘管置入起搏电极,右房电极定位固定至右心耳,右室电极定位固定至右室间隔部或心尖部(均使用主动固定电极),测试阈值㊁阻抗㊁感知等参数满意后,拔除可撕开鞘管,电极尾端连接脉冲发生器并埋置于囊袋内,充分止血㊁冲洗后逐层缝合,最后加压包扎㊂1.3㊀观察指标和随访所有患者在植入术前1周内及术后6个月内完成经胸超声心动图对三尖瓣反流情况进行评估㊂使用GE或飞利浦超声探头,在彩色血流多普勒下测量三尖瓣反流束面积与右心房面积比和(或)缩流颈宽度综合评估三尖瓣反流情况的变化㊂其中,面积比<10%为微量反流,10%~20%为少量或轻度反流,21%~40%为中量或中度反流,>40%为大量或重度反流;缩流颈宽度<3mm为少量或轻度反流,缩流颈宽度3~7mm为中量或中度反流,缩流颈宽度>7mm为大量或重度反流㊂此外,三尖瓣反流恶化定义为与术前相比,术后面积比增加超过5%和(或)缩流颈宽度增加超过1mm㊂1.4㊀统计学方法应用SPSS20.0软件进行统计分析㊂符合正态分布的计量资料用 xʃs表示,组间比较采用独立样本t检验;计数资料用百分构成比表示,组间比较采用χ2检验㊂Logistic回归分析影响术后新增三尖瓣中㊁大量反流的相关因素㊂P<0.05为差异有统计学意义㊂2㊀结果2.1㊀两组的基线临床资料比较如表1所示,两组的诊断差异有统计学意义,表现为无导线起搏组诊断为ȡⅡ度房室传导阻滞的比例显著低于传统起搏组,而诊断为心房颤动伴RR长间歇的比例显著高于传统起搏组(P= 0.005)㊂其余基线临床资料相似,差异均无统计学意义(均为P>0.05)㊂2.2㊀两组的起搏器植入术后即刻右室电极参数比较无导线起搏组中,38例(80.9%)使用Micra TM表1㊀两组的基线临床资料比较项目总体(94例)无导线起搏组(47例)传统起搏组(47例)t/χ2值P值年龄( xʃs,岁)78.9ʃ9.979.3ʃ9.978.4ʃ10.00.4390.688男性[例(%)]56(59.6)28(59.6)28(59.6)0.000 1.000诊断[例(%)]10.7810.005㊀窦房结功能障碍38(40.4)19(40.4)19(40.4)㊀ȡⅡ度房室传导阻滞34(36.2)11(23.4)23(48.9)㊀心房颤动伴RR长间歇22(23.4)17(36.2)5(10.6)心功能指标( xʃs)㊀左室射血分数(%)62.0ʃ7.262.7ʃ6.261.2ʃ8.10.9900.325㊀左室舒张末期内径(mm)46.6ʃ6.646.4ʃ6.846.9ʃ6.50.2950.769表2㊀两组起搏器植入术后即刻右室电极参数比较( xʃs)项目总体(94例)无导线起搏组(47例)传统起搏组(47例)t值P值右室电极阻抗(Ω)797.8ʃ214.0819.6ʃ196.8775.9ʃ230.00.9880.326右室电极阈值(V@0.4ms)0.70ʃ0.420.70ʃ0.490.71ʃ0.340.1310.896 R波感知振幅(mV)9.96ʃ4.759.28ʃ4.4010.64ʃ5.02 1.3980.166表3㊀两组术前和术后的三尖瓣反流情况比较[例(%)]项目总体(94例)无导线起搏组(47例)传统起搏组(47例)χ2值P值术前三尖瓣反流14.7960.002㊀无或微量32(34.0)10(21.3)22(46.8) 6.8230.009㊀少量/轻度43(45.7)21(44.7)22(46.8)0.0430.836㊀中量/中度11(11.7)8(17.0)3(6.4) 2.5740.109㊀大量/重度8(8.5)8(17.0)0(0.0)8.7440.003术后三尖瓣反流14.1480.003㊀无或微量28(29.8)7(14.9)21(44.7)9.9700.002㊀少量/轻度35(37.2)18(38.3)17(36.2)0.0460.831㊀中量/中度18(19.1)11(23.4)7(14.9) 1.0990.294㊀大量/重度13(13.8)11(23.4)2(4.3)7.2310.007MC1VR01(起搏模式VVI),9例(19.1%)使用Micra TM AV MC1AVR1(起搏模式VDD),所有无导线起搏器均位于右室中低位间隔部㊂传统起搏组中,9例(19.1%)使用单腔起搏器(模式VVI),38例(80.9%)使用双腔起搏器(模式DDD);右室电极导线在心尖部3例(6.4%),在间隔部44例(93.6%)㊂如表2所示,两组起搏器植入术后右室电极的即刻参数均相似,差异无统计学意义(均为P>0.05)㊂2.3㊀两组术前和术后的三尖瓣反流情况比较如表3所示,两组术前的三尖瓣反流情况差异有统计学意义(P=0.002),表现为无导线起搏组的无或微量三尖瓣反流率明显低于传统起搏组(P= 0.009),而大量/重度三尖瓣反流率明显高于传统起搏组(P=0.003)㊂两组术后的三尖瓣反流情况差异也有统计学意义(P=0.003),表现为无导线起搏组的无或微量三尖瓣反流率明显低于传统起搏组(P=0.002),而大量/重度三尖瓣反流率明显高于传统起搏组(P=0.007)㊂与术前比较,术后新增的有临床意义的三尖瓣中大量反流有12例,其中无导线起搏组6例(12.8%),传统起搏组6例(12.8%),组间比较差异无统计学意义(χ2=0.000,P=1.000)(图1)㊂三尖瓣反流恶化者共29例(30.9%),其中无导线起搏组14例(29.8%),传统起搏组15例(31.9%),组间比较差异无统计学意义(χ2=0.050, P=0.823)(图1)㊂图1㊀两组发生三尖瓣反流情况比较2.4㊀术前三尖瓣反流程度对术后发生三尖瓣反流恶化的影响进一步研究显示,术前三尖瓣无或微少量反流者在术后出现反流恶化的比例为29.3%(22/75),而术前三尖瓣中㊁大量反流者在术后出现反流恶化的比例为36.8%(7/19),两者之间比较差异无统计学意义(χ2=0.401,P=0.527)㊂2.5㊀Logistic回归分析结果采用二元logistic回归分析(Wald后退法),分析术后新增三尖瓣中㊁大量反流的影响因素,无导线起搏组纳入因素为年龄㊁性别㊁起搏适应证诊断㊁术前左室射血分数㊁舒张末期内径及术前三尖瓣反流情况,传统起搏器纳入因素除上述外,增加右室电极位置及起搏器类型(单腔或双腔)㊂最终在无导线起搏组中未发现影响术后新增三尖瓣中㊁大量反流的有统计学意义相关因素(均为P>0.05);而在传统起搏患者中,发现起搏器类型[Exp(B)= 35.589,P=0.01]是独立影响因素,其中单腔起搏器患者术后出现新增三尖瓣中㊁大量反流的比例远高于双腔起搏器患者[4例比2例,44.4%(4/9)比5.3%(2/38),χ2=10.031,P=0.002]㊂3　讨论本研究发现,无导线起搏器与传统起搏器相比,术后短期发生三尖瓣反流恶化及新发中㊁大量三尖瓣反流的比例无统计学差异,故无导线起搏可能并不能够减少对三尖瓣反流的负面影响㊂三尖瓣反流是右心室起搏的常见并发症㊂国外研究报道术后三尖瓣反流的发生率7%~21%,三尖瓣反流恶化或加重的比例为10%~45%[1]㊂一般认为,导致或加重三尖瓣反流的机制以机械损伤为主,机械机制主要包括植入过程中起搏电极导线直接损伤瓣叶导致穿孔或撕裂㊁导线嵌顿于瓣叶之间㊁导线与瓣叶粘连或与腱索缠绕等㊂与普通电极导线相比,更粗㊁更硬的除颤电极导线导致三尖瓣反流的概率更高;此外,长期高比例右室非生理性起搏㊁慢性右心扩大及三尖瓣环扩张也是远期三尖瓣反流发生及加重的因素㊂其中,术中电极导管对三尖瓣的直接机械损伤是短期发生三尖瓣反流的主要机制㊂使用的电极越硬㊁越粗或暴力操作等均是潜在的危险因素,而慢性电极导线粘连㊁高比例右室非生理起搏及右心扩大瓣环扩张则是远期发生三尖瓣反流的主要机制[1-3]㊂国内关于三尖瓣反流的报道的例数较少且还有争议,赵波等[4]发现长期右室心尖部起搏仅导致轻微反流,引起有临床意义的三尖瓣反流恶化的比例更低㊂邹宝明等[5]发现无论右室心尖部还是间隔部起搏都不会在短期内明显加重三尖瓣反流㊂无导线起搏是最新的心脏起搏技术,与传统右室起搏不同,无导线起搏在植入后并不会长期遗留跨三尖瓣的电极导线,因此其对三尖瓣的影响及机制可能会不同㊂目前国外关于无导线起搏对三尖瓣反流作用的研究报道有限,而国内尚无相关报道㊂2019年Beurskens等[6]报道无导线起搏术后1年三尖瓣反流加重的比例为43%㊂2022年一项关于无导线起搏器的真实世界研究,纳入植入心房感知㊁心室起搏的无导线起搏器患者,发现中度以上的三尖瓣反流发生率为48.8%(21/43)[7]㊂因此,无导线起搏器导致或加重三尖瓣反流的风险依然存在,甚至可能比传统起搏器高㊂此项研究发现,在起搏器植入术后短期内,总体三尖瓣反流恶化发生概率为30.9%,无导线起搏组为29.8%,传统起搏组为31.9%,考虑到本研究中我们为了更早地发现短期影响效果,所定义的三尖瓣反流恶化的超声心动图指标较为敏感,远比临床症状更早出现变化,因此该比例应该会高于真实世界中有临床症状的三尖瓣反流发病率㊂我们发现两组间差异无统计学意义,可认为无导线起搏并不能够减少对三尖瓣的负面影响㊂表1中两组间的入院诊断有统计学差异,无导线起搏组的心房颤动伴RR长间歇患者比例更高,这是其最早及最强的植入适应证,很可能对结果造成一定影响㊂由表3中可看出,本研究无导线起搏组术前的中㊁大量三尖瓣反流者更多,这是由于我们在开展无导线起搏器植入术初期误以为其对三尖瓣反流的影响较小,因此在病人选择上有了偏差,而后续统计分析发现术前反流程度并未影响其术后恶化情况,故这种差异并不影响本文的主要研究结论㊂而经过本研究之后,我们对无导线起搏与三尖瓣的相互作用又有了更多认识,将进一步优化及改善今后对患者的处理决策,希望能更好改善预后㊂从表面上看,由于无导线起搏器并不会长期遗留跨瓣导线,从理论上来说慢性三尖瓣粘连及腱索缠绕的发生率可能会低于传统起搏器,似乎避免了传统起搏引发三尖瓣反流的一些机制㊂但是,无导线起搏器植入须使用更粗㊁更硬的输送装置,操作中对三尖瓣的损伤可能会大于传统起搏,发生瓣膜穿孔的风险是否增加尚无报道㊂另外,国外有学者发现,无导线起搏器植入后对三尖瓣瓣下复合体的干扰较大,瓣下复合体是个解剖概念,主要指与瓣膜㊁腱索连接的乳头肌,三尖瓣下一般有三组乳头肌,前组在右室游离壁,下组及间隔组分别在下壁及右室间隔面,下组及后组乳头肌可能表现不完全而腱索就直接连接到间隔面或心室壁[8]㊂固定于间隔面的无导线起搏器虽然无跨瓣导线,但可能会显著影响间隔侧的三尖瓣瓣下复合体功能,由此加重三尖瓣反流㊂然而,目前对于无导线起搏器与三尖瓣相互作用的认识有限,还需要进一步的研究及临床实践来明确,尤其需要心脏外科及心脏结构专业与起搏电生理专业的合作㊂本研究有一些局限性㊂本研究仅为临床观察性研究,例数较少,并非严密设计的随机对照研究,而且三尖瓣反流的可能影响因素较多,本研究也未能完全排除无导线/传统起搏选择以外的其他可能干扰因素,结论的说服力有限㊂总之,与传统起搏器相比,无导线起搏器可能并不减少术后短期发生三尖瓣反流的风险㊂利益冲突:无参㊀考㊀文㊀献[1]Addetia K,Harb SC,Hahn RT,et al.Cardiac ImplantableElectronic Device Lead-Induced Tricuspid Regurgitation[J].JACC Cardiovasc Imaging,2019,12(4):622-636.DOI:10.1016/j.jcmg.2018.09.028.[2]郑晓琳,张澍,陈珂萍.心内膜导线相关的三尖瓣反流[J].中国心脏起搏与心电生理杂志,2014,28(5):443-445.DOI:10.13333/ki.cjcpe.2014.05.018.㊀Zheng XL,Zhang S,Chen KP.Tricuspid valve regurgitationassociated with Endocardium leads[J].Chin J Card PacingElectrophysiol,2014,28(5):443-445.DOI:10.1333/ki.cjcpe.2014.05.018.[3]Kim JB,Spevack DM,Tunick PA,et al.The effect oftransvenous pacemaker and implantable cardioverter defibrillatorlead placement on tricuspid valve function:an observational study[J].J Am Soc Echocardiogr,2008,21(3):284-287.DOI:10.1016/j.echo.2007.05.022.[4]赵波,宋建平,邹操.长期右室心尖部起搏对三尖瓣反流的影响[J].中国心脏起搏与心电生理杂志,2012,26(4):315-318.DOI:10.13333/ki.cjcpe.2012.04.014.㊀Zhao B,Song JP,Zou C.Effects of long-term permanent rightventricular apical pacing on tricuspid regurgitation[J].Chin JCard Pacing Electrophysiol,2012,26(4):315-318.DOI:10.13333/ki.cjcpe.2012.04.014.[5]邹宝明,王景武,孙克陆,等.围术期右室流入道间隔部起搏对三尖瓣反流的影响[J].中华全科医学,2015,13(6):896-898.DOI:10.16766/ki.issn.1674-4152.2015.06.019.㊀Zou BM,Wang JW,Sun KL,et al.Influence of right ventricularinlet septum pacing on tricuspid regurgitation during perioperativeperiod[J].Chin J Gen Pract,2015,13(6):896-898.DOI:10.16766/ki.issn.1674-4152.2015.06.019. [6]Beurskens NEG,Tjong FVY,de Bruin-Bon RHA,et al.Impactof Leadless Pacemaker Therapy on Cardiac and AtrioventricularValve Function Through12Months of Follow-Up[J].CircArrhythm Electrophysiol,2019,12(5):e007124.DOI:10.1161/CIRCEP.118.007124.[7]Kowlgi GN,Tseng AS,Tempel ND,et al.A real-worldexperience of atrioventricular synchronous pacing with leadlessventricular pacemakers[J].J Cardiovasc Electrophysiol,2022,33(5):982-993.DOI:10.1111/jce.15430.[8]Tadic M.Multimodality Evaluation of the Right Ventricle:AnUpdated Review[J].Clin Cardiol,2015,38(12):770-776.DOI:10.1002/clc.22443.(收稿日期:2023-01-31)(本文编辑:李鹏)㊃读者㊃作者㊃编者㊃GB/T7713.2 2022‘学术论文编写规则“已于2023年7月1日实施㊀㊀2022年12月30日,国家市场监督管理总局和国家标准化管理委员会联合发布了GB/T7713.2 2022‘学术论文编写规则“,并已于2023年7月1日实施㊂无论是学术论文㊁学位论文还是科技报告,其撰写和编排都需要遵循一定的规范,以利于信息系统的收集㊁存储㊁处理㊁加工㊁检索㊁利用㊁交流㊁传播㊂GB/T7713 1987‘科学技术报告㊁学位论文和学术论文的编写格式“,对学术论文㊁学位论文和科技报告的撰写要求及编排格式作了统一规定㊂鉴于三者的使用对象及使用目的不尽相同,撰写要求及编排格式差异较大,后来修订GB/T7713时,将其分为3个部分分别进行修订㊂第1部分:学位论文编写规则㊂目的在于规定了学位论文的撰写格式和要求㊂第2部分:学术论文编写规则(简称本规则 )㊂目的在于规定了学术论文的撰写要求和编排格式㊂第3部分:科技报告编写规则㊂目的在于规定了科技报告的编写㊁组织㊁编排等要求㊂本规则描述了撰写和编排学术论文的基本要求和格式规范㊂学术论文编写的标准化和规范化,是使其格式和体例规范化,语言㊁文字和符号规范化,技术和计量单位标准化,以便于学术论文的检索和传播,促进学术成果的交流和使用㊂本规则的适用范围,包括一切反映自然㊁社会和人文等的科学体系的学术论文㊂然而,由于学科门类㊁选定课题㊁研究工作方法㊁工作进行阶段㊁观测和调查等各方面的差异,采用本规则进行学术论文编写宜采取严肃性和灵活性相结合的原则㊂本规则对GB/T7713 1987中的学术论文编写内容进行了必要的检查㊁更新,进而形成单独的学术论文编写规则,代替GB/T7713 1987中的学术论文编写格式部分㊂现可登录国家标准化管理委员会网站或通过以下网址/bzgk/gb/showGb?type=online&hcno= 0B963916637B8F34B295FCF4A51A1BE5查询本规则全文㊂。

Peters (2010) Episodic Future Thinking Reduces Reward Delay Discounting

NeuronArticleEpisodic Future Thinking ReducesReward Delay Discounting through an Enhancement of Prefrontal-Mediotemporal InteractionsJan Peters1,*and Christian Bu¨chel11NeuroimageNord,Department of Systems Neuroscience,University Medical Center Hamburg-Eppendorf,Hamburg20246,Germany*Correspondence:j.peters@uke.uni-hamburg.deDOI10.1016/j.neuron.2010.03.026SUMMARYHumans discount the value of future rewards over time.Here we show using functional magnetic reso-nance imaging(fMRI)and neural coupling analyses that episodic future thinking reduces the rate of delay discounting through a modulation of neural decision-making and episodic future thinking networks.In addition to a standard control condition,real subject-speciﬁc episodic event cues were presented during a delay discounting task.Spontaneous episodic imagery during cue processing predicted how much subjects changed their preferences toward more future-minded choice behavior.Neural valuation signals in the anterior cingulate cortex and functional coupling of this region with hippo-campus and amygdala predicted the degree to which future thinking modulated individual preference functions.A second experiment replicated the behavioral effects and ruled out alternative explana-tions such as date-based processing and temporal focus.The present data reveal a mechanism through which neural decision-making and prospection networks can interact to generate future-minded choice behavior.INTRODUCTIONThe consequences of choices are often delayed in time,and in many cases it pays off to wait.While agents normally prefer larger over smaller rewards,this situation changes when rewards are associated with costs,such as delays,uncertainties,or effort requirements.Agents integrate such costs into a value function in an individual manner.In the hyperbolic model of delay dis-counting(also referred to as intertemporal choice),for example, a subject-speciﬁc discount parameter accurately describes how individuals discount delayed rewards in value(Green and Myer-son,2004;Mazur,1987).Although the degree of delay discount-ing varies considerably between individuals,humans in general have a particularly pronounced ability to delay gratiﬁcation, and many of our choices only pay off after months or even years. It has been speculated that the capacity for episodic future thought(also referred to as mental time travel or prospective thinking)(Bar,2009;Schacter et al.,2007;Szpunar et al.,2007) may underlie the human ability to make choices with high long-term beneﬁts(Boyer,2008),yielding higher evolutionaryﬁtness of our species.At the neural level,a number of models have been proposed for intertemporal decision-making in humans.In the so-called b-d model(McClure et al.,2004,2007),a limbic system(b)is thought to place special weight on immediate rewards,whereas a more cognitive,prefrontal-cortex-based system(d)is more involved in patient choices.In an alternative model,the values of both immediate and delayed rewards are thought to be repre-sented in a unitary system encompassing medial prefrontal cortex(mPFC),posterior cingulate cortex(PCC),and ventral striatum(VS)(Kable and Glimcher,2007;Kable and Glimcher, 2010;Peters and Bu¨chel,2009).Finally,in the self-control model, values are assumed to be represented in structures such as the ventromedial prefrontal cortex(vmPFC)but are subject to top-down modulation by prefrontal control regions such as the lateral PFC(Figner et al.,2010;Hare et al.,2009).Both the b-d model and the self-control model predict that reduced impulsivity in in-tertemporal choice,induced for example by episodic future thought,would involve prefrontal cortex regions implicated in cognitive control,such as the lateral PFC or the anterior cingulate cortex(ACC).Lesion studies,on the other hand,also implicated medial temporal lobe regions in decision-making and delay discounting. In rodents,damage to the basolateral amygdala(BLA)increases delay discounting(Winstanley et al.,2004),effort discounting (Floresco and Ghods-Shariﬁ,2007;Ghods-Shariﬁet al.,2009), and probability discounting(Ghods-Shariﬁet al.,2009).Interac-tions between the ACC and the BLA in particular have been proposed to regulate behavior in order to allow organisms to overcome a variety of different decision costs,including delays (Floresco and Ghods-Shariﬁ,2007).In line with theseﬁndings, impairments in decision-making are also observed in humans with damage to the ACC or amygdala(Bechara et al.,1994, 1999;Manes et al.,2002;Naccache et al.,2005).Along similar lines,hippocampal damage affects decision-making.Disadvantageous choice behavior has recently been documented in patients suffering from amnesia due to hippo-campal lesions(Gupta et al.,2009),and rats with hippocampal damage show increased delay discounting(Cheung and Cardinal,2005;Mariano et al.,2009;Rawlins et al.,1985).These observations are of particular interest given that hippocampal138Neuron66,138–148,April15,2010ª2010Elsevier Inc.damage impairs the ability to imagine novel experiences (Hassa-bis et al.,2007).Based on this and a range of other studies,it has recently been proposed that hippocampus and parahippocam-pal cortex play a crucial role in the formation of vivid event repre-sentations,regardless of whether they lie in the past,present,or future (Schacter and Addis,2009).The hippocampus may thus contribute to decision-making through its role in self-projection into the future (Bar,2009;Schacter et al.,2007),allowing an organism to evaluate future payoffs through mental simulation (Johnson and Redish,2007;Johnson et al.,2007).Future thinking may thus affect intertemporal choice through hippo-campal involvement.Here we used model-based fMRI,analyses of functional coupling,and extensive behavioral procedures to investigate how episodic future thinking affects delay discounting.In Exper-iment 1,subjects performed a classical delay discounting task(Kable and Glimcher,2007;Peters and Bu¨chel,2009)that involved a series of choices between smaller immediate and larger delayed rewards,while brain activity was measured using fMRI.Critically,we introduced a novel episodic condition that involved the presentation of episodic cue words (tags )obtained during an extensive prescan interview,referring to real,subject-speciﬁc future events planned for the respective day of reward delivery.This design allowed us to assess individual discount rates separately for the two experimental conditions,allowing us to investigate neural mechanisms mediating changes in delay discounting associated with episodic thinking.In a second behavioral study,we replicated the behavioral effects of Exper-iment 1and addressed a number of alternative explanations for the observed effects of episodic tags on discount rates.RESULTSExperiment 1:Prescan InterviewOn day 1,healthy young volunteers (n =30,mean age =25,15male)completed a computer-based delay discounting proce-dure to estimate their individual discount rate (Peters and Bu ¨-chel,2009).This discount rate was used solely for the purpose of constructing subject-speciﬁc trials for the fMRI session (see Experimental Procedures ).Furthermore,participants compiled a list of events that they had planned in the next 7months (e.g.,vacations,weddings,parties,courses,and so forth)andrated them on scales from 1to 6with respect to personal rele-vance,arousal,and valence.For each participant,seven subject-speciﬁc events were selected such that the spacing between events increased with increasing delay to the episode,and that events were roughly matched based on personal rele-vance,arousal,and valence.Multiple regression analysis of these ratings across the different delays showed no linear effects (relevance:p =0.867,arousal:p =0.120,valence:p =0.977,see Figure S1available online).For each subject,a separate set of seven delays was computed that was later used as delays in the control condition.Median and range for the delays used in each condition are listed in Table S1(available online).For each event,a label was selected that would serve as a verbal tag for the fMRI session.Experiment 1:fMRI Behavioral ResultsOn day 2,volunteers performed two sessions of a delay dis-counting procedure while fMRI was measured using a 3T Siemens Scanner with a 32-channel head-coil.In each session,subjects made a total of 118choices between 20V available immediately and larger but delayed amounts.Subjects were told that one of their choices would be randomly selected and paid out following scanning,with the respective delay.Critically,in half the trials,an additional subject-speciﬁc episodic tag (see above,e.g.,‘‘vacation paris’’or ‘‘birthday john’’)was displayed based on the prescan interview (see Figure 1)indicating which event they had planned on the particular day (episodic condi-tion),whereas in the remaining trials,no episodic tag was pre-sented (control condition).Amount and waiting time were thus displayed in both conditions,but only the episodic condition involved the presentation of an additional subject-speciﬁc event tag.Importantly,nonoverlapping sets of delays were used in the two conditions.Following scanning,subjects rated for each episodic tag how often it evoked episodic associations during scanning (frequency of associations:1,never;to 6,always)and how vivid these associations were (vividness of associa-tions:1,not vivid at all;to 6,highly vivid;see Figure S1).Addition-ally,written reports were obtained (see Supplemental Informa-tion ).Multiple regression revealed no signiﬁcant linear effects of delay on postscan ratings (frequency:p =0.224,vividness:p =0.770).We averaged the postscan ratings acrosseventsFigure 1.Behavioral TaskDuring fMRI,subjects made repeated choices between a ﬁxed immediate reward of 20V and larger but delayed amounts.In the control condi-tion,amounts were paired with a waiting time only,whereas in the episodic condition,amounts were paired with a waiting time and a subject-speciﬁc verbal episodic tag indicating to the subjects which event they had planned at the respective day of reward delivery.Events were real and collected in a separate testing session prior to the day of scanning.NeuronEpisodic Modulation of Delay DiscountingNeuron 66,138–148,April 15,2010ª2010Elsevier Inc.139and the frequency/vividness dimensions,yielding an‘‘imagery score’’for each subject.Individual participants’choice data from the fMRI session were then analyzed byﬁtting hyperbolic discount functions to subject-speciﬁc indifference points to obtain discount rates (k-parameters),separately for the episodic and control condi-tions(see Experimental Procedures).Subjective preferences were well-characterized by hyperbolic functions(median R2 episodic condition=0.81,control condition=0.85).Discount functions of four exemplary subjects are shown in Figure2A. For both conditions,considerable variability in the discount rate was observed(median[range]of discount rates:control condition=0.014[0.003–0.19],episodic condition=0.013 [0.002–0.18]).To account for the skewed distribution of discount rates,all further analyses were conducted on the log-trans-formed k-parameters.Across subjects,log-transformed discount rates were signiﬁcantly lower in the episodic condition compared with the control condition(t(29)=2.27,p=0.016),indi-cating that participants’choice behavior was less impulsive in the episodic condition.The difference in log-discount rates between conditions is henceforth referred to as the episodic tag effect.Fitting hyperbolic functions to the median indifference points across subjects also showed reduced discounting in the episodic condition(discount rate control condition=0.0099, episodic condition=0.0077).The size of the tag effect was not related to the discount rate in the control condition(p=0.56). We next hypothesized that the tag effect would be positively correlated with postscan ratings of episodic thought(imagery scores,see above).Robust regression revealed an increase in the size of the tag effect with increasing imagery scores (t=2.08,p=0.023,see Figure2B),suggesting that the effect of the tags on preferences was stronger the more vividly subjects imagined the episodes.Examples of written postscan reports are provided in the Supplemental Results for participants from the entire range of imagination ratings.We also correlated the tag effect with standard neuropsychological measures,the Sensation Seeking Scale(SSS)V(Beauducel et al.,2003;Zuck-erman,1996)and the Behavioral Inhibition Scale/Behavioral Approach Scale(BIS/BAS)(Carver and White,1994).The tag effect was positively correlated with the experience-seeking subscale of the SSS(p=0.026)and inversely correlated with the reward-responsiveness subscale of the BIS/BAS scales (p<0.005).Repeated-measures ANOVA of reaction times(RTs)as a func-tion of option value(lower,similar,or higher relative to the refer-ence option;see Experimental Procedures and Figure2C)did not show a main effect of condition(p=0.712)or a condition 3value interaction(p=0.220),but revealed a main effect of value(F(1.8,53.9)=16.740,p<0.001).Post hoc comparisons revealed faster RTs for higher-valued options relative to similarly (p=0.002)or lower valued options(p<0.001)but no difference between lower and similarly valued options(p=0.081).FMRI DataFMRI data were modeled using the general linear model(GLM) as implemented in SPM5.Subjective value of each decision option was calculated by multiplying the objective amount of each delayed reward with the discount fraction estimated behaviorally based on the choices during scanning,and included as a parametric regressor in the GLM.Note that discount rates were estimated separately for the control and episodic conditions(see above and Figure2),and we thus used condition-speciﬁc k-parameters for calculation of the subjective value regressor.Additional parametric regressors for inverse delay-to-reward and absolute reward magnitude, orthogonalized with respect to subjective value,were included in theGLM.Figure2.Behavioral Data from Experiment1Shown are experimentally derived discount func-tions from the fMRI session for four exemplaryparticipants(A),correlation with imagery scores(B),and reaction times(RTs)(C).(A)Hyperbolicfunctions wereﬁt to the indifference points sepa-rately for the control(dashed lines)and episodic(solid lines,ﬁlled circles)conditions,and thebest-ﬁtting k-parameters(discount rates)and R2values are shown for each subject.The log-trans-formed difference between discount rates wastaken as a measure of the effect of the episodictags on choice preferences.(B)Robust regressionrevealed an association between log-differences indiscount rates and imagery scores obtained frompostscan ratings(see text).(C)RTs were signiﬁ-cantly modulated by option value(main effectvalue p<0.001)with faster responses in trialswith a value of the delayed reward higher thanthe20V reference amount.Note that althoughseven delays were used for each condition,somedata points are missing,e.g.,onlyﬁve delay indif-ference points for the episodic condition areplotted for sub20.This indicates that,for the twolongest delays,this subject never chose the de-layed reward.***p<0.005.Error bars=SEM.Neuron Episodic Modulation of Delay Discounting140Neuron66,138–148,April15,2010ª2010Elsevier Inc.Episodic Tags Activate the Future Thinking NetworkWe ﬁrst analyzed differences in the condition regressors without parametric pared to those of the control condi-tion,BOLD responses to the presentation of the delayed reward in the episodic condition yielded highly signiﬁcant activations (corrected for whole-brain volume)in an extensive network of brain regions previously implicated in episodic future thinking (Addis et al.,2007;Schacter et al.,2007;Szpunar et al.,2007)(see Figure 3and Table S2),including retrosplenial cortex (RSC)/PCC (peak MNI coordinates:À6,À54,14,peak z value =6.26),left lateral parietal cortex (LPC,À44,À66,32,z value =5.35),and vmPFC (À8,34,À12,z value =5.50).Distributed Neural Coding of Subjective ValueWe then replicated previous ﬁndings (Kable and Glimcher,2007;Kable and Glimcher,2010;Peters and Bu¨chel,2009)using a conjunction analysis (Nichols et al.,2005)searching for regions showing a positive correlation between the height of the BOLD response and subjective value in the control and episodic condi-tions in a parametric analysis (Figure 4A and Table S3).Note that this is a conservative analysis that requires that a given voxel exceed the statistical threshold in both contrasts separately.This analysis revealed clusters in the lateral orbitofrontal cortex (OFC,À36,50,À10,z value =4.50)and central OFC (À18,12,À14,z value =4.05),bilateral VS (right:10,8,0,z value =4.22;left:À10,8,À6,z value =3.51),mPFC (6,26,16,z value =3.72),and PCC (À2,À28,24,z value =4.09),representing subjective (discounted)value in both conditions.We next analyzed the neural tag effect,i.e.,regions in which the subjective value correlation was greater for the episodic condi-tion as compared with the control condition (Figure 4B and Table S4).This analysis revealed clusters in the left LPC (À66,À42,32,z value =4.96,),ACC (À2,16,36,z value =4.76),left dorsolateral prefrontal cortex (DLPFC,À38,36,36,z value =4.81),and right amygdala (24,2,À24,z value =3.75).Finally,we performed a triple-conjunction analysis,testing for regions that were correlated with subjective value in both conditions,but in which the value correlation increased in the episodic condition.Only left LPC showed this pattern (À66,À42,30,z value =3.55,see Figure 4C and Table S5),the same region that we previously identiﬁed as delay-speciﬁc in valuation (Petersand Bu¨chel,2009).There were no regions in which the subjective value correlation was greater in the control condition when compared with the episodic condition at p <0.001uncorrected.ACC Valuation Signals and Functional Connectivity Predict Interindividual Differences in Discount Function ShiftsWe next correlated differences in the neural tag effect with inter-individual differences in the size of the behavioral tag effect.To this end,we performed a simple regression analysis in SPM5on the single-subject contrast images of the neural tag effect (i.e.,subjective value correlation episodic >control)using the behavioral tag effect [log(k control )–log(k episodic )]as an explana-tory variable.This analysis revealed clusters in the bilateral ACC (right:18,34,18,z value =3.95,p =0.021corrected,left:À20,34,20,z value =3.52,Figure 5,see Table S6for a complete list).Coronal sections (Figure 5C)clearly show that both ACC clusters are located in gray matter of the cingulate sulcus.Because ACC-limbic interactions have previously been impli-cated in the control of choice behavior (Floresco and Ghods-Shariﬁ,2007;Roiser et al.,2009),we next analyzed functional coupling with the right ACC from the above regression contrast (coordinates 18,34,18,see Figure 6A)using a psychophysiolog-ical interaction analysis (PPI)(Friston et al.,1997).Note that this analysis was conducted on a separate ﬁrst-level GLM in which control and episodic trials were modeled as 10s miniblocks (see Experimental Procedures for details).We ﬁrst identiﬁed regions in which coupling with the ACC changed in the episodic condition compared with the control condition (see Table S7)and then performed a simple regression analysis on these coupling parameters using the behavioral tag effect as an explanatory variable.The tag effect was associated with increased coupling between ACC and hippocampus (À32,À18,À16,z value =3.18,p =0.031corrected,Figure 6B)and ACC and left amygdala (À26,À4,À26,z value =2.95,p =0.051corrected,Figure 6B,see Table S8for a complete list of activa-tions).The same regression analysis in a second PPI with the seed voxel placed in the contralateral ACC region from the same regression contrast (À20,34,22,see above)yielded qual-itatively similar,though subthreshold,results in these same structures (hippocampus:À28,À32,À6,z value =1.96,amyg-dala:À28,À6,À16,z value =1.97).Experiment 2We conducted an additional behavioral experiment to address a number of alternative explanations for the observed effects of tags on choice behavior.First,it could be argued thatepisodicFigure 3.Categorical Effect of Episodic Tags on Brain ActivityGreater activity in lateral parietal cortex (left)and posterior cingulate/retrosplenial and ventro-medial prefrontal cortex (right)was observed in the episodic condition compared with the control condition.p <0.05,FWE-corrected for whole-brain volume.NeuronEpisodic Modulation of Delay DiscountingNeuron 66,138–148,April 15,2010ª2010Elsevier Inc.141tags increase subjective certainty that a reward would be forth-coming.In Experiment 2,we therefore collected postscan ratings of reward conﬁdence.Second,it could be argued that events,always being associated with a particular date,may have shifted temporal focus from delay-based to more date-based processing.This would represent a potential confound,because date-associated rewards are discounted less than delay-associated rewards (Read et al.,2005).We therefore now collected postscan ratings of temporal focus (date-based versus delay-based).Finally,Experiment 1left open the question of whether the tag effect depends on the temporal speciﬁcity of the episodic cues.We therefore introduced an additional exper-imental condition that involved the presentation of subject-speciﬁc temporally unspeciﬁc future event cues.These tags (henceforth referred to as unspeciﬁc tags)were obtained by asking subjects to imagine events that could realistically happen to them in the next couple of months,but that were not directly tied to a particular point in time (see Experimental Procedures ).Episodic Imagery,Not Temporal Speciﬁcity,Reward Conﬁdence,or Temporal Focus,Predicts the Size of the Tag EffectIn total,data from 16participants (9female)are included.Anal-ysis of pretest ratings conﬁrmed that temporally unspeciﬁc and speciﬁc tags were matched in terms of personal relevance,arousal,valence,and preexisting associations (all p >0.15).Choice preferences were again well described by hyperbolic functions (median R 2control =0.84,unspeciﬁc =0.81,speciﬁc =0.80).We replicated the parametric tag effect (i.e.,increasing effect of tags on discount rates with increasing posttest imagery scores)in this independent sample for both temporally speciﬁc (p =0.047,Figure 7A)and temporally unspeciﬁc (p =0.022,Figure 7A)tags,showing that the effect depends on future thinking,rather than being speciﬁcally tied to the temporal spec-iﬁcity of the event cues.Following testing,subjects rated how certain they were that a particular reward would actually be forth-coming.Overall,conﬁdence in the payment procedure washighFigure 4.Neural Representation of Subjective Value (Parametric Analysis)(A)Regions in which the correlation with subjective value (parametric analysis)was signiﬁcant in both the control and the episodic conditions (conjunction analysis)included central and lateral orbitofrontal cortex (OFC),bilateral ventral striatum (VS),medial prefrontal cortex (mPFC),and posterior cingulate cortex(PCC),replicating previous studies (Kable and Glimcher,2007;Peters and Bu¨chel,2009).(B)Regions in which the subjective value correlation was greater for the episodic compared with the control condition included lateral parietal cortex (LPC),ante-rior cingulate cortex (ACC),dorsolateral prefrontal cortex (DLPFC),and the right amygdala (Amy).(C)A conjunction analysis revealed that only LPC activity was positively correlated with subjective value in both conditions,but showed a greater regression slope in the episodic condition.No regions showed a better correlation with subjective value in the control condition.Error bars =SEM.All peaks are signiﬁcant at p <0.001,uncorrected;(A)and (B)are thresholded at p <0.001uncorrected and (C)is thresholded at p <0.005,uncorrected for display purposes.NeuronEpisodic Modulation of Delay Discounting142Neuron 66,138–148,April 15,2010ª2010Elsevier Inc.(Figure 7B),and neither unspeciﬁc nor speciﬁc tags altered these subjective certainty estimates (one-way ANOVA:F (2,45)=0.113,p =0.894).Subjects also rated their temporal focus as either delay-based or date-based (see Experimental Procedures ),i.e.,whether they based their decisions on the delay-to-reward that was actually displayed,or whether they attempted to convert delays into the corresponding dates and then made their choices based on these dates.There was no overall signiﬁcant effect of condition on temporal focus (one-way ANOVA:F (2,45)=1.485,p =0.237,Figure 7C),but a direct comparison between the control and the temporally speciﬁc condition showed a signiﬁcant difference (t (15)=3.18,p =0.006).We there-fore correlated the differences in temporal focus ratings between conditions (control:unspeciﬁc and control:speciﬁc)with the respective tag effects (Figure 7D).There were no correlations (unspeciﬁc:p =0.71,speciﬁc:p =0.94),suggesting that the observed differences in discounting cannot be attributed to differences in temporal focus.High-Imagery,but Not Low-Imagery,Subjects Adjust Their Discount Function in an Episodic ContextFor a ﬁnal analysis,we pooled the samples of Experiments 1and 2(n =46subjects in total),using only the temporally speciﬁc tag data from Experiment 2.We performed a median split into low-and high-imagery participants according to posttest imagery scores (low-imagery subjects:n =23[15/8Exp1/Exp2],imagery range =1.5–3.4,high-imagery subjects:n =23[15/8Exp1/Exp2],imagery range =3.5–5).The tag effect was signiﬁcantly greater than 0in the high-imagery group (t (22)=2.6,p =0.0085,see Figure 7D),where subjects reduced their discount rate by onaverage 16%in the presence of episodic tags.In the low-imagery group,on the other hand,the tag effect was not different from zero (t (22)=0.573,p =0.286),yielding a signiﬁcant group difference (t (44)=2.40,p =0.011).DISCUSSIONWe investigated the interactions between episodic future thought and intertemporal decision-making using behavioral testing and fMRI.Experiment 1shows that reward delay dis-counting is modulated by episodic future event cues,and the extent of this modulation is predicted by the degree of sponta-neous episodic imagery during decision-making,an effect that we replicated in Experiment 2(episodic tag effect).The neuroi-maging data (Experiment 1)highlight two mechanisms that support this effect:(1)valuation signals in the lateral ACC and (2)neural coupling between ACC and hippocampus/amygdala,both predicting the size of the tag effect.The size of the tag effect was directly related to posttest imagery scores,strongly suggesting that future thinking signiﬁ-cantly contributed to this effect.Pooling subjects across both experiments revealed that high-imagery subjects reduced their discount rate by on average 16%in the episodic condition,whereas low-imagery subjects did not.Experiment 2addressed a number of alternative accounts for this effect.First,reward conﬁdence was comparable for all conditions,arguing against the possibility that the tags may have somehow altered subjec-tive certainty that a reward would be forthcoming.Second,differences in temporal focus between conditions(date-basedFigure 5.Correlation between the Neural and Behavioral Tag Effect(A)Glass brain and (B and C)anatomical projection of the correlation between the neural tag effect (subjective value correlation episodic >control)and the behav-ioral tag effect (log difference between discount rates)in the bilateral ACC (p =0.021,FWE-corrected across an anatomical mask of bilateral ACC).(C)Coronal sections of the same contrast at a liberal threshold of p <0.01show that both left and right ACC clusters encompass gray matter of the cingulate gyrus.(D)Scatter-plot depicting the linear relationship between the neural and the behavioral tag effect in the right ACC.(A)and (B)are thresholded at p <0.001with 10contiguous voxels,whereas (C)is thresholded at p <0.01with 10contiguousvoxels.Figure 6.Results of the Psychophysiolog-ical Interaction Analysis(A)The seed for the psychophysiological interac-tion (PPI)analysis was placed in the right ACC (18,34,18).(B)The tag effect was associated with increased ACC-hippocampal coupling (p =0.031,corrected across bilateral hippocampus)and ACC-amyg-dala coupling (p =0.051,corrected across bilateral amygdala).Maps are thresholded at p <0.005,uncorrected for display purposes and projected onto the mean structural scan of all participants;HC,hippocampus;Amy,Amygdala;rACC,right anterior cingulate cortex.NeuronEpisodic Modulation of Delay DiscountingNeuron 66,138–148,April 15,2010ª2010Elsevier Inc.143。

法布里珀罗基模共振英文

法布里珀罗基模共振英文The Fabryperot ResonanceOptics, the study of light and its properties, has been a subject of fascination for scientists and researchers for centuries. One of the fundamental phenomena in optics is the Fabry-Perot resonance, named after the French physicists Charles Fabry and Alfred Perot, who first described it in the late 19th century. This resonance effect has numerous applications in various fields, ranging from telecommunications to quantum physics, and its understanding is crucial in the development of advanced optical technologies.The Fabry-Perot resonance occurs when light is reflected multiple times between two parallel, partially reflective surfaces, known as mirrors. This creates a standing wave pattern within the cavity formed by the mirrors, where the light waves interfere constructively and destructively to produce a series of sharp peaks and valleys in the transmitted and reflected light intensity. The specific wavelengths at which the constructive interference occurs are known as the resonant wavelengths of the Fabry-Perot cavity.The resonant wavelengths of a Fabry-Perot cavity are determined bythe distance between the mirrors, the refractive index of the material within the cavity, and the wavelength of the incident light. When the optical path length, which is the product of the refractive index and the physical distance between the mirrors, is an integer multiple of the wavelength of the incident light, the light waves interfere constructively, resulting in a high-intensity transmission through the cavity. Conversely, when the optical path length is not an integer multiple of the wavelength, the light waves interfere destructively, leading to a low-intensity transmission.The sharpness of the resonant peaks in a Fabry-Perot cavity is determined by the reflectivity of the mirrors. Highly reflective mirrors result in a higher finesse, which is a measure of the ratio of the spacing between the resonant peaks to their width. This high finesse allows for the creation of narrow-linewidth, high-resolution optical filters and laser cavities, which are essential components in various optical systems.One of the key applications of the Fabry-Perot resonance is in the field of optical telecommunications. Fiber-optic communication systems often utilize Fabry-Perot filters to select specific wavelength channels for data transmission, enabling the efficient use of the available bandwidth in fiber-optic networks. These filters can be tuned by adjusting the mirror separation or the refractive index of the cavity, allowing for dynamic wavelength selection andreconfiguration of the communication system.Another important application of the Fabry-Perot resonance is in the field of laser technology. Fabry-Perot cavities are commonly used as the optical resonator in various types of lasers, providing the necessary feedback to sustain the lasing process. The high finesse of the Fabry-Perot cavity allows for the generation of highly monochromatic and coherent light, which is crucial for applications such as spectroscopy, interferometry, and precision metrology.In the realm of quantum physics, the Fabry-Perot resonance plays a crucial role in the study of cavity quantum electrodynamics (cQED). In cQED, atoms or other quantum systems are placed inside a Fabry-Perot cavity, where the strong interaction between the atoms and the confined electromagnetic field can lead to the observation of fascinating quantum phenomena, such as the Purcell effect, vacuum Rabi oscillations, and the generation of nonclassical states of light.Furthermore, the Fabry-Perot resonance has found applications in the field of optical sensing, where it is used to detect small changes in physical parameters, such as displacement, pressure, or temperature. The high sensitivity and stability of Fabry-Perot interferometers make them valuable tools in various sensing and measurement applications, ranging from seismic monitoring to the detection of gravitational waves.The Fabry-Perot resonance is a fundamental concept in optics that has enabled the development of numerous advanced optical technologies. Its versatility and importance in various fields of science and engineering have made it a subject of continuous research and innovation. As the field of optics continues to advance, the Fabry-Perot resonance will undoubtedly play an increasingly crucial role in shaping the future of optical systems and applications.。

不对称自由基反应英文

不对称自由基反应英文Asymmetric Radical Reactions: An Insight into Their Mechanism and Applications.Introduction.Asymmetric radical reactions have emerged as a powerful tool in organic synthesis, enabling the synthesis of chiral compounds with high enantiomeric purity. These reactions differ significantly from their symmetric counterparts, as they involve the generation and utilization of chiral radicals. These chiral radicals can undergo a range of reactions, including substitution, addition, and cyclization, leading to the formation of enantiomerically enriched products.Mechanism of Asymmetric Radical Reactions.The mechanism of asymmetric radical reactions typically involves three key steps: radical generation, chiralitytransfer, and radical termination.Radical Generation.The first step involves the generation of a radical species. This can be achieved through various methods, such as photolysis, thermal decomposition, or redox reactions. The generated radical can be chiral or achiral, depending on the starting materials and the conditions used.Chirality Transfer.The second step involves the transfer of chirality from a chiral auxiliary or catalyst to the radical species. This chirality transfer can occur through covalent or non-covalent interactions between the catalyst/auxiliary and the radical. The nature of these interactions determines the stereoselectivity of the reaction.Radical Termination.The final step involves the termination of the radicalspecies, leading to the formation of the desired product. This termination can occur through various mechanisms, such as coupling with another radical species, hydrogen atom abstraction, or disproportionation.Applications of Asymmetric Radical Reactions.Asymmetric radical reactions have found widespread applications in various fields of organic synthesis, including the synthesis of natural products, pharmaceuticals, and functional materials.Synthesis of Natural Products.Natural products often possess complex chiral structures, making their synthesis challenging. Asymmetric radical reactions have proven to be effective tools for the synthesis of such chiral natural products. For example, the use of chiral radicals generated from appropriate precursors has enabled the enantioselective synthesis of alkaloids, terpenes, and amino acids.Pharmaceutical Applications.The enantiomers of chiral drugs often differ significantly in their biological activities, making it crucial to control their enantiomeric purity. Asymmetric radical reactions can be used to synthesize enantiomerically enriched chiral drugs with high selectivity. This approach has been successfully applied to the synthesis of various drugs, including anti-inflammatory agents, anticancer agents, and antiviral agents.Functional Materials.Chiral materials possess unique physical and chemical properties that make them useful in various applications, such as displays, sensors, and catalysts. Asymmetricradical reactions can be used to synthesize chiral building blocks for the preparation of such materials. For instance, chiral polymers can be synthesized by utilizing asymmetric radical polymerization reactions, leading to the formation of materials with controlled chirality and tailored properties.Conclusion.Asymmetric radical reactions have emerged as powerful tools for the synthesis of enantiomerically enriched chiral compounds. Their unique mechanism, involving chirality transfer from a chiral catalyst/auxiliary to the radical species, enables high selectivity and enantiopurity in the product. The widespread applications of asymmetric radical reactions in organic synthesis, particularly in the synthesis of natural products, pharmaceuticals, and functional materials, highlight their importance in modern chemistry.Future Perspectives.Despite the significant progress made in the field of asymmetric radical reactions, there are still numerous challenges and opportunities for further exploration.Improving Selectivity and Efficiency.One of the key challenges in asymmetric radical reactions is achieving high selectivity and efficiency. While significant progress has been made in this area, there is still room for improvement. Future research could focus on developing new chiral catalysts/auxiliaries that can promote asymmetric radical reactions with higher selectivity and efficiency.Expanding the Scope of Reactions.Currently, the scope of asymmetric radical reactions is limited by the availability of suitable precursors and the reactivity of the generated radicals. Future research could aim to expand the scope of these reactions by developing new methods for generating radicals with desired functionalities and reactivities.Applications in Sustainable Chemistry.In the context of sustainable chemistry, asymmetric radical reactions offer an attractive alternative to traditional synthetic methods. By utilizing renewableresources and mild reaction conditions, asymmetric radical reactions could contribute to the development of more sustainable synthetic routes for the preparation of chiral compounds.Integration with Other Techniques.The integration of asymmetric radical reactions with other techniques, such as photocatalysis, electrochemistry, and microfluidics, could lead to the development of new and innovative synthetic methods. By combining the advantages of these techniques, it may be possible to achieve even higher selectivity, efficiency, and scalability in asymmetric radical reactions.In conclusion, asymmetric radical reactions have emerged as powerful tools for the synthesis of enantiomerically enriched chiral compounds. While significant progress has been made in this area, there are still numerous opportunities for further exploration and development. Future research in this field could lead tothe discovery of new and innovative synthetic methods with improved selectivity, efficiency, and sustainability.。

英语

1.VOCABULARY AND STRUCTURES(5/5 分数)a) The possibility of moving toward _____ patients and the responsibilities that it implies undoubtedly with change psychologist’s future role.A. meditatingB. medicating B. medicating - 正确C. mediatingD. mediatizing b) The main compositions of the respiratory ______ are the airways and lungs.A. synthesisB. syngeneicC. system C. system - 正确D. systolec) Heart failure occurs when the heart is unable to maintain ______ cardiac output for the body’s need.A. sufficient A. sufficient - 正确B. subsequentC. suffocationD. successived) The physician must have the exact dosage and time _____ for administration written on the chart.A. durationB. spanC. frequencyD. interval D. interval - 正确e) Recent studies suggest angiotensin has a long-term pressor_____ .A. efficacyB. effectorC. effect C. effect - 正确D. effusion您已经使用了2次中的2次提交2. READING COMPREHENSION(5/5 分数)What is type 2 diabetes?The cells in your body need insulin to change glucose, the sugar that comes from the food you eat, into energy you need to live. Without insulin, this sugar cannot get into your cells to do its work. It stays in your blood instead. Your blood sugar level then gets too high.Type 2 diabetes usually begins with insulin resistance. This means that your pancreas is making enough insulin, but your cells are not able to use it. When your cells don’t get the sugar they need, your pancreas works harder at first to make more insulin. But after a while, your pancreas stops being able to make enough insulin.High blood sugar can harm many parts of the body. It can damage blood vessels and nerves throughout your body. You will have a bigger chance of getting eye, heart, blood vessel, nerve, and kidney disease.Your weight, level of physical activity, and family history affect how your body responds to insulin. People who are overweight, get little or no exercise, or have diabetes in the family are more likely to get type 2 diabetes.Type 2 diabetes is usually found in adults, which is why it used to be called adult-onset diabetes. But now more and more children and teens are getting it too. Type 2 diabetes is a disease that you will always have, but you can live a long and healthy life by learning how to manage it.How is type 2 diabetes diagnosed?Most likely you found out that you have diabetes when you saw your doctor for a regular checkup or for some other problem. Your doctor probably diagnosed type 2 diabetes by examining you, asking about your health history, and looking at the results of blood sugar tests.How is it treated?A healthy diet helps keep your blood sugar under control and helps prevent heart disease. Eating the right amount of carbohydrate at each meal is very important. Carbohydrate is found in sugar and sweets, grains, fruit, starchyvegetables and milk and yogurt. A dietitian or a certified diabetes educator can help you plan your meals.Eating right and getting more exercise are enough for some people to control their blood sugar levels. Others also need to take one or more medicines, including insulin.You may need to take other steps to prevent other problems from diabetes. These problems are called complications. People with diabetes are more likely to die from heart and blood vessel problems like heart attack and stroke. If you are 30 or older, talk to your doctor about taking a low-dose aspirin each day to help prevent these or other large blood vessel diseases. You may also need medicine for high blood pressure or high cholesterol. If you smoke, quitting may help you avoid problems with your heart and large blood vessels. (478)Adopted from NorthShore University HealthSystem (NorthShore) at:https://www. /globalassets/diabetes/patienteducation/educationpackettypeiidiabetes.pdff) From the first paragraph we may get to know that the sugar we take-in via food should be digested to the cells otherwise it will_________.A. hurt our insulinB. accumulated at the blood stream B. accumulated at the blood stream - 正确C. erode our pancreasD. poison our blood vesselsg) Insulin resistance as the author mentioned in the passage is that your body can not make full use of______, and then the pancreas stops to produce it in a normal way.A. insulin that pancreas produced A. insulin that pancreas produced - 正确B. insulin that the cells producedC. insulin that produced for bloodD. insulin that produced for pancreash) According to the passage, which of the following item is NOT mentioned to the sufferers of type 2 diabetes?A. The age of the sufferers.B. The gender of the sufferers. B. The gender of the sufferers. - 正确C. The life-long duration of the disease.D. The disease can be controlledi) When diagnosing type 2 diabetes, which of the following test index is not the major reference factor?A. Physical check-up results.B. Results of bloods sugar.C. Interview of your health history.D. X-ray reports for your chest. D. X-ray reports for your chest. - 正确j) As for the treatment method, if a patient over 30 years old the doctor would suggest the patient to take __________ as a special means to prevent the lesions to blood vessels.A. a low-dose aspirin each day A. a low-dose aspirin each day - 正确B. medicines for complicationsC. a special dietD. a special insulin injection您已经使用了2次中的2次提交CLOZE TEST(4/5 分数)Anesthesiology is the practice of medicine which involves the perioperative care of patients and the treatment of pain. The field is predominately a (k)_________specialty, which cares for patients (l)_____ pre-operatively,post-operatively and in critical care units. It also involves the treatment of acute and chronic pain as one of its major (m)_____. The practice of anesthesiology includes a wide (n)______ of patients: all ages, all degrees of illnesses and both sexes. The subspecialties include: pediatric, cardiac, neuro, obstetrical, ambulatory anesthesia as well as critical care medicine and pain management. Individuals interested in anesthesiology are those who enjoy physiology and applied (o)_______ in the clinical setting. They must be comfortable with managing acute life threatening problems and enjoy working in the operating room.k)A. clinic-focusedB. hospital-based B. hospital-based - 正确C. bed-sidedD. problem-basedl)A. acutelyB. severely B. severely - 不正确C. advancedD. sharplym)A. kindsB. ranksC. fieldsD. subspecialties D. subspecialties - 正确n)A. rangesB. raysC. spectrum C. spectrum - 正确D. categorieso)A. medicineB. pharmacology B. pharmacology - 正确C. pathologyD. anatomy 您已经使用了2次中的2次提交2.单选题(5/5 分数)1)Select the best answer and write the letter of your choice of each number.a)The word “ carcinogenic “ is formed with prefix ofcardio-carbo-carcin- carcin- - 正确carbam-b) The word “earwax” is a ______ word with ear and wax.compounding compounding - 正确prefixingcombatingcomplexingc) The suffixes “-ate” “-fy” and “-ize” in word usually form_____.adverbsadjectivesconjunctionsverbs verbs - 正确d) In the words “ dysphagia”, ”dysrhythmia”, dystonia” “dys-“ functions as prefix and has a meaning as________.firmdifficult difficult - 正确acutepaine) The suffixed “-ic” “-ous”, “-al” are found in _________.verbsnounspronounsadjectives adjectives - 正确单选题(5/5 分数)2)Complete the following sentences with the right medical terms given belowf) . The chain of events between ________ of a drug and production of these effects in the body can be divided into two important components, both of which contribute to variability in drug actions.administration administration - 正确preparationproscriptioninjectiong) Preoperative cardiac________ is routinely performed to provide definitive assessment of aortic valve area and the pressure gradient, as well as to assess the coronary arteries for significant stenosis.involvementtransformationalterationcatheterization catheterization - 正确h) The nervous system controls the secretion of many ______ glands, and some hormones in turn affect the function of the nervous system.exocrineendocrine endocrine - 正确endocardialentodermi) The secretion of insulin—which acts to lower the plasma glucose _____—is stimulated by a rise in glucose concentration, for example, and is inhibited by a fall in blood glucose.concentration concentration - 正确accumulationheap-upsummaryj) Bleeding may also occur spontaneously in patients who have received ______ or thrombolytic drugs, or who have coagulation disorders such as hemophilia.anticoagulants anticoagulants - 正确coenzymecoplanarcircumoral4.1单选题(3/5 分数)1. Read the following passage and then do the exercises (multiple choice) given below.Classification of Muscle ActionsIt is useful to be able to describe the effect of muscle contraction on a joint in terms which may be applied throughout the body and which are related to the anatomical position. The descriptive terms express very poorly, however, the complexities of movement, since they resolve movement to arbitrary planes of action. Flexion is the term used to describe the bending of a pan or the making of an angle, most easily visualized in the bending of the elbow or the knee. The opposite term extension fundamentally means a straightening. In the anatomical position most of the members of the body are in the extended position; the arms and legs are straight, as is also the back. In the case of the foot, these terms lead to some confusion since, in the erect position, the ankle is almost continuously semiflexed. From this position, further flexion is more readily understood under the term dorsiflexion and extension under the term plantar flexion. Plantar flexion is obviously bending in the direction of the sole; dorsiflexion, bending in the direction of the dorsum. For movement away from or toward the central axis of the body the terms abduction and adduction are applied. These terms lead to no confusion except in the hands and feel where there is movement of the digits away from and toward a plane wholly within these parts. Rotational movement is also recognized. Rotation of the anterior surface of a member toward the midplane of the body is medial rotation; rotation away from the midplane is lateral rotation. The rotary action of the forearm and hand, which can he readily observed as the hand is turned palm up or palm down, has a special designation. Pronation is rotation so as to turn the palm downward or backward; supination carries the palm upward or forward. There is a similar though less extensive movement of the foot in which rotation takes place in tile tarsal joints. The rotation of the foot so that the sole turns outward is eversion; the opposite movement so that the sole turns inward is inversion. A special case of rotation is that which is seen in the very important opposing action of the thumb. This movement of rolling the thumb over onto the hand so that the pads of the digits converge into a firm grasp is termed opposition; it is exhibited to a lesser degree in the little finger and in the great and small toes. Circumduction is circular movement; to produce this type of motion, flexion and extension, abduction and adduction are combined in a proper sequence. Special terms, such as protrusion and retraction, elevation and depression, will be referred to in their proper context but are relatively self-evident.a)Muscle actions in various patterns, have been mentioned this passage except________.contractionflotation flotation - 正确flexionextensionb) The term “flexion” refers bending of a joint muscle, “semiflexion” means half of the bending, while “dorsiflexion” may mean_________.aA. the muscle bending in backward directionB. the muscle bending in forward directionC. the muscle bending in outward direction C. the muscle bending in outward direction - 不正确D. none of abovec) “Plantar flexion” in the passage may means__________b.A. the bending of one’s angles in various directions A. the bending of one’s angles in various directions - 不正确B. the bending of one’s thenar in various dir ections.C. the bending of one’s figures in rotative waysD. the bending of one’s head both forward and backwardd) In this passage we can see the motions of various muscles that are connected_________.A. with our motional organs such as foot and handB. with our neural connective organs B. with our neural connective organs - 正确C. with our craniums and upper part of our bodyD. with the artery and veins in our bodye) The language used in this passage may be described as________.A. instructive with concepts interpretationsB. plain with figurative illustrationsC. complexity with logical analysis of theoretical ideasD. narrative with definitions to specific term in anatomy D. narrative with definitions to specific term in anatomy - 正确您已经使用了2次中的2次提交4.2单选题(5/5 分数)1. Read the following passage and then do the exercises (multiple choice) given below.PRINCIPLES OF PHARMACODYNAMICSOnce a drug accesses a molecular site of action, it alters the function of that molecular target, with the ultimate result of a drug effect that the patient or physician can perceive. For drugs used in the urgent treatment of acutesymptoms, little or no delay is anticipated (or desired) between the drug-target interaction and the development of a clinical effect. Examples include vascular thrombosis, shock, malignant hypertension, status epilepticus, or arrhythmias. For many conditions, however, the indication for therapy is less urgent, and in fact a delay between the interaction of a drug with its pharmacologic target(s) and a clinical effect is common. Pharmacokinetic mechanisms that can contribute to such a delay include uptake into peripheral compartments or generation and accumulation of active metabolites. A common pharmacodynamic mechanism is that the clinical effect develops as a downstream consequence of the initial molecular effect the drug produces. Thus, administration of a proton-pump inhibitor or an H2-receptor blocker produces an immediate increase in gastric pH but ulcer healing that is delayed. Cancer chemotherapy inevitably produces delayed therapeutic effects, often long after drug is undetectable in plasma and tissue. Translation of a molecular drug action to a clinical effect can thus be highly complex and dependent on the details of the pathologic state being treated. These complexities have made pharmacodynamics and its variability less amenable than pharmacokinetics to rigorous mathematical analysis. Nevertheless, some clinically important principles can be elucidated.A therapeutic drug effect assumes the presence of under lying pathophysiology. Thus, a drug may produce no action, or a different spectrum of actions, in unaffected individuals compared to patients. Further, concomitant disease can complicate interpretation of response to drug therapy, especially adverse effects. For example, increasing dyspnea in a patient with chronic lung disease receiving amiodarone therapy could be due to drug, underlying disease, or an intercurrent cardiopulmonary problem. Thus the presence of chronic lung disease, and interpretation of the symptom of increasing dyspnea, is one factor that should be considered ins election of antiarrhythmic therapies. Similarly, high doses of anticonvulsants such as phenytoin may cause neurologic symptoms, which may be confused with the underlying neurologic disease.The concept that a drug interacts with a speciﬁc molecular receptor does not imply that the drug effect will be constant over time, even if stable drug and metabolite concentrations are maintained. The drug receptor interaction occurs in a complex biologic milieu that itself can vary to modulate the drug effect. For example, ion channel blockade by drugs, an important anticonvulsant and antiarrhythmic effect, is often modulated by membrane potential, itself a function of factors such as extracellular potassium or ischemia. Thus, the effects of these drugs may vary depending on the external milieu. Receptors may be up- or downregulated by disease or by the drug itself. For example, adrenergicblockers upregulate ß-receptor density during chronic therapy. While this effect does not usually result in resistance to the therapeutic effect of the drugs, it may produce severe agonist–mediated effects (such as hypertension or tachycardia) if the blocking drug is abruptly withdrawn.(From: Kasper, et al. Ed ; Harrison's Principles of Internal Medicine 16th . © 2005, by The McGraw-Hill Companies, Inc p18.)a)According to the passage the drug in clinic application may achieve its efficacy in the following procedures except________.A.the drug molecule accesses the site of actionB.the drug molecules are accumulated in the blood stream rapidly B.the drug molecules are accumulated in the blood stream rapidly - 正确C.the drug molecule alters the function of the molecule targetD.the drug molecule and drug-target interaction to form its effect (B)b)The delay in action is known as common in the chemotherapy of the symptom ________ in clinic practice.vascular thrombosisstatusepilepticustachyarrhythmiahydronephrosis hydronephrosis - 正确c) When administration of a proton-pump inhibitor or an H2-receptor blocker produces an immediate increase in gastric pH but ulcer healing that is delayed, because _______.A. the drug produces a downstream consequence of the initial molecular effect A. the drug produces a downstream consequence of the initial molecular effect - 正确B. the drug produces an afterwards result of delayed effectC. the drug combines the target receptor and makes a prolonged effectD. the drug impact its effect on the receptor cell in an indirect wayd) Which of the following may be the reason for the no clinic action when administrated a certain drug for a specific disease or symptom?A. As the under lying pathophysiology, as the disease and symptom may commit different actions to astray or reject the drug of its functions.B. As the under lying pathophysiology, the drug may take no effect or other spectrum of action in affected individuals but its effector molecule acts with other functions than we desired.C. As the under lying pathophysiology, the drug may reach to a wrong site and combined with different receptor cell thus made no clinic effectD. As the under lying pathophysiology, the drug may take no effect or otherspectrum of action in unaffected individuals and the concomitant disease can complicate interpretation of response to drug therapy, especially adverse effects. D. As the under lying pathophysiology, the drug may take no effect or other spectrum of action in unaffected individuals and the concomitant disease can complicate interpretation of response to drug therapy, especially adverse effects. - 正确e) In this passage we can learn principles that a medicine in clinic administration may have __________.clinic efficacyno actionadviser effectall the three all the three - 正确您已经使用了2次中的2次提交单选题(5/5 分数)1. Read the following passage and then do the exercises (multiple choice) given below.Objectives relating to knowledgeGraduates completing basic medical education should have knowledge of the following areas:1. Scientific method relevant to biological, behavioural and social sciences at a level sufficient to understand the basis for present medical practice, and to assimilate the advances in knowledge that will occur over their working life.2. The normal structure, function and development of the human body and mind at all stages of life, the interactions between body and mind, and the factors that may disturb these.3. The etiology, pathology, symptoms and signs, natural history, and prognosis of common mental and physical ailments in children, adolescents, adults and the aged. (Graduates should have a detailed knowledge of the conditions that require urgent treatment and those that are of particular local significance.)4. Common diagnostic procedures, their uses and limitations.5. Management of common conditions including pharmacological, physical, nutritional and psychological therapies.6. Normal pregnancy and childbirth, the more common obstetrical emergencies, the principles of antenatal and postnatal care, and medical aspects of family planning.7. The principles of health education, disease prevention, amelioration of suffering and disability, rehabilitation, and the care of the dying.8. Cultural and social factors affecting human relationships, the psychological well-being of patients and their families, and the interactions between humans and their social and physical environment.9. Systems of provision of health care including their advantages and limitations, the costs associated with health care, the principles of efficient and equitable allocation of finite resources, and methods of meeting the health care needs of disadvantaged groups within the community.10. The principles of ethics that relate to health care and the legal responsibilities of the medical profession.Objectives relating to skillsGraduates completing basic medical education should have developed the following skills to an appropriate level for their stage of training:1. The ability to take a tactful, accurate, organized and problem-focused medical history.2. The ability to perform an accurate physical and mental state examination.3. The ability to choose the appropriate and practical clinical skills to apply in a given situation.4. The ability to interpret and integrate the history and physical examination findings to arrive at an appropriate diagnosis or differential diagnosis.5. The ability to select the most appropriate and cost-effective diagnostic procedures.6. The ability to formulate a management plan, and to plan management in concert with the patient.7. The ability to communicate clearly, considerately and sensitively with patients, relatives, doctors, nurses, other health professionals and the community.8. The ability to counsel sensitively and effectively, and to provide information in a manner that ensures patients and families can be truly informed when consenting to any procedure.9. The ability to recognize serious illness and to perform common emergency and life-saving procedures such as caring for the unconscious patient and cardiopulmonary resuscitation.10. The ability to interpret medical evidence in a critical and scientific manner, and to use libraries and other information resources to pursue independent inquiry relating to medical problems.Objectives relating to attitudes as they affect professional behaviourDuring basic medical education, students should acquire the following professional attitudes, which are regarded as fundamental to medical practice:1. Respect for every human being, with an appreciation of the diversity of human background and cultural values.2. An appreciation of the complexity of ethical issues related to human life and death including the allocation of scarce resources.3. A desire to ease pain and suffering.4. An awareness of the need to communicate with patients and their families, and to involve them fully in planning management of their condition.5. A desire to achieve the optimal patient care for the least cost to allow maximum benefit from the available resources.6. Recognition that the health interests of the patient and the community are paramount.7. A willingness to work effectively in a team with other health care professionals.8. An appreciation of the responsibility to maintain standards of medical practice at the highest possible level throughout a professional career.9. An appreciation of the need to recognize when a clinical problem exceeds their capacity to deal with it safely and efficiently and of the need to refer the patient for help from others when this occurs.10. A realization that it is not always in the interests of patients or their families to do everything which is technically possible to make a precise diagnosis or to attempt to modify the course of an illness.From World Health Organization Western Pacific Region(2001), WHO Guidelines for Quality Assurance of Basic Medical Education in the Western Pacific Regiona)According to the passage medical education quality system may including all of the following aspects of competences but __________.A.mastering the knowledges that related to medical practice in all aspects of biologic sciences and medicines, humanities and social scienceB.mastering the skills that related to clinic practice, communication and making use of respective informationC.understanding the concepts about medicine that may focus on interpretation of human himself and the relations with the world around C.understanding the concepts about medicine that may focus on interpretation of human himself and the relations with the world around - 正确D.develop the attitude toward their future profession and which may affect their behaviours laterb)In the first section, we can learn that the required knowledges a medical student should master may consist ________________.A.the natural processes of human individual and the diseases as well as how to deal with them A.the natural processes of human individual and the diseases as well as how to deal with them - 正确B.the sources that cause our diseases or alimentsC.the relations between individual and social community that maydecide your social statusD. the principles of nature and the earth that may affect our life and the environmentc) Systems of provision of health care may have the contents of________.A. how much our health may costB. how to make full use of the medical resources for the people at largeC. methods for make use of the health facilitatesD. all above D. all above - 正确d) The ability to counsel sensitively and effectively, and to provide information should be _____________.A. contented to the needs and demands of the patient and the familyB. frankly and objectively to ensure the colleagues for their caseC. truly and objectively and tactically for the patient and his family C. truly and objectively and tactically for the patient and his family - 正确D. decisively and absolutely for the case of treatment procedurese) In the career of medicine, a person should _________ all human being, as the foundation of his/her moral, regardless of their nationality, gender and social status.appreciateunderstandconsideraterespect respect - 正确您已经使用了2次中的2次提交单选题(5/5 分数)2、Read the following passage and then do the exercises (multiple choice) given below.Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes.1-7 Diabetes self- management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self- manage on an ongoing basis. Although different members of the health care team and community can contribute to this process, it is important for health care providers and theirpractice set- tings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial DSME is typically provided by a health professional, whereas ongoing support can be provided by personnel within a practice and a variety of community-based resources. DSME/S programs are designed to address the patient’s health beliefs, cultural needs, current knowledge, physical limitations, emotional concerns, family support, financial status, medical history, health literacy, numeracy, and other factors that influence each person’s ability to meet the challenges of self-management.The number of people with type 2 diabetes who receive DSME/S(Diabetes Self-management Education and Support), despite its proven benefits, is low. For example, only 6.8% of individuals with newly diagnosed type 2 diabetes with private health insurance participated in DSME/S within 12 months of diagnosis.66 Furthermore, only 4% of Medicare participants received DSME/S and/ or MNT.4 To increase the number of individuals with diabetes who receive DSME/S services described in this position statement, it is necessary to consider the barriers that currently limit provision. Barriers are associated with a number of factors, including the health system, the individual health care professional, community resources, and the individual with diabetes. Barriers can include a misunderstanding of the necessity and effectiveness of DSME/S, confusion regarding when and how to make referrals, lack of access to DSME/S services, and patient psychosocial and behavioral factors.67 Provider misconceptions that can limit access to DSME/S include a misunderstanding of reimbursement issues and the misconception that one or a few initial education visits are adequate to provide patients with the skills needed for lifelongself-management. Lack of or poor reimbursement for DSME/S also can hamper patients’ participation. Even when DSME/S programs are operating at peak service, they often struggle to cover costs—making it easy to eliminate programs despite their wider influence on reducing costs and improving health outcomes.13Although people with diabetes report wanting to be actively engaged in their health care, most indicate that they are not actively engaged by their providers and that education and psychological services are not readily available.68 In order to enhance patient and family engagement in DSME/S, provider communication about the necessity of self-management to achieve treatment and quality-of-life goals and the essential nature of both DSME and ongoing support throughout a lifetime of diabetes is essential.Removing barriers to access and increasing quality care can be achieved by。

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