The patient is a 19-year-old man who often wakes up in dreams with palpitations and fatigue. The electrocardiogram shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal electrophysiological examination (TEEPS) showed that: 1. When the S1S1 stimulation frequency is set at 260bpm, the atrioventricular conduction still shows a descending ratio of 1:1; 2. When S1S2 was set to 500-220ms, the atrioventricular node entered the refractory period earlier than the accessory pathway, atrial stimulation was transmitted to the ventricle through the accessory pathway, and the QRS waveform showed a complete preexcitation pattern. TEEPS diagnosis:High-risk preexcitation syndrome bypass. During radiofrequency catheter ablation, the patient suddenly developed atrial fibrillation and quickly converted to ventricular fibrillation. After defibrillation, ventricular fibrillation is transformed into sinus rhythm. Subsequently, the patient’s high-risk accessory pathway was successfully ablated. Postoperative electrocardiogram: 1. Sinus rhythm; 2.ST segment elevation (early repolarization). Studies have shown that about 25% of patients with WPW syndrome have a refractory period of less than 250 ms, which is one of the risk factors for the conversion of atrial fibrillation to ventricular fibrillation. Therefore, risk stratification is recommended for these symptomatic patients. TEEPS and intracardiac electrophysiology play a similar role in risk stratification of preexcitation syndrome, but the former is easier to implement, lower cost and lower risk. The diagnosis of TEEPS is a high-risk bypass for preexcitation syndrome, which provides a strong basis for follow-up diagnosis and treatment. TEEPS is a simple, safe and reliable non-invasive cardiac electrophysiological detection technique.

This article examines the radial vibrations of spherical isotropy embedded in an elastic medium according to the one-dimensional (1D) elastic theory. Based on the linear theory of elasticity, the rotation and inhomogeneity effects on wave propagation in orthotropic material are analyzed. The 1Delastodynamicsequation is solved in terms of radial displacement. We consider three boundaries: free, fixed, and mixed orthotropic materials. In the case of harmonic vibrations, the eigenvalues of the natural frequency of the radial vibrations for different boundary conditions are determined. For each case, the numerical results are presented, illustrated graphically, and then compared with those in the absence of rotation and non-homogeneity. An increase in the rotation and non-homogeneity parameters is observed, similar to the findings of the classical sphere theory. Therefore, this study can also be used in the design and optimization of microplates and nanoplates. The findings show that rotation and non-homogeneity have a strong impact on wave propagation in orthotropic material.

Stable isotopes have been sporadically used over the last two decades to characterise host-parasite trophic relationships. The main reason for this scarcity is the lack of an obvious pattern in the nitrogen stable isotope values (δ15N) of parasites in comparison to their host tissues, which would be key to understand any host-parasite system dynamics. To circumvent this, we focused on a single snail host, Zeacumantus subcarinatus, and three of its trematode parasites. We used stable isotopes to investigate each host-trematode trophic relationship and shed light on the mechanisms utilised by the parasite to reroute its hosts’ biomass. All our trematodes were found to be 15N-enriched compared to their host, with their δ15N values strongly related to their feeding behaviours: passive vs active. It was possible to ‘rank’ these parasite species and assess their ‘relative’ trophic position using δ15N values. We also demonstrated that including a broader range of samples (e.g. host food and faeces, multiple parasite life stages) helped understand the metabolic mechanisms used by the various participants, and that using carbon stable isotope values and C:N ratios allowed to identify an important lipid requirement of these trematode parasites. Finally, we show how critical it is to not ignore parasitic infections as they can have a great influence on their host’s trophic position.

Patients with hepatitis-associated aplastic anemia (HAA) who undergo living-donor liver transplantation (LDLT) have a poor prognosis with infectious and bleeding complications. Immunosuppressive therapy (IST) combined with thrombopoietin (TPO) receptor agonists is considered effective for aplastic anemia. There are no data on the benefits of adding TPO receptor agonists to IST for HAA. We present the case of a child with severe HAA who underwent LDLT, and who achieved rapid blood cell recovery with IST combined with romiplostim, a TPO receptor agonist. This case suggests that IST combined with TPO receptor agonists may be beneficial for HAA patients undergoing LDLT.

Objectives: We assessed clinical interpretation of the word parity amongst obstetricians and midwives in Wales and performed a literature review to identify a standardised definition. Design: A survey was conducted by electronic questionnaire followed by a literature review using dictionaries, standard texts, professional bodies and websites. Setting: Obstetricians across Wales and midwives across North Wales. References were obtained for the UK, USA, India, Malaysia and West Indies. Methods: The questionnaire was distributed to obstetricians using the Wales Information System. Midwives were surveyed using a health board wide distribution list. Results: There were 143 responses from 63 doctors and 80 midwives. 5% of doctors and 49% of midwives did not include stillbirths after 24 completed weeks in their definition of parity. 84% of all surveyed described having a previous twin delivery as Para 2. 23 references were obtained for a definition of parity. Parity was variability defined as the number of conceptions, pregnancies, births, and babies. Only 12 sources offered a definition in reference to multiple pregnancy. Of these, 8 sources defined multiple births as a single parous event. Conclusions: There are variations in definitions for the term parity from referenced sources and variation in understanding amongst staff surveyed. We recommend UK professional bodies take into consideration the findings of this study and provide a standard consensus definition of parity.

Polysorbate 80 (PS80) is a nonionic surfactants which is widely used in the development of protein pharmaceuticals. Due to their chemical structure, polysorbates are prone to degradation by oxidation and hydrolysis, which can render a pharmaceutical product instable or incompliant. In this study, we have investigated the chemical stability of PS80 purchased from different manufacturers as a function of light, pH, peroxides, trace metals and buffer type. For this purpose, a fast liquid chromatography-evaporative light scattering detector (LC-ELSD) detection method was developed which allows (1) to differentiate between hydrolytic and oxidative PS80 degradation and (2) to monitor the PS80 decay over time. According to the method, we analyzed the differences in the 6 main classes of PS80 subspecies purchased from three manufacturers and also analyzed the change of their area percent over time. The study showed that PS80 is relatively more stable under the condition of basic hydrolysis within 3 months. However, under histidine-buffer, pH6.0, the PS80 of manufacture B(PS80-B) is more sensitive than manufacture A (PS80-A) and manufacture C(PS80-C). The PS80 of three manufactures degraded under exposure to light, peroxides and trace metals over the time. The performance of PS80 of three different manufacturers was different.

Drought has gradually become one of the most severe abiotic stresses in plants. A growing body of evidence indicates that stress memory does exist in plants and can improve the plants’ stress resistance. In this study, a total of 195 candidate drought memory-related miRNAs were identified according to the miRNA sequencing data, and targets of 64 (32.8%) candidate miRNAs were validated by degradome sequencing. Several miRNAs like tae-miR408_L-1, tae-miR171a, tae-miR164a-5p, tae-miR396c-5p, tae-miR9778, tae-miR408_L-1, tae-miR9676-5p, tae-MIR9676-p3_1ss21GA, tae-miR9662a-3p and PC-3p-5049_3565 were validated crucial in drought memory. Besides, our results revealed that drought memory displayed a transcriptional stress memory. It could regulate auxin-activated signaling pathway, calcium-transporting, heavy metal transporting, glutathione biosynthetic, protein modification, electron transport, energy metabolism, amino acid metabolism, plant growth and development to respond to the drought. Furthermore, miRNAs may regulate various plant hormones and glucose metabolism pathways to indirectly regulate proline homeostasis and further increase the drought resistance of drought training plants. In addition, the mTOR signaling pathway was also found crucial in drought memory. Our results contribute to an understanding of drought memory in wheat seedlings and may lead to new strategies for drought-resistant breeding.

There are accumulating reports regarding poor response to the common antidepressant therapy. Antidepressant resistance has often been associated with activation of the inflammatory system. Accordingly, major depressive disorder (MDD) patients displaying inflammation prior to the treatment are less responsive to antidepressants. We hypothesized that the inefficacy of antidepressant therapy in some patients could be due to the drugs’ inflammatory mode of action that remained overshadowed by their substantial therapeutic value. Bupropion is a common-used antidepressant that is prescribed for seasonal affective disorders and smoking cessation as well. Nevertheless, there are some reports regarding inflammation induction and depressive behavior exacerbation in response to bupropion. Here, we put a spot on bupropion and investigate the alterations of innate and adaptive immunity cytokines and the influence on immune signaling pathways. Therefore, we treated LPS-stimulated human peripheral mononuclear cells (PBMCs) with different doses of bupropion. Pro-/ anti-inflammatory cytokines (TNF-ɑ, IL-1ß, IL-17, and IL-10) on both transcriptional and translational levels are assessed as well as the involvement of the JAK2 /STAT3, TLR2, and TLR4 signaling in this process. Bupropion decreased IL-17A, TNF-ɑ, and IL-1ß protein levels in the cultures. Nonetheless, the results regarding the target genes expression were controversial. Surprisingly, IL-1ß, TNF-ɑ, and IL-17A genes expression increased following bupropion treatment. TLR2, TLR4, JAK2, and STAT3 gene expression also rose in response to bupropion. Our findings suggest that bupropion possesses pro-inflammatory properties especially at concentrations of 50 and 100 and would rather be co-administrated with anti-inflammatory agents at least in patients with inflammatory conditions.

This study explores the role of exosomal miR-483-5p derived from the serum of polycystic ovary syndrome (PCOS) patients on PCOS progression. The expressions of miRNAs in exosomes from patients with or without PCOS (PCOS-exo or HC-exo) were quantified. Serum sex steroids, endocrine indexes, the association of miR-483-5p with PCOS were assessed in the clinical samples. HC-exo or PCOS-exo was injected into PCOS rats, and the location of exosomes was examined, in addition to detection on pathology changes, and autophagic vacuole. VAPB expression was measured as well as the uptake of exosomes by human ovarian granulosa cells, COV434 cells. COV434 cells were incubated or transfected with PCOS-exo, pcDNA3.1-VAPB, miR-483-5p Agomir, or miR-483-5p Antagomir, and then autophagy levels were detected. Interactions between miR-483-5p and VAPB were revealed. High expression of miR-483-5p was found in PCOS-exo, which was positively associated with PCOS-related indicators. PCOS-exo mainly located in follicles. Increased miR-483-5p and autophagosome formation as well as decreased VAPB were found in PCOS-exo. Human ovarian granulosa cells could endocytosed exosomes. PCOS-exo elicited autophagy in COV434 cells, which was reversed by miR-483-5p Antagomir or pcDNA3.1-VAPB. miR-483-5p targeted VAPB. Collectively, PCOS-exo derived miR-483-5p downregulates VAPB in granulosa cells, thus promoting granulosa cell autophagy and affecting PCOS.

Plant roots host a repertoire of bacteria and fungi, whose ecological interactions could improve their functions and plant performance. However, potential interactions and underlying mechanisms remain largely unknown in root-associated microbial communities at a continuous fine-scale. We analyzed microbial intra- and inter-domain network topologies, keystone taxa, and interaction-related genes across four compartments (non-rhizosphere, rhizosphere, episphere and endosphere) from a soil-mangrove root continuum, using amplicon and metagenome sequencing technologies. We found that both intra- and inter-domain networks displayed notable differences in the structure and topology across four compartments. Compared to three peripheral compartments, the endosphere was a distinctive compartment with more dense co-occurrences in bacterial-fungal network than in bacterial or fungal network, which could be related to three bacterial keystone taxa (Vibrio, Anaerolineae and Desulfarculaceae) detected in the endosphere as they are known to intensify inter-domain associations with fungi and stimulate biofilm formation. Also, high abundances of genes involved in cell-cell communications by quorum sensing (rhlI, lasI, pqsH and lasR) and aerobic cobamide biosynthesis (cobG, cobF and cobA) were detected in the endosphere. Our results reveal intensified bacterial-fungal associations in the mangrove root endophytes, creating a distinct micro-environment to promote a biofilm life-style.

Objectives. The study used re¬flux symptom index (RSI) and Reflux Finding Score (RFS) questionnaire to estimate laryngopharyngeal reflux (LPR) change after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). Design. An observational, retrospective study. Setting. University, tertiary level hospital. Participants. 91 subjects were recruited and divided into three groups: control group (n=27), OSA mild to moderate group (n=29) and OSA severe group (n=35) according to polysomnography. All subjects completed preoperative RSI and RFS under electronic laryngoscope. 34 OSA patients with UPPP surgery completed postoperative polysomnography, again after 6-month follow-up. Main outcome measures. Polysomnography, RSI and RFS questionnaire. Results. RSI and RFS in OSA patients were higher than non-OSA patients. Severe OSA patients also had higher RSI and RFS than mild to moderate OSA. LPR symptoms had positive and L-SpO2 had negative correlation with AHI and CT90. The mean RSI and RFS before UPPP surgery were 15.88±4.85 and 13.18±4.80; these number decreased to 9.53±4.16 and 8.65±4.87 after surgery (P<0.05). In 25 successful-surgery patients, RSI and RFS scores and individual variables of RSI were downward after surgery. Conclusion. LPR symptoms are common among OSA patients, the coexistence of OSA and LPR cannot be ignored. Successful UPPP surgery as a treatment for OSA patients, poten¬tially reduces laryngeal reflux symptoms and improves laryngoscope signs by alleviating sleep respiratory disorder.

Psoriatic arthritis (PsA) is a chronic inflammatory disease in the spondyloarthropathy group with the history of psoriasis. Although some PsA findings are similar to rheumatoid arthritis (RA), rheumatoid factor negativity, some radiological and clinical findings are different in PsA. There is no spesific laboratory examination for diagnosis of PsA. On the other hand, anti-CCP antibody positivity is a spesific finding for the diagnosis of RA. Objectives: We aimed in this study to analyse the frequency of anti-CCP positivity in PsA and the association with clinical and radiological findings. Methods: The study group is consisted of 100 PsA patients, who fulfilled the CASPAR cirteria for PsA and 100 healthy controls (HC). We filled a form for all patients, which included clinical and laboratory findings of patients. We analyzed anti-CCP antibody with micro ELISA in the sera of patients. Results: In our study, the anti-CCP positivity was detected in 15% of PsA group and 4% of healthy controls. The difference was statistically significant (p=0,014; OR=4.24, 95% CI=1.35–13.25). Nine out of 15 anti-CCP positive patients were female, the remaining 6 were male. Thirteen patients (86,7%) had peripheral arthritis, 1 patient (6,7%)had sacroiliitis, 1 patient (6,7%) had peripheral arthritis and sacroiliitis. 42,8% of PsA patients with peripheral arthritis had asymetric olygoarthritis (6/14), 28,5% had monoarthritis (4/14) and 28,5% had symetric polyarthritis (4/14). Anti-CCP antibody positivity had no effect on the involvement of peripheral arthritis. Sacroiliitis and dactilitis were more frequent in the anti-CCP negative group. No patient with dactylitis had anti-CCP positivity (p=0.005). While, 43,5% of RF positive patients were detected anti-CCP positivity, 6,5% of RF negative patients were detected anti-CCP positivity (p=0,000). Conclusions: Our data reveals that anti-CCP positivity is more frequent in PsA compared to HC. We found no statisticall association between anti-CCP positivity and clinical or radiological findings

Objective: To analyze the effect of surgical experience with laparoscopic radical hysterectomy (LRH) on oncological outcome in cervical cancer patients. Methods: We retrospectively compared the oncological outcomes of 1469 patients with stage IB1 cervical cancer receiving LRH from 2004 to 2016. The surgical volume for each surgeon was defined as low (fewer than 50 surgeries), mid (51-100 surgeries), and high (100 surgeries or more). Kaplan-Meier curves and the Cox proportional hazards model were used to estimate the effect of surgical experience on the oncological outcomes of patients. Results:A total of 1405 cases were included in this study. The average operative times of the low-volume (n = 427), mid-volume (n = 396) and high-volume (n=582) groups were 270, 260 and 227 minutes, respectively (P < 0·001), and mean blood loss was 218 ml, 197 ml and 179 ml, respectively (P = 0·004). The 5-year OS of the low-volume, mid-volume and high-volume groups was 96·1%, 93·1% and 92·5%, with 5-year DFS rates of 92·0%, 87·5% and 87·6%, respectively. There was no significant difference among the three groups. However, surgery volume was not an independent risk factor for shorter OS or DFS after controlling for case mix, nor was surgeons’ experience after 1:1 PSM (Propensity score matching) between each two of the three groups. Conclusion: The results showed that surgeons’ surgical volume did not affect the oncological outcome of LRH but that operative time and blood loss were significantly improved with a higher surgical volume.

A document by Gloria Esegbona. Click on the document to view its contents.

In this paper, we rank different channels in order to separate the noise channels from the cardiac signal channels. To rank the channels we have used the main characteristics of a cardiac signal that is pseudo-periodic ,we have proposed six methods for rating And then introducing a new benchmark that combines six of the above, We have been ranking cardiac signals. This is a fairly qualitative issue Because the quality of the ECG signal is also dependent on application.

This paper introduces a novel prototype for removal of Pseudomonas from water samples. Bacterial cells have the tendency to get attracted towards species specific chemicals justifying a phenomenon known as chemotaxis. We designed a strip integrating a combination of serine, a pseudomonas specific chemo-attractant and honey to attract and inhibit the bacteria in situ. Upon dipping the serine side of the strip, pseudomonal cells were attracted towards it. The porous property of the strip facilitates the ‘trapping’ and subsequent diffusion of the bacterial cells towards honey-adsorbed end of the strip. Honey, a natural antimicrobial agent, has garnered attention in its effective inhibitory role in Pseudomonal biofilms and wound infections. This ‘honeytrap’ reportedly leads to targeted elimination of Pseudomonas, hence facilitating its removal from water. The percentage removal efficacy of this ‘honeytrap’ device is 96% with a log reduction equivalent to 1.6 within a time frame of 2 hours. Pseudomonas aeruginosa, although, not a natural contaminant of the potable water, enters circulation due to improperly maintained plumbing fixtures and storage facilities. P. aeruginosa has been implicated as a causative agent in gastroenteritis, keratitis, endocarditis, urinary tract infections and septicemia amongst many, thus, making it a potent health risk. Honeytrap strip is an easy to use, biodegradable and cost-effective sustainable solution, which can passively neutralize pseudomonas from water. The scaled-up version of honeytrap device may help us in achieving better outcomes in terms of potable water with substantial improvement in quality of life.

In this paper, two nonlinear coupled systems, one is fractional-order with Riemann-Liouville (RL) derivative and another is integer-order, are considered via the bifurcation method and the complete discrimination system for polynomial method. Though our results, the necessity of qualitative analysis to nonlinear equations can be seen very clearly; the existences of periodic and a variety kinds of soliton solutions could be established even when the solution can not be given explicitly by the elementary functions nor commonly used special functions. Concrete examples are also carried out to illustrate our results.

The aim of this study to analyze the performance of some of the significant methods using machine learning techniques for diagnosis the Alzheimer’s disease (AD). Deep learning methods have been widely used in the AD diagnosis but Extreme learning machine (ELM) and kernel (ELM) methods have been hardly ever used. Before the deployment of these methods for computation, we present a short review in the section on related work. A series of three different cases consisting of classification models in deep learning is used. We show the computational results of three of its methods CNN, MLP and LSTM. Data set has been taken from ADNI and has been pre-processed using PCA and 10 cross-fold validation. The dataset is divided into three cases: case1, case2 and case3. The results are evaluated using two performance measures in terms of Accuracy and Error analysis. The ranking of computation methods are measured based on its performance matrices. It is observed that the performance of the proposed study to classify subjects as infected or fit using Alzheimer’s Disease Neuroimaging Initiative (ADNI*) dataset. The three cases are shuffling of presence or absence of Principal Component Analysis (PCA), and k-fold cross-validation in our operation carried out for the diagnosis. Then, a comparative study of accuracy and error as performance measures, obtained by these methods has been performed to select the best method for prediction of AD with maximum accuracy and minimum error and it is computed that the MLP deep learning method is having maximum accuracy of 82% with least error in the case3.

In this paper, we deal with the fractional p(.,.)-Laplacian problem with nonlocal Neumann boundary conditions. Applying the Ekeland principle and the variational method, under appropriate assumptions, we show that the above problem has nontrivial weak solutions.

Research objective: the aim is to study the features of the remodeling of the left atrium and pulmonary veins in CHF patients with paroxysmal AF, with permanent AF, and without arrhythmia (n=225). Materials and methods. The features of the remodeling of the left atrium and pulmonary veins were studied echocardiographically in patients having chronic heart failure with paroxysmal AF (n=38) and permanent AF (n=36) and without arrhythmia (n=225). Results. Structural changes of the left atrium and pulmonary veins in patients with chronic heart failure having permanent atrial fibrillation were significantly more distinct than those in patients with paroxysmal atrial fibrillation, in patients without arrhythmia, and in the control group. Thus, respectively, LA in the left lateral position was 46.35±1.93, 41.26±1.49, 38.60±0.90, and 29.57±0.68 mm; LAVI was 67.16±6.14, 58.81±5.92, 44.28±1.34, and 23.64±0.47; the maximum diameter of the left inferior pulmonary vein was 23.91±1.07, 22.21±0.69, 20.64±0.41, and 13.51±0.16 mm; the minimum diameter of the pulmonary vein was 15.10±1.06, 13.15±1.07, 10.51±0.41, and 5.70±0.09 mm, with higher E/e’ values of 14.78±1.45, 11.34±1.81, 10.03±0.47, and 6.26±0.28 mm. Conclusion. A more evident dilatation of the left atrium with the dilatation of pulmonary veins was diagnosed in patients with permanent AF as compared to that in patients with paroxysmal AF and patients having CHF without arrhythmia.

Corneal transplantation rejection remains a major threat to the success rate in high-risk patients. Given the many side effects presented by traditional immunosuppressants, there is an urgency to clarify the mechanism of corneal transplantation rejection and to identify new therapeutic targets. Kaempferol is a natural flavonoid that has been proven in various studies to possess anti-inflammatory, antioxidant, anticancer, and neuroprotective properties. However, the relationship between kaempferol and corneal transplantation remains largely unexplored. To address this, both in vivo and in vitro, we established a model of corneal allograft transplantation in Wistar rats and an LPS-induced inflammatory model in THP-1 derived human macrophages. In the transplantation experiments, we observed an enhancement in the NLRP3 / IL-1 β axis and in M1 macrophage polarization post-operation. In groups to which kaempferol intraperitoneal injections were administered, this response was effectively reduced. However, the effect of kaempferol was reversed after the application of autophagy inhibitors. Similarly, in the inflammatory model, we found that different concentrations of kaempferol can reduce the LPS-induced M1 polarization and NLRP3 inflammasome activation. Moreover, we confirmed that kaempferol induced autophagy and that autophagy inhibitors reversed the effect in macrophages. In conclusion, we found that kaempferol can inhibit the activation of the NLRP3 inflammasomes by inducing autophagy, thus inhibiting macrophage polarization, and ultimately alleviating corneal transplantation rejection. Thus, our study suggests that kaempferol could be used as a potential therapeutic agent in the treatment of allograft rejection.

Polysaccharides have shown efficacy in a broad range of applications, especially in immune regulation. However, there are only few effective methods available to evaluate and compare the immunoregulatory properties of the different polysaccharides in vitro. To screen stringently and extend the fields of application of polysaccharide-based treatments, a novel in vitro method, based on the use of cord blood-derived CD3+CD56+ NKT-like cells, was developed in this study. Four injectable polysaccharides used in clinics, including Lentinan (LNT), Bacillus Calmette-Guerin polysaccharide nucleic acids (BCG-PSN), ginseng polysaccharides (GPS), and Shengfu polysaccharides (SFPS), which all might benefit cancer therapy, were further validated by testing their effect on cell proliferation and cytotoxicity in vitro. This new evaluation system could discriminate the effects of the four polysaccharides. Cells treated for 4 days with either of the four polysaccharides were fewer than untreated cells. Upon 7-day treatments, plant- or bacteria-derived BCG-PSN, GPS, and SFPS induced higher level of IFN-γ, proportion of cells with a CD3+CD56+ phenotype, and cytolytic activity toward A549 cells, compared to controls. However, fungus-derived LNT yielded lower IFN-γ, proportion of CD3+CD56+ cells, and cytolytic activity than control conditions. Conclusively, cord blood-derived CD3+CD56+ NKT-like cells may represent a powerful tool to screen and evaluate the immunoregulatory potential of biological or chemical compounds for clinical developments and applications.

Objective: To explore self-reported experience for different outpatient modes in tinnitus patients. Methods: A observational study design was adopted. Tinnitus outpatients from the otological medicine and routine otolaryngology of our hospital fulfilling the study criteria were enrolled between October 2018 and January 2020. They were examined by semi-structured interview questionnaire. Groups were formed according to the different outpatient modes. The data were analyzed with SPSS 23.0. Results: 193 questionnaires were included; 118 questionnaires of otological medicine outpatients, 75 questionnaires of otolaryngology outpatients. Nearly half of the otological medicine patients (48.3%) said that they communicated for 5–10 minutes with their doctor and a routine otolaryngology outpatient service usually takes 3–5 minutes (61.3%). However, most patients expected a longer time. Patient satisfaction and return visit rate of otological medicine (95.5% and 43.9%) were better than routine otolaryngology (77.3% and 7.1%). The main factors of efficacy considered physician interpretation and guidance (66.7%). Conclusion: Both outpatient models can give patients a more satisfactory experience in the real world. Specialized outpatient service can better fit the shared decision making model, conducive to the rehabilitation and management of tinnitus. However, the long-term follow-up and management of patients still need to be scrutinized and improved continuously.

A process for preparing battery-grade lithium carbonate with lithium-rich solution obtained from the low lithium leaching solution of fly ash by adsorption method was proposed. A carbonization-decomposition process was used to remove impurities. First, primary Li2CO3 was treated by CO2 to get the more soluble bicarbonates. The decomposition of LiHCO3 produced insoluble Li2CO3 at 90 ℃. And Li2CO3 was smashed by air stream pulverization. The final precipitation yielded a high purity (99.6%) and homogeneous Li2CO3. Some factors affecting the production efficiency were investigated. The results showed that a liquid-solid ratio of 25: 1, a carbonization temperature of 25 ℃, an air velocity of 2 L/ min, and a stirring speed of 400rpm; a decomposition temperature of 90 ℃ and a stirring speed of 400rpm, a molar ratio of EDTA to Ca 2:1; an air pressure of 0.3Mpa and hot water washing precipitate (L/S mass ratio 2:1) promoted ions removal.