Objective To design a FPGA(Field-Programmable Gate Array)-based image & voice signal optical transmission system,which can accomplish video & audio frequency long-distance transmission.Methods FPGA was used as the main processing chip.High speed transceiver TLK2501 and SFP optical module were also used to realize high-speed serial fiber transmission.Results A non-compressed digital video optical fiber transmission system based on the TDM technology was designed.Conclusion The system achieves the real-time transmission of video and voice signals,thus greatly improving the accuracy of the examination and providing references for diagnostic experts.

Objective To evaluate the consistency of psoriasis-involved body surface area (BSA) measurement among raters from different clinical centers after training in a new standard operating procedure (SOP) for involved BSA measurement,so as to provide a method for the evaluation of psoriasis with high accuracy and operability.Methods Firstly,two raters from Guangdong Provincial Hospital of Chinese Medicine (GPHCM) independently and alternately assessed the disease severity in 40 patients with psoriasis after systematic training in the BSA-SOP.Then,one of the raters from GPHCM and 11 raters from 11 subcenters separately assessed the disease severity in 209 patients with psoriasis by using the BSA-SOP,and the consistency was evaluated by using intraclass correlation coefficient (ICC).Results There was a very high degree of consistency in involved BSA values between the 2 raters from GPHCM (ICC =0.989,95％ confidence interval:0.979-0.994).The consistency of involved BSA values for the assessment of psoriasis severity was also high among the rater from GPHCM and the raters from 11 subcenters (ICC ranging from 0.849 to 0.998).Conclusion The raters from different centers showed high consistency of involved BSA measurement for the assessment of psoriasis severity after training in the new BSA-SOP,so the BSA-SOP can serve as a reliable reference for multicenter clinical studies.

Objective To provide a suggestion for physicians participating clinical research of how to write a clinical trial protocol correctly and standardly in the course of clinical trial design.Methods By exploring clinical trial protocols,we analyzed their common problems in the methodological details and the reporting standards with respect to typical cases.Results The common problems in the clinical trial protocols are:lack of clear outline when selecting the research subject;incorrect selection of research type;lack of comprehensiveness and accuracy of PICO elements;inappropriate application of methodologies in randomization and blinding;absence of statistical analysis plan;incorrect calculation of sample size;non-standard format of the protocol etc.Conclusions Many clinicans do not have enough understanding of the key points in designing the clinical trial and writing the protocol.However,the quality of the clinical trial protocol determines success or failure of the whole study.Therefore,carefully handling the technical details of PICO elements,methodology and statistics application,and writing the protocol in accordance with the CONSORT (Consolidated Standards of Reporring Trials) 2010 and SPIRIT (Standard Protocol Items:Recommendations for Interventional Trials)2013 Statements,are the key points that each clinical researcher should pay attention to.

Nowadays,the prevalence of nonalcoholic fatty liver disease(NAFLD)is constantly rising in China and globally,and its incidence rate is increasing year by year,which has seriously affected human life and health.Lipophagy is molecular chaperone-mediated autophagy and has the functions of promoting lipolysis,maintaining the lipid homeostasis of hepatocytes,and alleviating hepatocyte fatty degeneration.Lipophagy has three main processes of lipid droplet catabolism,lipid droplet autophagy,and fatty acid β-oxidation,which are regulated by key genes,receptors,and enzymes.Currently,important advances have been achieved for the intervention methods of traditional Chinese medicine,Western medicine,diet,and exercise in the research on lipophagy,which provides new perspectives for the prevention and treatment strategies for NAFLD.

Objective To explore the CT manifestations and clinical features of checkpoint inhibitor-related pneumonitis(CIP).Methods Chest CT images and clinical data of 34 patients with CIP in Ningbo No.2 Hospitael were collected to retrospectively analysis.According to the site of tumor occurrence,22 patients were divided into lung cancer group and 12 patients in other malignant tumor group,and the differences in CT manifestations between two groups were compared.Results Cough(70.59％)and dyspnea(52.94％)were the common clinical symptoms.CIP occurred earlier and over a greater time span in lung cancer group 114.5(41.50,281.50)d than in other maligment tumor group 144(55.75,226.25)d.Eosinophil count was significantly higher only in other maligment tumor group(P=0.009).After hormonal therapy 18 patients improved,8 were stable and 8 progressed or even died.CT signs were prevalent in ground glass shadow(70.59％)and solid shadow(76.47％),and the imaging pattern was dominated by organic pneumonia pattern(47.6％),which was not related to type of primary tumor,and some of them could show nodular granulomatous reaction.Compared to lung cancer group,the other maligment tumor group was more likely to exhibit symmetrical infiltration(58.33％)distribution.Conclusion The clinical features of CIP are nonspecific,compared with other patients with primary malignancies,lung cancer patients are more likely to develop CIP,which is difficult to relieve after treatment,and are easy to develop severe disease.

Objective The purpose of this study was to examine the predictive value of elevated cardiac troponin I (cTnI) and Score for the Targeting of Atrial Fibrillation (STAF) in the diagnosis of cardiogenic cerebral infarction. Methods Two hundred twenty-three patients with acute ischemic stroke were recruited in the study including 38 patients in cardiogenic cerebral infarction (CCI) group and 185 in non-cardiac cerebral infarction (NCCI) group. Clinical data were collected. Chemiluminescence immunoassay was used to detect serum cTnI concentrations in patients and STAF scores were calculated. The clinical baseline data of the two groups were compared. A receiver operating characteristic (ROC) curve was used to determine the boundary value of cTnI and STAF scores in diagnosing CCI and in analyzing their predictive value. Results In the CCI group, the patients were older with higher frequency in atrial fibrillation and ischemic heart disease. Moreover, the NIHSS scores, the value of cTnI and STAF scores were significantly higher in CCI group than in the NCCI group (P＜0.05). The area under the ROC curve of STAF scores was 0.954, and its 95%CI was between 0.924 and 0.985. The area under the ROC curve of the cTnI value was 0.852, and its 95% CI was between 0.788 and 0.916. The cutoff of STAF scores was 4 points, with a sensitivity of 92.1% and a specificity of 89.2%. The cutoff of cTnI value was 0.0085ng/ml, with a sensitivity of 73.7% and a specificity of 84.9%. Conclusion Serum cTnI value and STAF score have a good predictive value for CCI, and STAF score have a higher value than serum cTnI in predicting the diagnosis of CCI. Clinically, serum cTnI and STAF score may be helpful for etiology classification of acute ischemic stroke.

Objective:To evaluate the effect of eye-covering pretreatment on acute delirium in ophthalmology preschool-age children who underwent binocular and monocular surgery by general anesthesia.Methods:The 300 preschool-age children who underwent general anesthesia of elective ophthalmic surgery in the Second Affiliated Hospital, Zhejiang University School of Medicine, from August 2019 to February 2021 were selected as the research object. They were divided into control group and blindfold group with 150 cases each by random number-table. Children in the control group received regular education on cartoon animation videos before surgery; children in the blindfold group received eye-covering pretreatment on the basis of cartoon animation videos(monocular surgery with monocular cover, binocular surgery with binocular cover). The Modified Yale Preoperative Anxiety Scale (m-YPAS) , the Nursing Delirium Screening Scale(NU-DESC), the incidence rate of delirium and the score of postoperative nursing difficulty were compared between two groups.Results:The 271 cases were completed in this study, including 129 cases(monocular surgery 66 cases, binocular surgery 63 cases) in the blindfold group and 142 cases (monocular surgery 73 cases, binocular surgery 69 cases) in the control group. The preoperative m-YPAS score, the postoperative NU-DESC score, the incidence rate of acute delirium and postoperative nursing care difficulty score of monocular surgery in the blindfold group , monocular surgery was (40.28 ± 15.02) points, 1.00 (0.00, 2.00) points, 27.3%(18/66), 1.00 (1.00, 2.00) points,and binocular surgery was (41.69 ± 16.35) points, 1.00 (0.00, 2.00), 39.7%(25/63), 1.00(1.00, 2.00); in the control group, monocular surgery was (46.28 ± 15.76) points, 2.00 (1.00, 3.00) points, 67.1% (49/73), 2.00 (1.00, 3.00) points, and binocular surgery was (47.77 ± 14.82) points, 3.00 (2.00, 4.00) points, 82.6% (57/69) and 2.00 (1.50, 3.00) points respectively. The difference between the two groups was statistically significant ( t= -2.29, -2.24, Z values were -5.74 - -2.95, χ2= 32.94, 25.78, all P<0.05). The preoperative m-YPAS score, the postoperative NU-DESC score, the incidence rate of acute delirium and postoperative nursing care difficulty score of monocular surgery patients in the blindfold group had no significantly statistical difference with that of binocular surgery patient (all P>0.05) . Conclusions:Monocular/ binocular eye-covering pretreatment can effectively decrease the preoperative m-YPAS score, the postoperative NU-DESC score, incidence rate of acute delirium and the postoperative nursing care difficulty in preschool-age children who underwent general anesthesia both monocular or binocular surgery. There was no difference in the application effect of monocular or binocular surgery.

Mitochondrial DNA depletion syndrome (MDS) is a group of genetic diseases in which the number of mitochondrial DNA copies is severely decreased due to mutations in nuclear genes and affects energy metabolism in several tissues and organs. Renal involvement of MDS is often manifested as proximal renal tubular disease, while MDS combined with nephrotic syndrome is rare. This paper report a case of child with mitochondrial DNA depletion syndrome 8A (MTDPS8A) complicated with nephrotic syndrome due to compound heterozygous variants of RRM2B gene. The child mainly presented with epilepsy, auditory dysfunction, and nephrotic syndrome as clinical manifestations. The histopathological findings indicated focal segmental glomerulosclerosis (collapsing variant). The child was treated with glucocorticoid combined with immunosuppressant, energy support and symptomatic treatment, while the effect was not significant. He continued to experience progressive deterioration of renal function during the six-month follow-up period and had a long-term peritoneal dialysis for maintenance therapy.

Objective:To retrieve, appraise and summarize the evidence for the airway humidification management of the inpatient with laryngectomy and tracheotomy but nonmechanical ventilation and to provide references for the clinical nursing.Methods:The evidence question was raised based on the study objective. The evidence was retrieved from some databases according to the evidence pyramid model during inception to December, 2018. The literature types included clinical practice guideline, evidence summary, best practice information sheet, recommended practice and systematic review. The quality of the literature were evaluated by the suitable evaluated tool based on their types. The level and recommedation grade of the evidence were appraised by the suitable tools of JBI.Results:Thirteen studies were recruited, including one clinical practice guideline, two evidence summaries, one best practice information sheet and nine systematic reviews. Totally thirteen items of best evidence were summarized and generalized to four categories including assessment, method, liquid and operation of airway humidification.Conclusion:The evidences of the studies are scientific and practical, but on the one hand, it is recommended that when applying the evidences in clinic, it is necessary to assess the clinical situation and chose the proper evidence. And on the other hand, there are lacking of some evidences of airway humidification and the level of some evidences is low. So it needs to create more high level evidences.

Objective:To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume (CTV) and organs at risk (OAR) of intensity modulated proton therapy (IMPT) for localized prostate cancer during the treatment planning and daily treatment.Methods:Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the "Proton Therapy System" (SAPT-PS-01) registered clinical trial were retrospectively analyzed. All patients were male and the median age was 72 years old. A total of 30 sets of IMPT plans were obtained. Based on the planning CT (30 sets) and weekly verification CT during treatment (172 sets), bladder volume, CTV and OAR dose parameters were collected. Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans, and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results:The V 95% of CTV1 and CTV2 were both 100.0%±0.0% in IMPT plans. Bladder volume was significantly negatively correlated with D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder ( P<0.001, 0.003, <0.001, <0.001,<0.001), and D mean, V 50 Gy(RBE) of the small intestine (both P<0.001). During treatment, bladder D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE)( P<0.001, 0.001, <0.001, <0.001, <0.001), rectal D mean, V 50 Gy(RBE), V 40 Gy(RBE) (all P<0.001), small intestine D mean, V 50 Gy (RBE) (both P<0.001) of patients with bladder volume increase >20% compared to baseline were significantly decreased compared to those in IMPT plans. But CTV1 V 100%, and CTV2 V 95% were significantly decreased too( P=0.029, 0.020). In the bladder volume decreased>20% patients, the D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder were significantly increased compared to those in IMPT plans (all P<0.001). However, a bladder volume reduction of ≤20% and increase of ≤20% from baseline had no significant impact on CTV and OAR dosimetric parameters during treatment. Conclusions:For patients with localized prostate cancer undergoing proton therapy, a certain bladder volume should be ensured during planning CT scans. During the daily treatment, the bladder volume should be maintained between 80%-120% of the baseline level to ensure CTV coverage and good dose sparing to OAR.