Fetal heart sound is nonlinear and non-stationary, which contains a lot of noise when it is colleced, so the denoising method is important. We proposed a new denoising method in our study. Firstly, we chose the preprocessing of low-pass filter with a cutoff frequency of 200 Hz and the resampling. Secondly, we decomposed the signal based on empirical mode decomposition method (EMD) of Hilbert-Huang transform, then denoised some selected target components with wavelet soft threshold adaptive noise cancellation algorithm. Finally we got the clean fetal heart sound by combining the target components. In the EMD, we used a mask signal to eliminate the mode mixing problem, used mirroring extension method to eliminate the end effect, and referenced the stopping rule from the research of Rilling. This method eliminated the baseline drift and noise at once. To compare with wavelet transform (WT), mathematical morphology (MM) and the Fourier transform (FT), the SNR was improved obviously, and the RMSE was the minimum, which could satisfy the need of the practical application.
Algorithms ; Fetal Heart ; physiology ; Heart Sounds ; Humans ; Signal Processing, Computer-Assisted ; Signal-To-Noise Ratio ; Wavelet Analysis

Objective To investigate the differential diagnosis of Reye syndrome and the characteristics of primary carnitine deficiency,and to provide diagnostic strategy for similar cases.Methods There was a case presented with fever,poor response,convulsions and hepatomegaly hospitalized in Wuhan Children's Hospital,and the clinical manifestations were described,the physical examination was comprehensively conducted,the auxiliary examination results were recorded,some pediatric specialists from ICU,neurology department,genetic metabolic department,digestive system department were invited to discuss the case.The treatment was adjusted according to the suggested opinions;the treatment effects and the final diagnosis were tracked.Results The primary diagnosis of the case was central nervous system infection or toxic encephalopathy at the time of admission,but Reye syndrome could not be excluded.Although the cerebrospinal fluid test and brain MRI examination detected nothing abnormal,liver function suggested alanine aminotrans ferase ALT increase,blood sugar decrease,the liver volume increase,which was detected by liver ultrasound.Blood amino acids examination revealed the carnitine level decreased,and it was confirmed as primary carnitine deficiency in the end.L-carnitine was used to treat the disease,and its effect was good.Conclusions Great importance should be attached to children with onset age,physical check-up,and multidisciplinary cooperation.Use monism to explain the illness and the auxiliary inspection as far as possible,so that it can get early diagnosis and treatment,and the outcome is good.

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Objective: To evaluate the global scientific output of PTG research and explore their hotspots、frontiers and trend from 2008 to 2018, using bibliometric methods. Methods: Based on web of science core collection database, the literature with keywords"Posttraumatic Growth or Post-traumatic Growth"in topic and time limit set between 2008 and 2018 were searched, and 1668 literature were accepted, using the CiteS pace to depict the hot keywords, cited references. Results: The subject domains of posttraumatic growth could be divided into traumatic event, growth and change, and influence factors of PTG. Keywords and references analysis indicated that the quality of life and breast cancer were the research hotspots, whereas physiological indicators and research tools of PTG were the frontiers. The United States of America ranked highest in the countries with most citations, and the leading institute was the North Carolina University. Publications were mainly in Journal of Traumatic Stress. Conclusion: Future research could focus on the exploration of PTG intervention program, such as qualitative research and longitudinal study to trace its dynamic change.

Objective To compare the performances of four commercially available LINAC daily QA instruments.Methods The dosimetric stability of a LINAC including central axis output,flatness and symmetry were verified and fine-tuned using a 3-dimensional water phantom,dosimeters and ionization chambers.The baseline of the four instruments including LINA-C,QUICK-C,BEAM-C and QA3 were set thereafter.Daily measurements of LINAC were conducted with these instruments respectively and the results were compared.Arbitrary errors (CAX and SYM) beyond TG-142 tolerances were introduced to the LINAC to test the sensibilities of each instrument in detecting these changes.Results Relative to the baseline that were measured by the 3-dimensional water phantom and dosimeters,the results monitored by the four instruments were comparable.The maximum disparities of the CAX,FLAT,and SYM were 0.5％ (LINA-C),-0.45％ (QUICK-C),and 0.5％ (BEAM-C),respectively.All checkers detected the known errors successfully.Conclusions The stabilities of all the four evaluated instruments met the requirements of daily QA for LINAC.LINA-C verifies CAX only.QUICKE-C,BEAM-C and QA3 can be used to perform all the daily QA protocols as suggested by AAPM TG 142 report.They also provide unique additional functions.The setup of baseline determines if the morning checkers could measure the LINAC dosimetric parameters correctly.When an error is alarmed by the morning checker,it is recommended to verify the performance of the instrument first rather than recalibrating the LINAC immediately.

Objective To explore the Monte Carlo calculation methods for the absolute dose calibration and output factor of 6 MV flattening-filter ( FF) and flattening-filter free ( FFF) photon beams based on TrueBeam accelerator .Methods The BEAMnrc code was used to model the LINAC head of FF and FFF modes.The BEAM_up covers the components from the target to the monitor chamber , and BEAM_down includes the structures beneath the chamber , the dose deposit to the monitor chamber contributed by the incidence electrons and scattered particles from the secondary collimators were calculated respectively .The incidence electron-induced dose at certain depths on the central axis were simulated by means of the DOSXYZnrc code .By means of dose calibration equation , the calibration factor for the standard field (10 cm ×10 cm) and the output factors for various fields (1 cm ×1 cm-40 cm ×40 cm) were computed respectively .Results For the 6 MV FF and FFF beams under the standard 10 cm ×10 cm field, 1 MU equals to 7.747 ×1013 ±3.099 ×1011 and 3.248 ×1013 ±1.624 ×1011 electrons to the target , respectively , which deposited 21.53 and 35.01 cGy to the monitor chamber of the virtual accelerator respectively .The difference between the simulated and calculated output factors were 0.72%±1.4%and 0.56%±0.78%for FF and FFF , respectively .Conclusions The model generated and measured output factors agree well , indicating the good accuracy of the dose calculation by the model , which would provides basis for further clinical dosimetric studies .

Premature infants are at high risk of vitamin D deficiency, thereby commonly treated with vitamin D supplementation after birth. However, the nutritional status of vitamin D in premature infants is not optimistic due to the fact of high incidence of vitamin D deficiency. Studies have found that vitamin D is associated with a variety of diseases in premature infants, including metabolic bone disease, respiratory distress syndrome, bronchopulmonary dysplasia, neonatal necrotizing enterocolitis and infection. Clinicians should be aware of the importance of vitamin D for premature infants and prescribe vitamin D supplementation as early as possible with the dose reference of serum 25-hydroxyvitamin D level.

Objective:To investigate the clinical value and age stratification significance of anti-mullerian hormone (AMH) combined with sex hormone in the diagnosis of patients with polycystic ovary syndrome (PCOS).Methods:The clinical data of 164 patients with PCOS(PCOS group) and 120 healthy women(control group) were retrospectively chosen from January 2015 to December 2018.The age, sex hormone index levels and AMH levels of the two groups were compared.The clinical efficacy of single index and combined index detection in the diagnosis of PCOS were analyzed.The correlation between AMH level and age, sex hormone index was evaluated and the influence of age stratification on the diagnosis of PCOS was observed.Results:The levels of AMH, T, LH and LH/FSH ratio in the PCOS group were (62.90±5.19)pmol/L, (1.36±0.55)nmol/L, (12.86±2.4)IU/L, (2.27±0.86), respectively, which were significantly higher than those in the control group [(27.22±3.72)pmol/L, (0.87±0.30)nmol/L, (6.41±1.18)IU/L, (1.15±0.53)] ( t=7.38, 3.76, 5.15, 3.89, all P<0.05). The sensitivity of AMH in the diagnosis of PCOS was significantly higher than LH and LH/FSH(χ 2=5.72, 14.10, all P<0.05). The sensitivity of AMH+ T, AMH+ LH and AMH+ T+ LH were 89.02%, 87.80%, 95.12%, respectively, which were significantly higher than AMH alone (80.49%)(χ 2=5.67, 4.33, 10.94, all P<0.05). There was no significant ststistically difference among AMH, T, LH and LH/FSH in the diagnosis of PCOS(χ 2=0.38, P>0.05). There was no significant ststistically difference in the specificity of AMH alone, AMH+ T, AMH+ LH, AMH+ LH/FSH and combination of AMH+ T+ LH in the diagnosis of PCOS(χ 2=0.45, P>0.05). The AUC of AMH in diagnosis of PCOS was 0.86, which was significantly higher than T, LH and LH/FSH(0.714, 0.765, 0.783)( Z=2.09, 2.43, 2.20, all P<0.05). Spearman correlation analysis showed that there was positive correlation between AMH level and T, LH, LH/FSH in PCOS group ( r=0.27, 0.25, 0.33, all P<0.05). There was negative correlation between AMH level and age in healthy group( P>0.05). The critical value of AMH in diagnosis of PCOS was decreased with the increase of age.The sensitivity, specificity and ROC-AUC of AMH in 25-29 years old group and 30-37 years old group were higher than whole population( r=-0.33, P<0.05). Conclusion:The combination of AMH+ T, AMH+ LH or AMH+ T+ LH can improve the diagnosis sensitivity of PCOS, but the specificity is similar to AMH alone; then age stratification for the AMH critical value can increase the diagnosis accuracy of PCOS.

Objective:To analyze clinical characteristics of patients with novel coronavirus Omicron variant of concern infection, and to provide practical data and experience for subsequent clinical treatment.Methods:A retrospective analysis was performed for the clinical data of 5 cases with novel coronavirus Omicron variant of concern infection treated in the First Hospital of Jiaxing from December 18, 2021 to January 28, 2022. The patients' clinical data were recorded, including gender, age, length of hospital stay, vaccination status, clinical symptoms, laboratory indicators [white blood cell count (WBC), lymphocyte count (LYM), eosinophil count (EOS), hypersensitivity C-reactive protein (hs-CRP), novel coronavirus antibody immunoglobulin (IgG and IgM)], chest CT, treatment course and disease outcome.Results:All 5 patients were male, aged 24-37 years old. Four patients were vaccinated with novel coronavirus vaccine (one patient received 3 doses of the vaccine and 3 patients received only the first 2 doses of the vaccine), and no infection was found in chest CT. Laboratory examination showed that WBC, LYM, EOS and hs-CRP levels were normal, and only showed mild symptoms of upper respiratory tract infection. One patient was not vaccinated with novel coronavirus vaccine, and signs of viral pneumonia could be seen in chest CT, laboratory examination showed that WBC and hs-CRP levels increased, suggesting that bacterial infection, fever, cough, sputum and other respiratory symptoms were obvious, and the treatment time was long. All 5 patients were treated with Chinese medicine Lotus antipyretic and Baihu Yinqiao decoction based on routine antiviral therapy.Conclusions:Patients with novel coronavirus Omicron variant of concern infection vaccinated with the novel coronavirus vaccine have milder clinical symptoms, with less obvious chest CT findings and faster recovery. Chinese medicine Lotus antipyretic and Baihu Yinqiao decoction has obvious therapeutic effect on such patients.

Objective:To preliminary investigate the impact of the diagnosis-related groups (DRG) payment method reform on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders (NMOSD), and to propose potential improvement strategies.Methods:A single-center, retrospective study. From October 1, 2020, to September 30, 2022, 44 hospitalized medical insurance patients with acute-phase NMOSD diagnosed and treated at the First Affiliated Hospital of Northwest University (Xi'an First Hospital) were included in the study. Among them, there were 11 males and 33 females, with an average age of (40.8±20.2) years. According to the implementation time of DRG payment, patients were divided into two groups: group A, which consists of cases one year before the implementation of DRG payment from October 1, 2020 to September 30, 2021, and group B, which consists of cases one year after the implementation of DRG payment from October 1, 2021 to September 30, 2022, with 20 and 24 cases, respectively. Detailed information such as hospitalization duration, treatment methods, and hospitalization costs of the two groups of patients was collected. Comparative analysis was conducted on hospitalization costs and treatment methods between the two groups. For intergroup comparison, t-test was used for normally distributed data, and Mann-Whitney U test was used for skewed distributed data. Results:Among the 44 patients, 5 cases (5/24, 20.8%) received plasma exchange (PE) treatment, all of whom were in group B. The numbers of patients who received and did not receive intravenous immunoglobulin (IVIG) treatment were 9 and 11 in group A, respectively, and 7 and 12 in group B (except for 5 cases who received PE treatment), respectively. Compared with group A, there was no significant decrease in hospitalization duration ( t=0.004) and total hospitalization costs ( Z=0.036), as well as costs for western medicine ( Z=0.036), examinations ( Z=0.011), laboratory tests ( Z=0.040), treatments ( Z=0.017), and nursing ( Z=3.131) in group B, and the differences were not statistically significant ( P>0.05). For patients receiving PE treatment, except for the cost of western medicine ( Z=0.062, P=0.804), the other costs ( Z=8.288, 5.013, 11.400, 10.925, 9.126) were significantly higher than those of patients not receiving PE treatment, and the hospitalization duration ( t=20.474) was significantly prolonged, with statistically significant differences ( P<0.05). The total hospitalization costs of patients receiving IVIG treatment were significantly higher than those not receiving IVIG treatment in both group A and group B, with statistically significant differences ( Z=7.690, 10.314; P<0.05). There was no statistically significant difference in the comparison of total hospitalization costs between patients receiving IVIG treatment in group A and group B ( Z=0.137, P>0.05). Conclusions:There is no significant decrease in various hospitalization costs of NMOSD medical insurance patients in Xi'an after the implementation of DRG payment, especially for patients receiving PE treatment. It is suggested to optimize the rate stratification of NMOSD patients when implementing DRG payment methods.