Objective:To preliminarily verify the feasibility of applying a wearable teleconsultation device in the diagnosis of common skin diseases.Methods:Totally, 600 outpatients with skin diseases were prospectively enrolled from the Department of Dermatology from November 1 to December 31 2023, and both on-site and remote diagnoses were performed. In the face-to-face clinic, there was one resident physician A and one chief physician B, while there was one resident physician C and one chief physician D in the remote consultation clinic. Using the diagnostic results of physician B in the face-to-face clinic as a reference, diagnostic agreement rates of physicians A, C, and D were calculated separately. Additionally, diagnostic results were compared between physician A and physician C, as well as between physician A and physician D. Statistical analysis was carried out using McNemar's test and Kappa consistency analysis.Results:Among the 600 patients with skin diseases, there were 285 males (47.50%) and 315 females (52.50%), and their age was 38.75 ± 21.12 years. The most common skin diseases were dermatitis and eczema (138 cases, 23.00%), followed by viral skin diseases (79 cases, 13.17%), urticaria (53 cases, 8.83%), hair diseases (53 cases, 8.83%), skin tumors (46 cases, 7.67%), fungal skin diseases (38 cases, 6.33%), etc. Compared with the physician B, the physician A made consistent diagnoses in 477 cases (79.5%) and inconsistent diagnoses in 123 cases (20.5%), the physician C made consistent diagnoses in 465 cases (77.5%) and inconsistent diagnoses in 135 cases (22.5%), and the physician D made consistent diagnoses in 568 cases (94.6%) and inconsistent diagnoses in 32 cases (5.33%). There was no significant difference in the diagnostic accuracy between the physician A and physician C ( P = 0.430), with a Kappa value of 0.852, indicating very strong consistency. The diagnostic accuracy of the physician D was significantly higher than that of the physician A ( P = 0.001), with a Kappa value of 0.274, indicating weak consistency. Conclusion:Chief dermatologists can provide medical guidance to resident physicians through a wearable teleconsultation system.

Background The chronic injury of the hematopoietic system caused by ionizing radiation (IR) is often ignored. The essential cause of this injury is the damage of hematopoietic stem and progenitor cells (HSPCs). Objective To explore the long-term effects of IR at different radiation doses and at different radiation fractions of the same radiation dose on HSPCs in the bone marrow of mice, and to provide a scientific basis for reducing the chronic damage to the hematopoietic system caused by IR. Methods A total of 16 male C57BL/6 mice aged 8-10 weeks were randomly divided into four groups that received different doses or fractions of total body X-ray irradiation, including 1.5 Gy×4 irradiation group (n=5), 3 Gy irradiation group (n=4), 6 Gy irradiation group (n=4), and non-irradiation group (n=3). Two months after irradiation, bone marrow cells from each mouse were collected and counted. The clone forming ability of bone marrow cells was analyzed by cobblestone area-forming cell (CAFC) assay. The proportion of HSPCs was measured by flow cytometry. The cell cycle of HSPCs was assessed by antigen identified by monoclonal antibody Ki 67 (Ki-67) and 7-amino-actinomycin D (7-AAD) double staining. The reactive oxygen species (ROS) levels of HSPCs were estimated with a 2,7-dichlorodihydrofluorescein diacetate (DCFDA) probe. The cellular senescence of HSPCs was evaluated with a 5-dodecanoylaminofluorescein di-β-D-galactopyranoside (C12FDG) probe. The expression of senescence related genes such as P16, P19, P21, and P27 was measured by real-time fluorescence quantitative PCR. Results There was no significant change in the numbers of bone marrow cells 2 months after different doses and fractions of radiation (P>0.05). The clone forming ability of bone marrow cells was significantly decreased after 3 Gy and 6 Gy irradiation when compared to non-irradiated mice (P<0.01). HSPCs responded inconsistently to different doses and fractions of irradiation. Overall, there was no significant change in long-term hematopoietic stem cells (LT-HSCs) proportion after irradiation (P>0.05), the proportions of hematopoietic progenitor cells (HPCs), hematopoietic stem cells (HSCs), short-term hematopoietic stem cells (ST-HSCs), and multipotent progenitors 2 (MPP2) increased after irradiation (P<0.05), and the proportions of LSK, MPP1, MPP3, and MPP4 cells decreased after irradiation (P<0.05); except for HPCs and MPP2, the proportion of HSPCs in G0 phase was decreased (P<0.05). The ROS production in HSPCs was increased significantly after 6 Gy irradiation (P<0.05), while the ROS levels after 3 Gy and 1.5 Gy×4 irradiation were similar to that of the non-radiation group (P>0.05). The cellular senescent proportion of HPCs, LSK, and HSCs increased after irradiation (P<0.05). The expression levels of senescence related genes P16, P19, and P21 in HSCs were significantly increased (P<0.05). Conclusion The responses of HSPCs in bone marrow to IR vary depending on doses and fractions of irradiation. Increased ROS production and cellular senescence may be involved in the damage process of HSPCs under radiation settings.

Objective:To investigate the imaging and clinical characteristics of posttransplantation lymphoproliferative disorders (PTLD) after liver transplantation in children.Methods:From February 2017 to November 2020, the imaging and clinical data of 17 children with PTLD after liver transplantation confirmed by pathology or clinical diagnosis were retrospectively analyzed in Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University. The site, range, density/signal/echo of the lesions were observed.Results:The mean age at transplantation was 8 (7, 11) months, and 14 patients were younger than 1 year old. The interval between liver transplantation and PTLD diagnosis was 22 (10, 34) months, ranging from 3 to 54 months. The interval was less than 1 year in 6 patients (early onset) and equal or greater than 1 year in 11 patients (late onset). Fifteen patients had Epstein-Barr virus infection. Among the 12 pathologically confirmed PTLD cases, 8 cases were diffuse large B-cell lymphoma, 3 cases were Burkitt lymphoma, and 1 case was reactive plasma cell hyperplasia. Among the 17 children with PTLD, 8 cases demonstrated involvement of lymph nodes and 16 cases had extranodal involvement. The latter included 15 cases of abdominal involvement. Abdominal sites involved included small intestine in 14 cases, colon in 7 cases, mesentery in 4 cases, kidney in 3 cases, liver in 2 cases, abdominal lymph nodes in 2 cases, peritoneum in 1 case, and stomach in 1 case. The sites of extra-abdominal involvement included lymph nodes in 7 cases, lung in 3 cases, skull in 1 case, brain in 1 case, pleura in 1 case, chest wall in 1 case, and nasopharynx in 1 case. The most common abdominal imaging abnormalities were thickening of the intestinal wall, eccentric mass and dilation of the lumen. Both small intestines and colons could be involved, and the former more commonly. Multiple masses were found in patients with liver and kidney involvement. The most common imaging manifestation of PTLD outside the abdomen was lymph node enlargement, which was found in 7 cases, and the most common was in the neck. The manifestation was shorter diameter of lymph nodes>10 mm, uniform density and signal, with mild enhancement.Conclusions:PTLD can occur months to years after liver transplantation in children, which can affect many parts of the whole body. Extranodal lesions are more than intranodal lesions. Abdominal involvement is most common in PTLD, and the infection rate of EB virus is high. Combined with medical history, EB virus infection status and imaging examination are helpful for early diagnosis.

Objective:To investigate the effects of meditation therapy on fear of disease progress and mental health among acute myocardial infarction (AMI) patients.Methods:Totally, 120 cases of acute myocardial infarction patients admitted to Affiliated Hospital of Jiangnan University were divided into experimental group and control group according to the enrolled time. 60 patients with AMI treated from June to November 2018 served as the control group and 60 patients with AMI treated from January to May 2019 served as the experimental group. The patients in the control group received routine nursing, the experimental group carried out 4-week meditation therapy based on the routine nursing. Before and after intervention, the effect was assessed by Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and Symptom Checklist-90 (SCL-90), respectively.Results:After intervention, the physical health and social family function dimension scores in FoP-Q-SF as well as total FoP-Q-SF scores were (12.78±3.47), (10.45±2.44), (23.24±4.25) points, significantly lower than in the control group (14.33±2.72), (11.59±2.82), (25.91±3.89) points, the difference was statistically significant ( t values were 2.623, 2.277, 3.499, P<0.05); the scores of somatization, compulsion, anxiety, depression and total SCL-90 were (1.26±0.19), (1.42±0.23), (1.19±0.28), (1.20±0.16) and (121.81±9.59) points, significantly lower than (1.83±0.25), (1.68±0.37), (1.82±0.41), (1.71±0.33) and (145.85±9.12) points in the control group, the difference was statistically significant ( t values were from 4.580 to 13.659, P<0.001). Conclusion:Meditation therapy can effectively decrease disease progress and promote mental health in patients with acute myocardial infarction.

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Objective: To investigate the radiographic manifestations and clinical relevance to central nervous system complications of leukemia (CNSCL)in children. Methods: The CT and magnetic resonance imaging(MRI) fin-dings and clinical features of 49 pediatric patients with CNCSL in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from May 2010 to June 2018 were retrospectively analyzed. Results: (1) Cerebrovascular abnormalities in 23 cases included hemorrhage(20 cases), infarction(2 cases) and sinus thrombosis(1 case). One case of epidural hematoma and 19 cases of intracerebral multiple bleeding were seen in the hemorrhage group, which demonstrated high-density on CT and different signal on MRI as time went by.Microhe-morrhage displayed as low signal on susceptibility weighted imaging.(2) Among 23 cases of leukemic infiltration, the dura and/or skull were involved in 18 cases, which presented as fusiform or mass, with high density on CT, low signal on T1WI, intermediate signal on T2WI and strong enhancement; 6 leptomeningeal infiltration demonstrated as meningeal thickening and enhancement; 2 parenchymal involvement manifested with high-density mass; 2 oculomotor nerve and 1 optic nerve infiltration demonstrated thickening and enhancement.(3)White matter disease was seen in 2 cases, with hyper-intensity on T2WI.(4) One case of secondary tumor was glial tumor in the brainstem. Conclusions The radiographic manifestations of CNCSL in children are various.CT and MRI are of important diagnostic values.Choosing the best imaging examination method and sequence according to clinical symptoms and test results can provide more valuable information for clinical diagnosis and treatment.

Objective? To investigate the coping style of postpartum patients with pelvic floor dysfunction and to analyze the effect of family support on coping style of postpartum women with pelvic floor dysfunction. Methods? From May to October 2017, we selected postpartum patients with pelvic floor dysfunction of department of gynaecology in the First Affiliated Hospital of Wenzhou Medical University as subjects by convenience sampling. All of the patients were investigated with the Simplified Coping Style Questionnaire (SCSQ) and Perceived Social Support form Family(PSS-Fa) to understand the coping style and family support of patients. The correlation between them was explored. A total of 200 questionnaires were sent out and 186 valid of them were collected with 93.0% for the valid rate. Results? Among 186 postpartum patients with pelvic floor dysfunction, the score of positive coping was (1.56±0.73) lower than that of norm; the score of negative coping was (1.85±0.65) higher than that of norm; the differences were statistical (P＜0.05); the score of family support was (3.01±0.68) having a positive correlation with positive coping (r=0.45,P＜ 0.01) and a negative correlation with negative coping (r=-0.25,P＜ 0.01). Hierarchical regression analysis showed that family support was the influencing factors of positive coping among postpartum women with pelvic floor dysfunction after controlling general information. Conclusions? Postpartum women with pelvic floor dysfunction have negative coping style. Family support is the main influencing factor of positive coping. We should increase the publicity of pelvic floor dysfunction, encourage patients to cope positively and to seek family support properly.

Objective To investigate the efficacy and safety of endoscopic radiofrequency ablation on patients with advanced stage unresectable cholangiocarcinoma. Methods Clinical data of 45 cases with unresectable cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography from October 2011 to October 2014 were collected. The patients were divided into two groups: the group A included 23 cases undergoing radiofrequency ablation, and the group B included 22 cases without ablation. The occurrence of complications, the postoperative levels of CA19-9 and total bilirubin ( TBIL) in blood plasma, the patency of stents, and survival period were compared between the two groups. Results All of the 45 patients completed treatment, and no perforation, bleeding and bile leakage occurred. In the group A, 2 patients got fever and 5 patients got pancreatitis after operation, and the number in the group B was 3 and 4, respectively. Their symptoms disappeared after suitable treatment. The postoperative pain rate in group A ( 21. 7％, 5/23) was significantly lower than that of group B ( 54. 5％, 12/22,χ2=5. 148, P=0. 023) . At 7th day of post-operation, the levels of CA19-9 in the two groups were 960. 5 ± 362. 7 U/mL and 979. 3 ± 378. 1 U/mL, respectively, and the levels of TBIL were 95. 25±28. 36μmol/L and 98. 75±20. 76μmol/L, respectively, which were not significantly different between the two groups( P>0. 05) , but were significantly decreased compared with the levels of pre-operation ( P<0. 05) . The patency of self-expandable metal stent in group A ( 60. 0％, 6/10) was significantly higher than that of group B ( 10. 0％, 1/10,χ2=5. 495, P=0. 019) 9 months after operation. Kaplan-Meier analysis showed that the median survival time in the two groups had no statistical difference [ 271. 0 days ( 95％CI: 168. 4-373. 4days ) VS 245. 0 days ( 95％CI:200. 3-289. 7 days), χ2=1. 380, P=0. 258]. Conclusion For the patients with advanced unresectable cholangiocarcinoma, endoscopic radiofrequency ablation is able to relieve cancer pain, prolong the patency of stents, and improve the life quality, which deserves clinical applications.

Objective To explore the value of preventive nursing process in the management of incontinence-associated dermatitis (IAD) in the department of neurology. Methods From January 2016 to May 2016, 38 hospitalized patients with neurological disorders were set as the control group . The control group was given routine nursing according to traditional way, and another 38 patients hospitalized from June 2016 to October 2016 who were set as the observation group were implemented with IAD preventive nursing process, including the training of nurses, risk factor evaluation,measures implented and IAD health education. The two groups were compared in terms of incidence, severity and harms of IAD. Results The incontinence incidence of IAD in the observation group was lower than that of the control group (P<0.05). The IADS score of the observation group was significantly lower as well (P<0.05). Conclusion Preventive nursing process can help to reduce the risk and severity of IADS in the patients with urinary incontinence in neurology department.

Objective To improve the understanding,the incidence and imaging findings of tuberous sclerosis complex (TSC) combined with cardiac rhabdomyomas (CRs) in fetuses and infants.Methods The imaging findings of 9 infants with TSC combined with CRs and 4 fetuses with TSC combined with CRs from our hospital between June,2006 and November,2013 were retrospectively reviewed.Results The brain MRI of 9 with TSC combined with CRs showed bilateral subependy-mal nodules,subcortical white matter and cortical tubers.Subependymal nodules were isointense or hypointense on spin-echo T1WI and hypointense or hyperintense on spin-echo T2WI.Subcortical white matter and cortical tubers were hypointense or hyperintense on T1WI and hypointense or hyperintense on T2WI.There was varying contrast enhancement.Three of 9 infants presented single cardiac tumor and 6 of 9 infants presented multiply cardiac lesions.CRs on contrast cardiac MRI showed round solid masses in ventricular septums,ventricular outflow tract,ventricle or atrial free walls.The masses were isointense relative to the cardiac muscles on T1WI,T2WI and B-TFE sequence.There was varying contrast enhancement.Four fetuses with TSC on ultrafast MRI showed bilateral multiply subependymal nodules,the nodules were isointense or hyperintense on TFE T1WI and isointense or hypointense signals on SSTSE or B-FFE sequence,Four fetuses with CRs showed isointense to hyperintense solid masses in ventricular septums on ultrafast MRI,ventricle or atrial free walls on B-FFE sequence and SSTSE sequence images.Conclusions TSC in infant and fetus is a kind of neurocutaneous syndrome,usually combines with CRs.Fetal ultrafast and routine MRI is a useful method to make a definite diagnosis for cranial and cardiac lesions.The development of MRI might improve the timeliness and accuracy of the assessment for this disease.