Standardized patient (SP) has been widely used for medical teaching and assessment in medical colleges at home and abroad. Pediatric consultations are mostly directed toward parents, so in pediatric education, SP is usually referred to as standardized family (Sfam), which is trained to portray the patient's family members. At present, the development of Sfam in pediatric teaching in China is relatively slow. Based on the characteristics of pediatric teaching, the paper summarizes the necessity of Sfam, the application of different types of Sfam, the integration of Sfam with other clinical teaching methods, and the value of Sfam in pediatric teaching, and also discusses the future direction and prospects of Sfam combined with artificial intelligence in pediatric teaching. After years of development, Sfam has been proved to be an effective teaching model. We hope this paper can help more pediatric clinical educators gain a deeper understanding of the Sfam teaching method, and promote the application of Sfam in pediatric teaching to maximize its role in advancing the development of pediatric education.

Objective To observe the value of shear wave elastography(SWE),superb microvascular imaging(SMI)and their combination with conventional ultrasound for diagnosing cervical cancer.Methods Data of 178 patients with cervical lesion confirmed by pathology were retrospectively analyzed.The patients were divided into malignant group(n=32)and benign group(n=146),and those in benign group were further divided into low-grade or high-grade cervical intraepithelial neoplasia subgroups,cervical leiomyosarcoma subgroup,cervical polyps subgroup and cervicitis subgroup.The manifestations of lesion on conventional ultrasound,SWE and SMI were observed,and the mean value of Young's modulus(Emean)and SMI flow index(Ratio)were collected.The optimal cut-off value of SWE Emean and SMI Ratio were obtained with receiver operating characteristic(ROC)curves,and the classification of benign or malignant lesions were predicted.The consistency of predictive results and pathology results were assessed with the Kappa test.The diagnostic efficacies of conventional ultrasound,SWE and SMI alone and their combination were compared.Results The age of patients in malignant group was higher than that in benign group(P＜0.05).SWE Emean and SMI Ratio were both higher in malignant group than those in each benign subgroup(all P＜0.05).Taken 44.35 kPa and 3.95％ as the best cut-off values,the consistency of SWE Emean classification results and pathological results was good(Kappa=0.818),while of SMI Ratio was moderate(Kappa=0.453).The efficacy of conventional ultrasound,SWE and SMI alone for classifying benign and malignant cervical lesions(AUC=0.845,0.914,0.892)were all higher than that of their combination(AUC=0.806,all adjusted P＜0.05).The sensitivity of SWE and SMI for diagnosing cervical cancer was 90.60％ and 93.78％ respectively,with specificity of 95.20％ and 72.60％,respectively.Conclusion SWE hag higher efficacy for diagnosing cervical cancer,while SMI had better sensitivity but lower specificity.Combination of conventional ultrasound,SWE and SWI did not increase the efficacy of ultrasound for diagnosing cervical cancer.

Breast cancer has been the second most common solid tumor that metastasizes to the central nervous system after lung cancer.Triple-negative breast cancer(TNBC)has an earlier occurrence and high incidence of brain metastasis with its associated poor prognosis and limited treatment options due to the presence of the blood-brain barrier and lack of targeted drugs.Local treatment,including surgery and radiation therapy,are still the main therapy for brain metastasis.Surgical resection can not only relieve neurologic impairment of brain metastasis patients,but also can clarify the pathological type.Moreover,surgical resection combined with radiotherapy can improve the prognosis of brain metastasis patients compared to surgery or radiotherapy alone.By now,whole-brain radiation therapy(WBRT)is still considered the gold standard for multiple brain metastases,and meningeal metastases,but it will lead to neurocognitive decline,so hippocampal avoidance is essential.For selected patients with oligometastases,stereotactic radiotherapy has replaced WBRT to reduce cognitive toxicity.However,local treatment of TNBC brain metastasis cannot control the progress of brain metastasis and has significant side effects,so systemic therapy is needed.Chemotherapy drugs such as capecitabine and cisplatin can penetrate the blood-brain barrier,but their efficacy is limited.Therefore,the research and development of new targeted drugs and the exploration of new targets are necessary for TNBC brain metastasis.Research has found that patients carrying germline BRCA1/2 mutations have a higher risk of brain metastasis.Currently,the poly adenosine diphosphate ribose polymerase(PARP)inhibitor demonstrated antitumor activity in patients with advanced breast cancer and a germline BRCA1/2 mutation,and it can penetrate the blood-brain barrier.The phase Ⅲ trial EMBRACA reported that the PARP inhibitor talazoparib can prolong the progression-free survival of TNBC patients with brain metastasis.In addition,antibody drug conjugates(ADCs)trastuzumab deruxtecan(T-DXd)can also penetrate the blood-brain barrier.Studies such as DEBBRAH have shown that T-DXd has significant therapeutic effects in HER2 positive brain metastasis patients,while research on HER2 low expression patients has not yet reached the endpoint,and its role in TNBC brain metastasis is worth looking forward to.Sacituzumab govitecan(SG)is also an ADC composed of an antibody targeting the human trophoblast cell-surface antigen 2.The phase Ⅲ ASCENT study showed that in the full population(including 61 patients with brain metastasis),SG could significantly prolong the progression-free survival of advanced TNBC patients compared to the patients who received chemotherapy.ANG1005,a novel taxane derivative,can cross the blood-brain barrier as well.A multicenter,open-label phase Ⅱ study revealed that ANG1005 could prolong overall survival of patients with brain metastasis.In addition,phosphoinositide3-kinase,(PI3K)/protein kinase(AKT)/mammalian target of rapamycin(mTOR)pathway inhibitors,fatty acid synthase inhibitors,and the drugs with new delivery systems have become potential treatment options for TNBC brain metastasis patients.Although the Impassion 130 reported that no benefit trend for immunotherapy in TNBC brain metastasis,basic research has shown that radiotherapy combined with immunotherapy has a synergistic effect.Currently,multiple clinical trials(NCT03483012,NCT03449238,etc.)are exploring the efficacy of radiotherapy combined with immunotherapy in brain metastasis,and the results are promising.This article reviewed the research progress of TNBC brain metastasis treatment.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective:To subdivide clinical classification of refractory atlantoaxial dislocation, and evaluate the reliability of new subdivide clinical classification of refractory atlantoaxial dislocation.Methods:From January 2010 to December 2018, 48 patients with refractory atlantoaxial dislocation were treated, including 19 males and 29 females, aged 16 to 65 years, with an average of 39.2±13.3 years. According to the changes of relative anatomical position of C 1 and C 2 under general anesthesia with heavy traction of 1/6 body weight, subdivide clinical classification of refractory atlantoaxial dislocation were proposed, and refractory atlantoaxial dislocation was divided into traction loosening type (atlantoaxial angle≥5°) and traction stabilization type (atlantoaxial angle<5°). The traction loosening type was directly reduced by posterior atlantoaxial screw-rod fixation and fusion without anterior or posterior soft tissue release. For traction stabilization type, transoral soft tissue release was performed first, and then transoral anterior reduction plate fixation and fusion or posterior atlantoaxial screw-rod fixation and fusion were performed. Atlantodental interval (ADI) and atlantoaxial angle (AAA) were measured and collected before and after surgery to evaluate atlantoaxial reduction. The space available for the spinal cord (SAC) were measured to evaluate spinal cord compression. Visual analogue score (VAS) was used to evaluate the neck pain levels, and Japanese Orthopaedic Association (JOA) scores was used to evaluate the neurological function. American Spinal Cord Injury Association impairment scale (AIS) was used to evaluate the degree of spinal cord injury. One week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT scan were checked, in order to evaluate the reduction, internal fixation and bone graft fusion. Results:Among all 48 cases, 22 cases were traction loosening type, of which posterior atlantoaxial screw-rod fixation and fusion were performed in 16 cases and occipitocervical fixation and fusion in 6 cases. 26 cases were traction stabilization type, and they all underwent anterior transoral release, and then, anterior TARP fixation and fusion were performed in 24 cases and posterior screw-rod fixation and fusion in the other 2 cases. X-ray, CT and MRI images and of all patients 1 week after surgery showed good atlantoaxial reduction and decompression of spinal cord. In each of the two types, there was one case lost to follow-up. For 46 cases in follow-up, the follow-up time ranged from 6 to 72 months, with an average of 38.0±17.2 months. Among 46 cases, 21 cases of traction loosening type showed that, ADI reduced from preoperative 9.9±2.2 mm to 2.3±0.9 mm at 3 months after surgery and 2.3±1.0 mm at the last follow-up, AAA increased from preoperative 57.9°±12.3° to 91.0°±2.2° at 3 months after surgery and 90.9°±2.2° at the last follow-up, SAC increased from preoperative 9.8±1.3 mm to 15.1±0.7 mm at 3 months after surgery and 14.9±0.7 mm at the last follow-up, VAS score reduced from preoperative 1.5±2.1 to 0.7±1.0 at 3 months after surgery and 0.3±0.6 at the last follow-up, and JOA score increased from preoperative 10.2±1.7 to 13.3±1.3 at 3 months after surgery and 14.9±1.5 at the last follow-up. Twenty-five cases of traction stabilization type presented that, ADI reduced from preoperative 9.7±2.0 mm to 2.1±1.4 mm at 3 months after surgery and 2.1±1.3 mm at the last follow-up, AAA increased from preoperative 55.8°±9.2° to 90.9°±1.4° at 3 months after surgery and 90.9°±1.3° at the last follow-up, SAC increased from preoperative 10.5±1.0 mm to 15.4±0.5 mm at 3 months after surgery and 14.8±2.8 mm at the last follow-up, VAS score reduced from preoperative 1.7±2.1 to 0.7±0.9 at 3 months after surgery and 0.3±0.5 at the last follow-up, and JOA score increased from preoperative 10.1±1.3 to 12.9±1.5 at 3 months after surgery and 14.4±1.3 at the last follow-up. In the traction loosening type, all the 10 grade D patients were improved to grade E at the last follow-up. In the 2 grade C patients of traction stabilization type before surgery, 1 patient was improved to grade E, 1 patient was improved to grade D, and all 11 patients with grade D were improved to grade E at the last follow-up. Bony fusion was obtained in all patients from 3 to 6 months, with an average of 4.4±1.5 months. During follow-up period, no looseness of internal fixation or redislocation happened.Conclusion:Refractory atlantoaxial dislocation can be divided into traction loosening type and traction stabilization type. For traction loosening type, satisfactory reduction can be achieved by using posterior atlantoaxial screw-rod system without soft tissue release. For traction stabilization type, anterior release is preferable, and then anterior TARP or posterior screw-rod can be used to achieve satisfactory reduction.

Shaken baby syndrome, also known as abusive head trauma, is one of the deadliest and most devastating forms of child abuse.This paper reviewed the risk factors, cognitive status and preventive measures of shaken baby syndrome, in order to provide reference for the prevention of shaken baby syndrome and further research on shaken baby syndrome.

In order to improve the operation difficulties in the narrow space of the nasal maxillary sinus, the nasal continuum minimally invasive surgical robot system is designed. The ball-and-socket joints and NiTiNol tubes are used as the main body of the continuum structure to improve the degree of freedom. The hardware systems and software systems are designed. The security control policies are planned. Finally, the robot confirmed prototype experiments are conducted and the feasibility of continuum robot confirmed through master-slave control experiment and animal experiment.
Animals ; Biomechanical Phenomena ; Equipment Design ; Minimally Invasive Surgical Procedures ; Robotic Surgical Procedures ; Robotics ; Software

【Objective】 To establish a management information system (referred to as the system) for plasma collection stations in Zhejiang province, so as to explore the current situation of plasma donors and implement effective supervision in Zhejiang. 【Methods】 The system was developed and connected to four plasma collection stations that were officially operating in Zhejiang in terms of plasma station setting and approval, as well as the publicity, recruitment and management of plasma donors, information management of the whole process of plasma collection, management of deferral plasma donors, plasma quality management and administrative supervision etc. Relevant plasma donor information was uploaded to the system by each plasma station, and information before (January 2016 to December 2020) and after (January 8, 2021 to June 2021) the system was collected. Information included the number of plasma donors/donations, demographic information of eligible plasma donors in the past 5 years, the type of plasma donors, and the deferral donors after the system was activated. The online approval of Plasma Donation Certificate and the intelligent supervision of key points of plasma apheresis stations in Zhejiang were also conducted. The frequency and composition ratio were described, and chi-square test was used for statistical analysis. 【Results】 The system (V1.0) was established and was officially launched on January 8, 2021, realizing the interconnection of blood donation and plasma donation information as well as the unified management of 24 quality indicators. Since the system was applied (January 8, 2021-June 2021), the proportion of donors both donated blood and plasma over the province was 3.56 (832/23 389), and 352 deferred donors were masked by the system. And 30.11% (106/352) , who intended to donate plasma, were deferred due to insufficient interval after blood donation; 11.65% (41/352) due to permanent masking in blood donations; 23.86% (23.86%) , who intended to donate blood, were deferred due to insufficient interval after plasma donation ( 84/352); 34.38% (121/352) due to permanent masking in plasma donations. The median approval rate of four plasma stations applying for Plasma Donation Certificate before the system (January 1, 2016 to January 7, 2021) and after the system (January 8 to June 2021) were 93.38% (10 609/11 361) vs 99.50% (2 602/2 615). Before the system was put into launch, the ratio of male to female donors and the proportion of regular donors showed an overall upward trend, while the age decreased slightly. The median proportion of women in the past 5 years was 61.52 %, significantly higher than that in last 6 months after the launch(58.86%). 【Conclusion】 The application of the system can realize information interconnection between blood centers and plasma collection stations in Zhejiang as well as the real-time supervision of plasma collection process, which is helpful to overcome the shortcomings in plasma donor management.

Objective:To determine clinical curative effects of ozone therapy for pemphigus vulgaris.Methods:Ozone hydrotherapy was used as an aid treatment for 32 patients with pemphigus vulgaris.The hydropathic compression of potassium permanganate solution for 34 patients with pemphigus vulgaris served as a control.The main treatment for both groups were glucocorticoids and immune inhibitors.The lesions of patients,bacterial infection,usage of antibiotics,patient's satisfaction,and clinical curative effect were evaluated in the 2 groups.Results:There was no significant difference in the curative effect and the average length of staying at hospital between the 2 groups (P＞0.05).But rate for the usage of antibiotics was significantly reduced in the group of ozone hydrotherapy (P=0.039).The patients were more satisfied in using ozone hydrotherapy than the potassium permanganate solution after 7-day therapy (P＞0.05).Conclusion:Ozone hydrotherapy is a safe and effective aid method for pemphigus vulgaris.It can reduce the usage of antibiotics.

This article combed the connotation of competency involving general nursing, specific nursing, holistic nursing, scientific research and education of nursing, team work and professionalism for advanced nursing practitioners. Besides, this article analyzed the existing problems in training of clinical practice among master of nursing specialist of our country. It also explored the causes in the low level of social identity in nursing occupation, insufficient standards for talent of use, undefined training objective, a low level of resources integration, insufficiently systematic education concept, weak check and supervision. It aimed at making suggestions for nurses' working environments, occupation standards, idea of nursing education, resource integration, growth law of talents, check and supervision so as to realize cultivating master of nursing specialist based on competency of advanced nursing.