Objective To investigate the eftect of radiation dose of dual-source computed tomography (CT) dual energy single-phase enhanced scan in patients with esophageal cancer.Methods The prospective study was conducted.The clinicopathological data of 56 patients with esophageal cancer who were admitted to the Lishui Hospital of Zhejiang University between January 2015 and December 2016 were collected.All the patients were divided into the experimental group (undergoing dual-source CT dual energy single-phase enhanced scan) and control group (undergoing dual-phase CT enhanced scan) bv randomised block method.TNM classification of esophageal cancer (Seventh Edition) published by American Joint Committee on Cancer (AJCC) was used as a standard TNM staging.Two observers independently read films.All the patients underwent radical resection of esophageal cancer or palliative surgery,and then received adjuvant radiochemotherapy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to March 2017.Observation indicators:(1) consistencies of T staging,N staging and M staging;(2) accuracies of T staging,N staging and M staging (pathological results as a gold standard);(3) radiation dose of CT scan;(4) treatment and follow-up situations.The Kappa test was used for evaluating the consistency,κ≥0.75 as a good consistency,0.40≤κ＜0.75 as a normal consistency and κ＜0.40 as a poor consistency.Comparisons of count data and ratio were done by the chi-square test.Comparisons of measurement data were analyzed by the t test.Results A total of 50 patients were enrolled in the study,including 25 in the experimental group and 25 in the control group.(1) Consistencies of T staging,N staging and M staging:all the 50 patients finished successfully CT scans.Two observers considered that consistencies of T staging,N staging and M staging in the 2 groups were normal (κ =0.452,0.618,0.729,P＜0.05).Consistencies of N staging and M staging were superior to T staging.(2) The pathological results were used as a gold standard.Accuracies of T staging,N staging and M staging in the experimental and control groups were 72％,76％ and 88％,84％ and 92％,88％,respectively,with no statistically significant difference between the 2 groups (x2 =0.10,0.37,0.50,P＞0.05).(3) Radiation dose of CT scan:volume CT dose index (CTDIvol),dose length production (DLP) and effective radiation dose (E) were (10.35±2.01) mGy,(400.63± 34.13) mGy · cm,(5.61 ± 0.47) mSv in the experimental group and (3.55 ± 0.60)mGy,(140.66± 10.89) mGy · cm,(1.98±0.17) mSv in the control group,respectively.There were statistically significant differences in CTDIvol and E between the 2 groups (t =16.23,36.30,P＜0.05).(4) Treatment and follow-up situations:of 50 patients,43 patients received treatments,including 32 undergoing radical resection (11 receiving postoperative adjuvant chemotherapy),6 undergoing palliative surgery,3 receiving single radiotherapy and 2 receiving single chemotherapy.Thirty-six of 43 patients were followed up for 3-18 months,with a median time of 6 months.During follow-up,1-year survival rate was 61.1％.Conclusion Dual-source CT dual energy single-phase enhanced scan in patients with esophageal cancer cannot reduce accuracy of TNM staging,but decreased effectively radiation dose.

BACKGROUND:Oversize stress of a dental implant and its surrounding tissue is the main factor to affect the
long-term use of dental implants. So, the reasonable and precise design of implant shape is one of the important methods of prolonging the life span of dental implants.
OBJECTIVE:To make the optimal analysis and design of the diameters of connector screw and central screw of the adjustable-angle dental implant invented in the earlier stage.
METHODS: The finite element analysis model of the edentulous mandible with adjustable-angle dental implant was established by software Pro/E 5.0, Mimics 10.0 and ANSYS Workbench 14.5. The maximum equivalent
stress of dental implant-edentulous mandibular model was analyzed.
RESULTS AND CONCLUSION:The maximum equivalent stress of dental implant-edentulous mandibular model

Objective To approach the nursing experience and clinical therapeutic effect of using aerosol inhalation of Scutellaria baicalensis leachate to prevent occurrence of ventilator-associated pneumonia (VAP) in critically ill patients in intensive care unit (ICU). Methods Ninety-two severe patients who received mechanical ventilation (MV) in ICU of Hangzhou Geriatric Hospital from April 2016 to August 2017 were enrolled, and they were divided into a test group and a control group according to their wishes and self-selection, 46 cases in each group. The patients in both groups were given fine nursing care model, in the control group aerosol inhalation of physiological saline was used; in the test group aerosol inhalation of Scutellaria baicalensis leachate was applied. The incidence of VAP, the duration of MV and time of ICU stay were compared between the two groups. Results Compared to the control group, the total incidence of VAP, duration of MV, time of ICU stay in the test group were significantly lower than those in control group [total incidence of VAP: 17.39% (8/46) vs. 36.95% (17/46), duration of MV (days): 11.37±5.23 vs. 15.21±5.93, time of ICU stay (days): 18.54±5.92 vs. 27.33±5.27, all P < 0.05]. Conclusion Under the fine nursing care pattern, compared with the aerosol inhalation of saline, the aerosol inhalation of Scutellaria baicalensis leaching can be more effectively to prevent VAP in ICU critically ill patients and reduce their duration of MV and of ICU stay, so the latter one's clinical therapeutic effect is better.

The quality of life of elderly patients with lung cancer can be affected by various symptoms such as frailty, coexistence of multiple diseases, malnutrition, and decreased function.Identifying these potential problems through reasonable and effective assessment, and providing early intervention and symptom management, can help improve the quality of life of patients.Although several methods have been developed, applied, and clinically verified to evaluate the quality of life in elderly patients with lung cancer, they all have their limitations.Therefore, choosing the appropriate evaluation method has become a practical challenge in clinical settings.This article aims to review the different methods used to assess the quality of life of elderly patients with lung cancer, providing theoretical guidance for clinicians and researchers.

Objective:To analyze the ideal entry parameters and entry points for C 7 pedicle screws based on three-dimensional CT reconstruction model. Methods:A retrospective case series study was used to analyze the cervical spine CT image data of 50 adult volunteers collected from April 2021 to March 2022 at Taizhou People′s Hospital Affiliated to Nanjing Medical University, including 25 males and 25 females; aged 20-67 years [(43.8±13.5)years]. No significant structural abnormalities were seen in the cervicothorax of all volunteers. First, the 50 CT images were imported into the medical engineering software Mimics 17.0 to reconstruct the three-dimensional C 7 model, and the C 7 pedicle screw diameter (PSD), pedicle screw length (PSL), sagittal angle (SA) and lateral angle (LA) were measured. Then, the anatomical markers, namely the lateral notch and the midpoint of the inferior edge of the C 6 articular process, were used to measure the horizontal distance between the midpoint of the inferior edge of the C 6 articular process and the ideal entry point (line segment A), and the horizontal and vertical distances between the lateral notch and the ideal entry point (line segments B and C). Finally, the lateral notch and the midpoint of the inferior edge of the C 6 articular process were used as markers to observe the distribution of entry points. The values of the above measured parameters were recorded and compared with each other to analyze the differences between different sides and genders. Intra-group correlation coefficients (ICC) were also used to assess intra- and inter-observer agreement. Results:All 100 pedicles from 50 C 7 models were accessed, with the PSD being (6.5±0.7)mm, PSL being (31.8±4.5)mm, SA being (89.8±8.8)°, LA being (31.0±6.7)°, line segment A being 0.9(-0.4, 2.1) mm, line segment B being (5.8±1.7)mm, and line segment C being (3.6±1.5)mm. All ideal entry points were located medial above the lateral notch; moreover, with the midpoint of the inferior edge of the C 6 articular process as a reference, 71 (71%) of the entry points were located laterally and 29 (29%) were located medially. The 12 mm area around the midpoint of the inferior edge of the C 6 articular process was divided into 6 sections, with 47% of the entry points being located within 2 mm lateral to the midpoint, 25% within 2 mm medial to the midpoint, 19% within 2-4 mm lateral to the midpoint, and only 9% within 50% lateral to the midpoint. The measured parameters were not significantly different between the left and right sides (all P>0.05). The PSD, SA, and line segment B in males were (6.8±0.7)mm, (92.0±8.2)°, and (6.3±1.6)mm, which were significantly greater than those in females [(6.2±0.6)mm, (87.5±8.0)°, and (5.3±1.6)mm] (all P<0.01). The remaining parameters were similar between two genders (all P>0.05). All measured parameters had high intra- and inter-observer agreement (ICC: 0.84-0.91), except for line segment A that had moderate intra- and inter-observer agreement (ICC: 0.46-0.63). Conclusions:For C 7 pedicle screw implantation, when the surface of the lateral mass is used as the reference plane, SA is approximately 90°; with reference to the lateral notch, all the ideal entry points are located medially above it; with reference to the midpoint of the inferior edge of the C 6 articular process, approximately 70% of the entry points are located laterally. There are no significant differences in the parameters between the different sides of screw implantation on pedicles. The measured parameters show high intra- and inter-observer agreement, except for line segment A.

Objective To study the effect of endovenous laser ablation combined with subfascial endoscopy therapy for venous ulcer of the lower limbs.Methods Clinical data of 112 patients undergoing endovenous laser ablation combined with subfascial endoscopy therapy for venous ulcer of the lower limbs from Oct 2011 to Feb 2016 was retrospectively evaluated.Results Patients had average 2-6 perforating veins in their affected lower limbs.Procedures were successful in all the patients,all the superficial varicose veins disappeared after 1 month and 1 year of ultrasound follow-up,perforating veins closed,ulcer healed,and chromatosis alleviated.Conclusion Endovenous laser ablation combined with subfascial endoscopy therapy for venous ulcer of the lower limbs is effective,safe and quick recovery.

Objective:To systematically evaluate the correlation between maternal arsenic exposure during pregnancy and congenital heart disease (CHD) in offspring.Methods:Literature search was performed through databases such as PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP.com to include epidemiological literature on association between maternal arsenic exposure during pregnancy and offspring CHD published domestically and internationally. The search was conducted from database establishment until November 2, 2022. Stata MP15 software was used for meta-analysis of binary variables, and I 2 statistics and Q test were used for heterogeneity test, fixed effect model or random effect model was selected based on the test results. Using OR value (95% CI) as the effect evaluation indicator, subgroup analysis was conducted based on CHD subtypes [conotruncal defects (CTD), atrioventricular septal defect (AVSD), total anomalous pulmonary venous return (TAPVR), left ventricular outflow tract obstruction (LVOTO), right ventricular outflow tract obstruction (RVOTO), atrial septal defect (ASD)/ventricular septal defect (VSD), and patent ductus arteriosus (PDA)]. Results:Nine articles were finally included, including two Chinese and seven English articles. Among them, 8 articles had CHD as the outcome, 5 articles had ASD/VSD as the outcome, 4 articles had CTD as the outcome, 3 articles had LVOTO as the outcome, 2 articles had PDA as the outcome, and 1 article had RVOTO as the outcome. An analysis was conducted on 8 articles with CHD as the outcome. After heterogeneity testing, I 2 = 88.5% and P < 0.001, indicating significant heterogeneity. A random effect model was used for meta-analysis, and the combined OR value (95% CI) was 1.51 (1.40 - 1.62). The results of CHD subgroup analysis showed that the combined OR values (95% CI) for ASD/VSD, CTD, LVOTO, PDA, and RVOTO were 1.68 (1.53 - 1.84), 1.64 (1.29 - 2.09), 2.89 (1.82 - 4.61), 1.78 (1.53 - 2.08), and 0.81 (0.64 - 1.03), respectively. Conclusion:Maternal arsenic exposure during pregnancy is associated with development of offspring CHD, including ASD/VSD, CTD, LVOTO, and PDA as the common lesions in offspring CHD.

A total of 820 patients who visited Endocrinology department in our hospital were enrolled in the study from June 2016 to May 2018. These patients were divided into diabetic retinopathy ( DR ) and non-diabetic retinopathy ( NDR) groups according to the occurrence of DR. Factors such as gender, age, course of diabetes, smoking/drinking history, family history of diabetes, and onset age of diabetes were compared between the two groups, and logistic regression was used to analyze the risk factors of DR. The results showed that there were 387 smoker( 47. 2％) and 433 non-smoker ( 52. 8％) in 820 tyge 2 diabetic patients, and 339 ( 41. 3％) patients were diagnosed with DR. There were no statistical differences in gender, age, body mass index, family history of diabetes, drinking history, and HbA1C between the two groups. Logistic regression analysis showed that duration of diabetes (OR=2.653,P<0.001), hypertension(OR=1.371,P=0.041),onset age of diabetes<40years(OR=1.526,P=0.028) , and adolescent smoking history( OR=2.178,P<0.001) were independent risk factors for DR.