Purpose To explore the value of low tube voltage, original data iterative reconstruction (SAFIRE) and intelligent optimum tube voltage scanning (CARE kV) technology in reducing radiation dose of high resolution CT (HRCT) temporal bone scanning and its impact on image quality. Materials and Methods Ninety patients with ear problem underwent clinical HRCT scan. All the patients were randomly divided into group A (conventional scanning), group B (CARE kV) and group C (low tube voltage) according to chronological order, with 30 cases in each group. Image quality was double-blind scored by two qualified radiologists. CT value, noise, contrast to noise ratio (CNR), signal to noise ratio (SNR), CT dose index volume (CTDIvol), dose-length product (DLP) and effective dose (ED) were compared among three groups. Results Image quality and the average CT value had no statistical difference among three groups (F=3.70, 3.61;P>0.05);noise, CNR, SNR, CTDIvol, DLP and ED had statistical difference among three groups (F=1.23, 1.42, 2.05, 2.13, 1.79, 1.32; P<0.05). Compared with group B, noise reduced about 14.1%in group C, while CNR and SNR increased about 32.1%and 26.3%, respectively (q=3.64, 3.45, 4.36; P<0.05). CTDIvol, DLP and ED were significantly different between group B and group C (q=3.13, 4.24, 4.24; P<0.05). Conclusion Scanning with low tube voltage, SAFIRE and CARE kV technology not only effectively reduce radiation dose, but also obtain satisfactory image quality. It should be widely utilized.

PurposeTo evaluate the impact of filtered back-projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) technique on the image quality of routine dose temporal bone high resolution CT (HRCT) scan, and to provide reference for the realization of low dose scanning.Materials and Methods Sixty patients underwent routine dose temporal bone HRCT scan, 6 groups of images were reconstructed with FBP and SAFIRE (strength grade 1-5), average CT value, noise (SD), signal to noise ratio (SNR), contrast to noise ratio (CNR), subjective score and lesion detection were compared between different groups.Results There was no significant difference of average CT value among the 6 groups (P>0.05); compared with FBP, SD of SAFIRE (strength 1-5) reconstruction decreased gradually (F=1.78,P<0.01), which was 23.1%, 39.2%, 42.4%, 54.1% and 61.2% respectively; SNR and CNR increased gradually (F=1.42 and 3.15, P<0.05), SNR increased 26.6%, 40%, 71.1%, 117.7% and 153.3% respectively, while CNR increased 17.4%, 33.1%, 63.2%, 104.1% and 147.2% respectively. The differences among the 6 groups were statistically significant (P<0.05), subjective scores of SAFIRE 2-4 were higher than those of FBP, SAFIRE 1 and SAFIRE 5 group, while the difference among SAFIRE 2-4 group was statistically insignificant, reconstruction smoothness and edge sharpness of SAFIRE 3 group was better, with highest objective score.Conclusion Routine dose temporal bone HRCT scan combined with SAFIRE reconstruction can increase the image quality of temporal bone high resolution scan effectively, with the potential for radiation dose reduction.

Purpose To assess the feasibility of applying dual-energy dual-source CT virtual non-contrast (VNC) imaging in the diagnosis of colorectal diseases. Materials and Methods Eighty-ifve patients with clinically suspected colorectal lesions underwent abdominal CT scan as well as arterial and venous phase dual-energy enhanced scan, VCN images of arterial and venous phase were obtained using the dual-energy software, the differences of image quality, radiation dose and diagnostic coincidence rate between the true non-contrast scan and VNC images were compared. Results The radiation dose of two-phase dual-energy scan was 34.8%lower when compared with the conventional three-phase scans. The CT values of the intestinal lesions, metastasis lymph nodes and intestinal fat in VNC were lower than the true unenhanced scan (P<0.05 or P<0.01), whereas were higher than the real scan in liver and liver metastases (P<0.01), there was no signiifcant difference of VNC between the arterial and venous phase. Differences of intestinal wall thickness, metastasis lymph node size, peripheral invasion and liver metastases observed from real non-contrast scan and VNC were not statistically significant (P>0.05), and neither was the diagnostic coincidence rate for intestinal diseases (P>0.05). The noise level of images obtained from VNC was lower than that of the real non-contrast scan (P<0.05), with higher SNR and CNR, there was no signiifcant difference of image scoring among the three groups (P>0.05). Conclusion For colorectal lesions, the virtual non-contrast images from the dual-energy dual-source CT scan can be used to reduce the radiation dose without effecting image quality and diagnosis accuracy.

Objective To investigate the effect of meridian-unblocking and mind-regulating acupuncture pretreatment on neurobehavioral functions and cerebral water content and explore its mechanism for modulating miRNA664 and MMP9 expressions in cerebral ischemia/reperfusion rats.Methods One hundred and thirty Wistar rats were randomized into group A (electroacupuncture pretreatment) of 30 rats, group B (moxibustion pretreatment) of 30 rats, group C (aspirin pretreatment) of 30 rats, group D (model) of 30 rats and group E (blank control) of 10 rats. Group A received electroacupuncture; group B, suspended moxibustion with moxa sticks; group C, an oral gavage of aspirin 10 mg/kg. A model of cerebral ischemia/reperfusion was made in every group after seven days. Rat neurobehavioral functions were observed and cerebral water content and relative miRNA664 and MMP9 expressions in the cortical region were determined at 24 hours after reperfusion.Results There was a statistically significant difference in the neurobehavioral score between group A, B, C or D and group E (P<0.01), between group A or B and group C (P<0.01) and between groups A and B (P<0.01). There were statistically significant differences in cerebral water content and relative miRNA664 and MMP9 expressions between group A, B, C or D and group E (P<0.01,P<0.05), between group A, B or C and group D (P<0.01), between group A or B and group C (P<0.01,P<0.05) and between groups A and B (P<0.01,P<0.05).Conclusions Meridian-unblocking and mind-regulating acupuncture pretreatment can effectively decrease the neurobehavioral score and cerebral water content and reduce relative MMP9 expression through modulating miRNA664 expression in cerebral ischemia/reperfusion rats. One of the mechanisms of Du meridian-unblocking and mind-regulating acupuncture pretreatment for protecting the brain may be reducing relative MMP9 expression, inducing tolerance to cerebral ischemia and relieving cerebral edema by the modulation of miRNA664 expression.

Objective:To investigate the effectiveness and advantage of visual laryngoscope in the treatment of patients with sudden cardiac arrest who need spontaneous respiration tracheal intubation.Methods:Totally 60 patients who suffered from cardiac arrest and needed spontaneous respiration tracheal intubation were enrolled from June 2020 to February 2021 in the Affilicated Hospital of Chifeng University. Theywere randomlydivided into two groups-traditional laryngoscope (TL) group and visual laryngoscope (VL) group, with30 patients in each group. Then the success rate of glottis exposure, the operative time, success rate and complication rate of tracheal intubation were compared between the two groups. Subgroup assessment between the junior emergency resident doctor (A group) and the senior emergency resident doctor (B group) was conducted.Results:According to Cormack Lehan grades, the success rate of glottis exposure in VL group was higher than that in TL group ( P>0.05), and the success rate of Grade I in VL group was significant higer than that in TL group: 56.70%(17/30) vs. 30.00%(9/30), P<0.05. The trial times of successful intubation cases and the operative time of successful intubation cases were significantly less than those in TL group (1.30 vs 1.67, P = 0.049) and (56.37 s vs 67.12 s, P<0.05). In the subgroup, the one-time success rate of tracheal intubation in A-TL group was significantly lower than that in B-TL group (4/15 vs. 11/15, P<0.05), while the one-time success rate of tracheal intubation in A-VL group was 60.00%, which is lower than that in B-VL group ( P>0.05). The operative time consumed for successful intubation in A-TL group was significantly longer than that in B-TL group: 78.00 s vs. 55.57 s, P<0.05, while the operative time in A-VL group was a little longer than that in B-VL group ( P>0.05). Conclusions:Visual laryngoscope used in spontaneous respiration tracheal intubation can not only increase the success rate of glottis exposure, decrease trial times and shorten operative time of intubation, but also improve the success rate and decrease the complication rate of emergency tracheal intubation.

Objective:To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning (bone 3-phase image).Methods:A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics, The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females, aged from 19 to 64 years (average, 39.7 years).The nonunions occurred mainly at the tibia (113 cases) and the femur (72 cases).The preoperative results of their white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards, the sensitivity, specificity, area under curve (AUC) of receiver operator characteristic (ROC) and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results:Compared with the pathological observations, the radioisotope scanning showed a sensitivity of 80.7%, a specificity of 73.3%, an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test, that of radioisotope scanning and CRP produced the largest AUC of 0.683, a sensitivity of 98.0%, a specificity of 70.3%, and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests, that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895, a sensitivity of 94.3%, a specificity of 67.3%, and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%, a specificity of 79.7%, an AUC of 0.925 and a Youden index of 0.762.Conclusion:Combination of haematological testing and radioisotope scanning can be a reliable preoperative diagnosis of low-grade infection nonunion.

Objective:To analyze the clinical symptoms and epidemiological characteristics of patients with tsutsugamushi disease (TD) in Utica County, Shiyan City, providing reference for scientific prevention and control of TD.Methods:The information of 57 TD patients admitted to the Department of Infectious Diseases of the People's Hospital of Utica County in Shiyan City from January to December 2022 was collected, including age, gender, occupation, clinical manifestations (tarsus or chigger, high fever, rash and accompanying syndromes), laboratory and imaging test results, and field work and travel history. Blood samples and body crusts were collected, and enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) were used to detect antibodies against Orientia tsugamushi (Ot-Ab-IgM) and Orientia tsutsugamushi (Ot). The scores of each patient were calculated using the TD Diagnostic Scale. A score of ≥8.5 was considered a clinical diagnosis of TD. According to the number of system functional damages (0, 1, 2, ≥3), 57 patients were divided into 4 groups, A, B, C, and D, TD was analyzed for system functional damages of each system.Results:Among the 57 TD patients, 26 (45.61%) were male and 31 (54.39%) were female, and the proportion of patients aged 40 - 79 years was 92.98% (53/57); farmers accounted for 89.47% (51/57). May was the peak of TD incidence, with 19 cases, which accounted for 33.33% (19/57) of the total number of patients affected that year. Fifty-four patients had a history of fieldwork or field trips before the onset of the disease. The incidence of high fever in 57 TD patients was 100.00%(57/57), the detection rate of body scorch or chiggers was 80.70% (46/57), and the incidence rate of rash was 98.25% (56/57); the incidence rate of tsutsugamushi disease triad (accompanied by scabs, high fever, and rash) was 80.70% (46/57); the incidence of eosinophil decline was 100.00%(57/57), and 77.19% (44/57) of TD patients experienced multiple-system functional damage (MSFD). The TD score diagnostic scale for 57 patients ranged from 8.5 to 10.5 points. After being hospitalized for 1 - 5 days, all TD patients experienced a decrease in body temperature to the normal range, and the damage to various systems functional gradually recovered.Conclusions:TD has become one of the most common natural infectious diseases in Utopia County, Shiyan City, Hubei Province. The patients are mainly middle-aged and elderly people, and the triple syndrome is a typical clinical manifestation. Asymptomatic injuries to the blood system, liver and kidneys are the most common.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective:To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods:A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results:Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively.Conclusions:The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

Objective:To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods:A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results:Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively.Conclusions:The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.