Digital Imaging and Communications in Medicine (DICOM) is the international standard for medical images and related information (ISO 12052). It defines the formats for medical imaging that can be exchanged with the data and quality necessary for clinical use. DICOM is implemented in almost every radiology, cardiology imaging, and radiotherapy device (X-ray, CT, MRI, ultrasound, etc.), PET devices data transferring, and increasingly in devices in other medical domains such as ophthalmology and dentistry. During the procurement plan process of imaging equipment, not only the hardware technology needs to be planed, but also the invisible software part needs to be detail planed, the DICOM technology is always easily ignored or not decrypted inaccurately. This article is to elaborate the basic application of the DICOM standard and introduce the most common DICOM interfaces and their functions in equipment procurement. These interfaces include imaging equipment procurement such as CT, MR, US, PET.

ObjectiveTo investigate the effectiveness of introducing CAD/CAM system into Prosthodontics experimental teachin.MethodsStudents from Chongqing Medical University with major of Dental Department in Grade 2007 was selected.To make all students master the basic knowledge of CAD/CAM system,problem-based learning was used to teach the undergraduate grasping the CAD/CAM system of the affiliated hospital.Results 90 ％ of the students showed strong interest in learning knowledge of the CAD/CAM system.98 ％ of the students could master CAD/CAM system knowledge.ConclusionCAD/CAM system knowledge is suitable for development of prosthodontics.It is necessary that the basic knowledge of CAD/CAM was introduced into prosthodontics experimental courses.

Objective To analyze the effect of clinical temporomandibular joint (TMJ) functional training for prevention of trismus in nasopharyngeal carcinoma (NPC) patients treated with radiotherapy.Methods According to the performance of patients clinical TMJ functional training, 43 NPC patients treated with three-dimensional conformal radiation therapy (3DCRT) and 82 NPC patients treated with general twodimensional radiation therapy were assigned respectively to the study group and the contrast group. The clinical TMJ functional training on patients of the study group was performed regularly and intensively under good guidance and supervision from the beginning of radiotherapy. The clinical TMJ functional training on patients of the contrast group was performed without such strict supervison after the first guidance. The size of the distance was measured between the incisors of the patients of the study group and the contrast group before radiotherapy and the final follow-up within two years after radiotherapy. Results The reduction of the distance between the incisors were [(0.64±0.59) cm] in the study group of 3DCRT in contrast to the [(0.81±0.64) cm] in the contrast group (P ＞0.05). The incidence of trismus was 8.1% in the study group of 3DCRT in contrast to the 21.1% in the contrast group (P ＞0.05); The reduction of the distance between the incisors were [(0.72±0.65) cm] in the study group of general two-dimensional radiotherapy in contrast to the [(1.64±0.73) cm] in the contrast group (P ＜0.01). The incidence of trismus was 19.0% in the study group of general two-dimensional radiotherapy in contrast to the 47.5% in the contrast group (P ＜0.01). Conclusion TMJ Functional training method is the good method that can lower the severity and the incidence of trismus in NPC patients treated with radiotherapy. It is more evident and more important for patients with general twodimensional radiotherapy.

BACKGROUND:Animal studies showed that functional early load or immediate load on immediate implant did not affect the prognosis of implant.
OBJECTIVE:To analyze the effect of immediate loading with different forces on the binding surface of immediate implant bone ossification.
METHODS:Six adult healthy male dogs were selected. Al teeth (three premolars) between cuspid teeth of lower mandible and the first molar were pul ed out. One implant (OSSTEM GSII) was immediately implanted, total y 36 implants. The vertical immediate loading by device was used on the implants at 24 hours after implantation. Grouped by the loading force values:0, 10, 20 N on the left three implants of each dog from front to back, 30, 40, 50 N on the contralateral three implants of each dog, at a frequency of 1 Hz for 10 minutes every day. The implant stability quotient (ISQ) was tested using resonance frequency measurement instrument (OSSTELL) at 0 day, 4, 8, and 12 weeks.
RESULTS AND CONCLUSION: With increased load forces, serum osteocalcin expression increased, and peaked on 20 N, but decreased in 30 N group, and lowest in 50 N group. At 4 weeks after immediate implantation, the ISQ values were slightly less than pre-implantation in each group, especial y the 50 N group. At 8 weeks after immediate implantation, ISQ values were increased in each group to different degrees. The increased degree of the 20 N group was maximal. At 12 weeks, a peak value was detected in each experimental group. The implants could bind to bone tissues to different degrees. The range of implant-bone interface formation was positively associated with time. Results indicated that the smal force cannot impact implant-bone ossification, but promotes it in a manner, but large force value (≥ 20 N) wil affect the stability of the implant-bone ossification.

BACKGROUND:Activating transcription factor 4 is found as an activating factor that can regulate osteogenic differentiation and function, and plays a critical role in the osteogenic differentiation.
OBJECTIVE:To investigate the expression and significance of activating transcription factor 4 in the osteogenic differentiation of bone marrow mesenchymal stem cells from Sprague-Dawley rats.
METHODS:Bone marrow mesenchymal stem cells from Sprague-Dawley rats were cultured using the whole bone marrow adherence method, and ossification revulsant was added to induce passage 3 cells. cells with no osteogenic induction served as controls. RT-PCR and western blot assay were employed to dynamical y monitor expression of activating transcription factor 4.
RESULTS AND CONCLUSION:RT-PCR results showed that activating transcription factor 4 mRNA expression increased with the increasing osteogenic differentiation, and peaked at day 16. Western blot analysis showed that the protein expression of activating transcription factor 4 tended to increase with the increasing osteogenic differentiation, peaked at day 16 and stil maintained at a higher level at day 19. Compared with the uninduced cells, activating transcription factor 4 in the induced cells exhibited a higher expression at mRNA and protein levels (P<0.05). These findings indicate that activating transcription factor 4 expression is elevated during osteogenic differentiation, showing a positive correlation with osteogenic ability of bone marrow mesenchymal stem cells.

Objective To compare the dose distribution of mantle-field radiotherapy using conven-tional radiotherapy(CRT) and four intensity-modulated radiotherapy(IMRT) techniques in stage Ⅰ and Ⅱ Hodgkin's lymphoma(HL). Methods Ten patients with patholocally proved early stage HL underwent CT simulation. Then both CRT and IMRT planning performed using ECLIPS treatment planning system(TPS). The dosimetric parameters of different irradiation plans were analyzed, including conformal index (CI), homo-geneity index (HI), D95 and V95 of planning target volume (PTV), Dmax,Dmean,Dmin,V5,V10,V20 and V30 of the lung, as well as Dmax of the spinal cord. Results The isodose distribution and homogeneity of PTV were better in IMRT plans when compared with CRT plans. Target coverage, target dose conformity and homogene-ity were similar among all the four IMRT techniques. The V30 of the lung using IMRT was lower than using CRT,but the low-dose volume of the lung was higher. Among the four IMRT technique plans,the lung V20 and V30 were lower in plans with more-field technique,but the V5 and V10 were higher. The Dmax of the spinal cord using IMRT was all lower than that using CRT. Conclusions IMRT is better than CRT in target cov-erage, conformity, homogeneity and normal tissue sparing, especially in protecting the spinal cord and decrea-sing high-dose lung volume,though the low-dose lung volume is higher. Seven-field IMRT technique for man-de-field radiotherapy is recommanded.

Objective:To investigate the serum antibody level in children with pertussis in Hangzhou city, and to evaluate the incidence of pertussis in children and the immunization effect of vaccine.Methods:A retrospective study was conducted.The pertussis toxin IgG antibody levels in 1 486 children aged 0-14 who received physical exa-mination in Hangzhou Children′s Hospital from January to December 2018 of were collected and analyzed.Serum antibody level ≥30 IU/mL was considered seropositive.The children enrolled were divided into the 0-3-year-old, 4-6-year-old, 7-9-year-old and 10-14-year-old groups; then the children under 3 years old were subdivided into groups of 0-<3 months, 3-<6 months, 6-<9 months, 9-<12 months, 12-<18 months, and 18-≤ 36 months; finally, the children were grouped according to their vaccination times, the pertussis toxin IgG antibody level and the infection rate of pertussis were compared among different groups by Mann- Whitney U, Kruskal- Wallis and χ2 tests. Results:The overall positive rate of the pertussis toxin IgG antibody was 23.62% (351/1 486), and the median antibody concentration was 6.60 IU/mL.Among children aged 0-14, the 0-3-year-old children had the highest positive rate of the pertussis toxin IgG antibody and the highest median antibody concentration, which were 24.58% (29/118) and 6.95 IU/mL, respectively.There was no significant difference in the antibody positive rate and the median antibody concentration among different age groups (all P>0.05). Among different subgroups of children aged 0-3, the pertussis toxin IgG antibody positive rate and the median antibody concentration were statistically significant (all P<0.05). It was predicted that the pertussis infection rate in children over 3 years old in Hangzhou was about 45.99%.The patients receiving more than 3 doses of vaccination accounted for 87.48% (1 300/1 486), and their antibody positive rate was 25.46% (331/1 300). After excluding unvaccinated children, the comparison results suggested that there was statistical significance in the antibody positive rate and median antibody concentration among different vaccination groups ( χ2=24.467, 67.438, all P<0.001). Conclusions:The serum pertussis toxin IgG antibody positive rate in children aged 0-14 in Hangzhou is low, but their predicted pertussis infection rate is higher.Children aged 0-14 are easy to become a main source of infection.Therefore, it is necessary to pay attention to and strengthen the vaccination plan and research, enhance the monitoring of the infection source, and prevent the " recurrence of pertussis" .

Objective To discuss the application of mind map in self-management of elderly patients after receiving mitral valve transcatheter edge-to-edge repair(M-TEER).Methods A total of 66 patients,who underwent M-TEER at Nanjing Hospital of Nanjing Medical University from August 2021 to October 2022,were enrolled in this study.Using the envelope concealment method,a total of 66 data analysis samples were included in the analysis.There were 33 patients each in the study group and control group.Routine health education was adopted for the patients of the control group,while the responsible nurse conducted health education for the patients of the study group under the guidance of the mind map that was designed by a multidisciplinary specialized nurses.Results There was a significant difference in postoperative medication compliance between the study group and the control group(P＜0.05),i.e.the degree of compliance,including taking medicine on time,insisting on taking medicine and taking medicine as prescribed,in the study group was obviously higher than that in the control group.The postoperative 6-min walking test,which was regarded as one of the indicators of cardiac functions,in the study group was remarkably better than that in the control group,the difference was statistically significant(P＜0.05).The postoperative quality of life(including daily activity ability,frailty degree,social support,and incidence of hospitalization for heart failure within one year after treatment)in the study group was strikingly better than that in the control group(P＜0.05).Conclusion The use of mind map in self-management of elderly patients after receiving M-TEER can effectively improve the medication compliance of the patients after discharge,improve the quality of life of patients,and reduce the incidence of hospitalization due to heart failure.

Objective:To investigate the relationship between the expression of CD103 +CD8 +T cells in locally advanced oral squamous cell carcinoma (LA-OSCC), and the response to neoadjuvant chemoimmunotherapy (NACI). Methods:Thirty LA-OSCC patients from the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, who underwent NACI from June 2020 to December 2022 were analyzed, including 16 responders and 14 non-responders. Using multiple immunofluorescence technique to stain sections of patients to verify the correlation between the expression of CD103 +CD8 +T cells and the efficacy of NACI. CD103 +CD8 +T cell density was counted using Inform and HALO software. The Spearman correlation coefficient in rank correlation is used to describe the correlation between CD103 +CD8 +T cell and neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII) It′s effectiveness as a predictive marker to NACI was analyzed by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Two-tailed t-test or Mann-Whitney U-test was used to compare data between two groups, and one-way ANOVA was used to compare data between multiple groups. SPSS 22.0 and GraphPad prism 9.0 software were used for statistical analysis and plotting of relevant statistical graphs such as histograms. P<0.05 was considered a statistically significant difference. Results:The density of CD103 +CD8 +T cells has expanded in advanced OSCC patients who are responsive to NACI. The CD103 +CD8 +T cell densities in the responsive and nonresponsive groups were 118.30(41.92, 197.80) pcs/mm 2 and 21.63(4.91, 71.92) pcs/mm 2 respectively, with statistically significant differences( U=52.00, P=0.012). CD103 +CD8 +T cell abundance was negatively correlated with NLR, dNLR, PLR, and SII ( P<0.05). ROC curve analysis showed that the AUC for predicting efficacy of NLR, dNLR, PLR, and SII were 0.781 ( P=0.009, 95% CI: 0.5715-0.9910), 0.671 ( P=0.105, 95% CI: 0.467-0.881), 0.679 ( P=0.020 95% CI: 0.549-0.951), 0.750 ( P=0.096, 95% CI: 0.461-0.896), respectively. The AUC for CD103 +CD8 +T cells alone was 0.861 ( P=0.013, 95% CI: 0.585-0.950), and the AUC of combining CD103 +CD8 +T cells with NLR was 0.896 ( P=0.025, 95% CI: 0.454-0.938). Conclusions:The density of CD103 +CD8 +T cells is expanded in advanced OSCC patients who are responsive to NACI. CD103 +CD8 +T cells positively predict favorable responses as a strong indicator to NACI in advanced OSCC patients. Co-interpretation of CD103 +CD8 +T cells and NLR value enhances the predictive accuracy of NACI in advanced OSCC patients.

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191