Objective To analyze the abnormal individual dose monitoring results in 206 medical institutions in a selected region in 2024, and to propose improvement measures. Methods Individuals with monitoring results exceeding the investigation level were subjected to high-dose investigation, and the results were statistically analyzed. Results In 2024, the individual dose monitoring of 206 medical institutions in a selected region showed 1.04% abnormal results. The proportions of abnormal results from primary, secondary, and tertiary medical institutions were 12.22%, 3.33%, and 84.45%, respectively. In analysis of the causes of abnormal results, 52.53% of the cases were due to personal dosimeters left in the radiation workplace, and 20.20% were due to the confusion in wearing personal dosimeters inside and outside the lead apron. In analysis of the occupational distribution of the radiation workers with abnormal monitoring results, interventional radiology and diagnostic radiology accounted for 73.34% and 24.44%, respectively. Statistical analysis of the dose range showed that doses in the ranges of 1.25-2.0 mSv and 2.0-5.0 mSv accounted for 42.22% and 33.33%, respectively. In the report of abnormal monitoring results, the proportions of reporting notional dose and reporting measured results accounted for 88.89% and 11.11%, respectively. Among institutions with consecutive abnormal results, primary, secondary, and tertiary medical institutions accounted for 15.39%, 7.69%, and 76.92%, respectively. Conclusion The level of the hospital, occupational type, the perceived importance of the hospital to the management of radiation protection, and the perceived importance and compliance of the radiation workers with the individual dose monitoring are potential causes of abnormal results. It is recommended that employers should enhance radiation protection training for their radiation workers to ensure proper wearing and storage of dosimeters, and progressively improve the standardization and effectiveness of individual dose monitoring practice.

Hearing loss is the most prevalent disabling disease. Cochlear implantation（CI） serves as the primary intervention for severe to profound hearing loss. This consensus systematically explores the value of genetic diagnosis in the pre-operative assessment and efficacy prognosis for CI. Drawing upon domestic and international research and clinical experience, it proposes an evidence-based medicine three-tiered prognostic classification system（Favorable, Marginal, Poor）. The consensus focuses on common hereditary non-syndromic hearing loss（such as that caused by mutations in genes like GJB2, SLC26A4, OTOF, LOXHD1） and syndromic hereditary hearing loss（such as Jervell & Lange-Nielsen syndrome and Waardenburg syndrome）, which are closely associated with congenital hearing loss, analyzing the impact of their pathological mechanisms on CI outcomes. The consensus provides recommendations based on multiple round of expert discussion and voting. It emphasizes that genetic diagnosis can optimize patient selection, predict prognosis, guide post-operative rehabilitation, offer stratified management strategies for patients with different genotypes, and advance the application of precision medicine in the field of CI.
Humans ; Cochlear Implantation ; Prognosis ; Hearing Loss/surgery* ; Consensus ; Connexin 26 ; Mutation ; Sulfate Transporters ; Connexins/genetics*

OBJECTIVE: To develop a method for identifying high-risk patients among septic populations requiring mechanical ventilation, and to conduct phenotypic analysis based on this method. METHODS: Data from four sources were utilized: the Medical Information Mart for Intensive Care (MIMIC-IV 2.0, MIMIC-III 1.4), the Philips eICU-Collaborative Research Database 2.0 (eICU-CRD 2.0), and the Anhui Medical University Second Affiliated Hospital dataset. The adult patients in intensive care unit (ICU) who met Sepsis-3 and received invasive mechanical ventilation (IMV) on the first day of first admission were enrolled. The MIMIC-IV dataset with the highest data integrity was divided into a training set and a test set at a 6:1 ratio, while the remaining datasets were served as validation sets. The demographic information, comorbidities, laboratory indicators, commonly used ICU scores, and treatment measures of patients were extracted. Clinical data collected within first day of ICU admission were used to calculate the sequential organ failure assessment (SOFA) score. K-means clustering was applied to cluster SOFA score components, and the sum of squared errors (SSE) and Davies-Bouldin index (DBI) were used to determine the optimal number of disease subtypes. For clustering results, normalized methods were employed to compare baseline characteristics by visualization, and Kaplan-Meier curves were used to analyze clinical outcomes across phenotypes. RESULTS: This study enrolled patients from MIMIC-IV dataset (n = 11 166), MIMIC-III dataset (n = 4 821), eICU-CRD dataset (n = 6 624), and a local dataset (n = 110), with the four datasets showing similar median ages and male proportions exceeding 50%; using 85% of the MIMIC-IV dataset as the training set, 15% as the test set, and the rest dataset as the validation set. K-means clustering based on the six-item SOFA score was performed to determine the optimal number of clusters as 3, and patients were finally classified into three phenotypes. In the training set, compared with the patients with phenotype II and phenotype III, those with phenotype I had the more severe circulatory and respiratory dysfunction, a higher proportion of vasoactive drug usage, more obvious metabolic acidosis and hypoxia, and a higher incidence of congestive heart failure. The patients with phenotype II was dominated by respiratory dysfunction with higher visceral injury. The patients with phenotype III had relatively stable organ function. The above characteristics were consistent in both the test and validation sets. Analysis of infection-related indicators showed that the patients with phenotype I had the highest SOFA score within 7 days after ICU admission, initial decreases and later increases in platelet count (PLT), and higher counts of neutrophils, lymphocytes, and monocytes as compared with those with phenotype II and phenotype III, their blood cultures had a higher positivity rates for Gram-positive bacteria, Gram-negative bacteria and fungi as compared with those with phenotype II and phenotype III. The Kaplan-Meier curve indicated that in the training, test, and validation sets, the 28-day cumulative mortality of patients with phenotype I was significantly higher than that of patients with phenotypes II and phenotype III. CONCLUSIONS Three distinct phenotypes in septic patients receiving IMV based on unsupervised machine learning is derived, among which phenotype I, characterized by cardiorespiratory failure, can be used for the early identification of high-risk patients in this population. Moreover, this population is more prone to bloodstream infections, posing a high risk and having a poor prognosis.
Humans ; Machine Learning ; Sepsis/therapy* ; Respiration, Artificial ; Intensive Care Units ; Organ Dysfunction Scores ; Male ; Female ; Middle Aged ; Adult

Objective To compare H_p(3) calibration with a homemade (A) thermoluminescent dosimeter (TLD) and an imported (B) TLD in a standard X-ray RQR radiation field, to explore the different responses of A and B, and to provide foundation for the calibration of H_p(3). Methods A column mode was selected. H_p(3) calibration was performed using A and B in a standard X-ray RQR radiation field in the Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, China Center for Disease Control and Prevention. Angle response, energy response, and linear response were calibrated with RQR4 (60 kV), RQR7 (90 kV), and RQR9 (120 kV), respectively. Results In terms of angle response, the calibration results of A were relatively high, while the calibration results of B were relatively low. In terms of energy response, the calibration results showed a similar pattern to angle response. In terms of linear response, the calibration results of both A and B were satisfactory. Conclusion Both A and B can be used for normal calibration of H_p(3) in a standard X-ray RQR radiation field. However, in actual monitoring, attention should be paid to the energy and angle response values of TLDs.

Objective:To develop a deep learning model based on multimodal data for glaucoma diagnosis and severity assessment.Methods:A diagnostic test was conducted.A total of 145 normal eyes from 86 participants and 507 eyes with primary open-angle glaucoma from 314 participants were collected at the First Affiliated Hospital of Kunming Medical University from June to December in 2023.Fundus photographs and visual field data were obtained, and glaucoma eyes were divided into three groups based on the mean deviation value of the visual field, namely mild group (154 eyes), moderate group (113 eyes), and severe group (240 eyes).Three convolutional neural network (CNN) models, including DenseNet 121, ResNet 50 and VGG 19, were used to build an artificial intelligence (AI) model.The impact of single-modal and multimodal data on the classification results was evaluated, and the most appropriate CNN network architecture for multimodal data was identified.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Kunming Medical University (No.2023L93).Written informed consent was obtained from each subject.Results:A total of 652 eyes had both fundus photographs and visual field test results.Images were randomly assigned to training and test datasets in a 4∶1 ratio by using computer random number method.AI models built with different CNN models showed high accuracy, with DenseNet 121 outperforming ResNet 50 and VGG 19 on various effectiveness measures.In the single-modal algorithm using fundus photographs, single-modal algorithm using visual field tests, and multimodal algorithm combining fundus photographs and visual field data, the area under the curve for early glaucoma detection was 0.87, 0.93 and 0.95, respectively.Conclusions:The use of multimodal data enables the development of a highly accurate tool for the glaucoma diagnosis and severity grading.

Objective:To compare the efficacy of unilateral percutaneous kyphoplasty (PKP) and unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve in the treatment of lumbar osteoporotic vertebral compression fracture (OVCF) in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 161 aged patients with newly developed lumbar OVCF, admitted to Xi′an Central Hospital Affiliated to Xi′an Jiaotong University School of Medicine from January 2019 to January 2023, including 58 males and 103 females, aged 61-88 [(72.9±6.3)years]. All the patients were diagnosed with type II compression fracture based on acute symptomatic osteoporotic thoracolumbar fracture classification (ASOTLF). Seventy-eight patients underwent unilateral PKP (PKP group), while the other 83 patients underwent unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve (PKP+contralateral block group). The operation time, intraoperative blood loss, and length of hospital stay were recorded. Beck index of the injured vertebra, Cobb angle of lumbar lordosis, Roland-Morris disability (RMD) score, visual analogue scale (VAS), and Oswestry disability index (ODI) were evaluated before operation, at 1 day, 1 week, 1 month, 3 months after operation, and at the last follow-up. The incidence of complications such as cement leakage was recorded as well.Results:All the patients were followed up for 6-8 months [(6.7±0.6)months]. There were no significant differences between the two groups in the operation time, intraoperative blood loss, or length of hospital stay ( P>0.05). The Beck index of the injured vertebra and Cobb angle of lumbar lordosis were not significantly different between the two groups before operation, at 1 day, 1 week, 1 month, 3 months after operation, and at the last follow-up ( P>0.05). The RMD score of the injured vertebra, VAS score, and ODI were not significantly different between the two groups before operation ( P>0.05). At 1 day, 1 week, 1 month, 3 months after operation, and at the last follow-up, the RMD scores in the PKP+contralateral block group were (11.23±1.05)points, (10.90±1.11)points, (10.10±1.06)points, (9.94±1.06)points, and (9.60±0.83)points respectively, which were all lower than (17.55±0.71)points, (15.78±0.86)points, (13.42±0.92)points, (10.67±0.78)points, and (9.78±0.72)points in the PKP group ( P<0.05 or 0.01); the VAS scores in the PKP+contralateral block group were (3.02±0.60)points, (2.96±0.55)points, (2.92±0.57)points, (2.88±0.61)points, and (2.70±0.51)points respectively, which were all lower than (3.60±0.57)points, (3.47±0.55)points, (3.32±0.46)points, (2.99±0.47)points, and (2.77±0.42)points in the PKP group ( P<0.05 or 0.01); the ODI values in the PKP+contralateral block group were 14.43±1.29, 14.54±1.24, 14.63±1.32, 14.37±1.31, and 13.42±1.45 respectively, which were all lower than 16.72±1.64, 16.09±1.49, 14.82±1.53, 14.74±1.46, and 13.69±1.75 in the PKP group ( P<0.05 or 0.01). The bone cement leakage rate was 12.0% (10/83) in the PKP+contralateral block group, similar to 11.5% (9/78) in the PKP group ( P>0.05). No other complications such as neurovascular injury, pulmonary embolism or adjacent vertebral fracture were found in either groups. Conclusion:In the treatment of lumbar OVCF in the elderly, unilateral PKP combined with posterior medial branch block of the contralateral spinal nerve is similar to unilateral PKP in terms of the operation time, intraoperative blood loss, length of hospital stay, effectiveness of reduction, and incidence of complications, but it can achieve better pain relief and more satisfactory functional recovery.

Neurosurgery is considered as one of the most difficult areas in the field of medicine, and the complexity of nervous system is a leading cause. Therefore, it demands neurosurgeons possess basic knowledge, spatial thinking, and practical experiences. Here, we introduce a rapid developing technique applying multi-modal neuroimaging reconstruction and virtual reality, which constitutes a novel learning model for boosting the growth of neurosurgeons. The incorporation of multi-modal neuroimaging and virtual reality builds a bridge from two-dimensional image to actual surgical view. Neurosurgeons are able to perform surgical planning and simulation with naked eyes under the constructed three-dimensional hologram. The technique also provides evidence of accurate localization and guidance for operation. Therefore, multi-modal neuroimaging reconstruction and virtual reality are expected to tremendously promote the progress of young trainees, and can further enhance their all-round abilities. In short, this revolutionary learning model would impact the neurosurgical specialists training profoundly.

Objective:To analyze the correlation between the body composition and cardiorespiratory fitness (CRF) decline in physical examination population of different genders.Methods:Clinical data of the cardiopulmonary exercise testing (CPET) and body composition analysis of 439 people who received physical examination in the Medical Examination Center of Peking University Third Hospital from May 2021 to September 2021 were retrospectively analyzed. The general data, physical examination, biochemical parameters, body composition and CPET results were collected. The subjects were divided into normal group and decline group according to the percentage of peak oxygen uptake (VO 2peak) levels ≥ 85% or<85%. Multivariate logistic regression was applied to investigate the influencing factors of CRF decline in subjects of different genders. Results:Among men, total cholesterol and triglyceride in the decline group were significantly higher than those in the normal group [(5.097±0.890) vs (4.865±0.856) mmol/L, (1.778±1.200) vs (1.485±0.709) mmol/L], and the blood homocysteine (Hcy) and skeletal muscle index were significantly lower than those in the normal group [13.00 (11.30, 15.90) vs 13.80 (12.05, 17.10) μmol/L, (7.89±0.65) vs (8.08±0.64) kg/m 2] (all P<0.05). Among women, skeletal muscle index in the decline group was significantly lower than that in the normal group [(6.21±0.52) vs (6.53±0.56)kg/m 2], and percent body fat was significantly higher than that in the normal group [(32.83±4.92)% vs (31.21±4.55)%] (all P<0.05). The elevation of triglyceride level ( OR=1.487, 95% CI: 1.042-2.121) and visceral fat area ( OR=1.032, 95% CI: 1.014-1.051) were positively correlated with the decline of CRF in man, the decrease of skeletal muscle index ( OR=0.215, 95% CI: 0.106-0.435) and the increase of percent body fat ( OR=1.149, 95% CI: 1.060-1.245) were positively correlated with the decrease of CRF in women (all P<0.05). Conclusions:There is a correlation between body composition and CRF decline in physical examination population of different genders. Men should control visceral fat more effectively, and women should pay attention to increase muscle mass while reducing body fat, in order to improve CRF.

Objective:To observe the effect of team resuscitation with Pit-Crew cardiopulmonary resuscitation (CPR) mode on improving the quality of chest compression.Methods:A control method was conducted in this study. Sixty-four medical staffs in ICU and Emergency departments were divided into the role division group and non-role division group according to the ratio of doctors to nurses, with 8 teams in each group and 4 staffs in each team. A team leader was appointed in each team of the role division group to organize and coordinate the whole CPR process, and the non-role division group was not appointed. Each team performed chest compression for 8 min according to the recommendations of the 2020 AHA CPR Guideline under the monitoring of the CPR quality tracking system using a resuscitation manikin. CPR time, chest compression fraction (CCF), times of pressing interruption, times of pressing exceeding standard interruption (>10 s), pressing frequency, chest full recoil rate and other parameters were observed and recorded. The computer system recorded the above parameters, Student's t test and Mann-Whitney U test were used to compare the differences of indexes between the two groups. Results:After the training, the role division group achieved higher CCF [(69.13±1.55)% vs. (59.13 ± 6.08)%, P<0.05], and the total time was significantly shorter and times of overshoot interruptions was significantly less in the role division group compared with the non-role division group [(79.88±28.76) s vs. (135.25±32.99) s; 4 (3, 5) times vs. 2 (1, 2) times respectively; P<0.01]. There were no statistical differences in the total time of CPR and interruption numbers ( P>0.05). In addition, there were also no statistically significant differences in the pressing total numbers, correct times, pressing frequency, pressing depth, and the full rebound times of compression, as well as the substandard indicators of compression such as pressing too fast, too slow, too deep and insufficient rebound times of compression (all P>0.05). Conclusions:Pit-Crew CPR mode with designated team leader contributes to the implementation of high quality CPR, and the monitoring of CPR quality parameters and the applying of real-time feedback system can effectively improve the quality of chest compression.

Objective:To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods:Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1, 2018 to October 31, 2020 were retrospectively analyzed. Demographic and clinical data were collected by electronic medical record system and telephone follow-up. Kaplan-Meier method was used to analyze the patency rate of vascular access.Results:A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients. The technical success rates of stenosis, chronic occlusion and acute occlusion lesion were 98.8%, 90.6% and 86.4%, respectively, and 406 cases (96.4%) of 246 patients were clinically successful. The postoperative brachial artery blood flow was 821(627, 1 029) ml/min, which was significantly higher than 309(202, 453) ml/min before the operation ( Z=-13.547, P<0.001). No serious complications occurred during and after the operation. At 6, 12, 18 and 24 months after operation, the primary patency rate was 74%, 59%, 48% and 45%, respectively, the assisted primary patency rate was 94%, 91%, 88% and 82%, and the secondary patency rate was 96%, 93%, 91% and 86%. Compared with the conventional inpatient surgery mode, the total cost of the day surgery mode was significantly reduced [12 067(10 051, 13 198) yuan vs 14 986(12 411, 20 643) yuan, Z=-13.185, P<0.001], and the hospital stay was significantly shortened [5.1(3.5, 6.9) h vs 73.4(31.6, 146.6) h, Z=-13.348, P<0.001]. Conclusion:It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode, which can save cost and time of hospitalization, and can be carried out in hospitals with relevant conditions.