Objective To develop and evaluate a standardised nursing protocol for multidisciplinary team surgery assisted by a da Vinci surgical system based on systems management theory.Methods With the systems management theory,a nursing protocol was developed for multidisciplinary team surgery assisted by a da Vinci surgical system.Convenience sampling was employed to select 100 patients who received surgery assisted by a da Vinci surgical system between October 2022 and September 2023 at a Tire-ⅢA hospital in Longyan.The patients received the surgery between October 2022 and April 2023(n=50)were assigned to the control group,and those between May 2023 and September 2023(n=50)were assigned to the trial group.The patients in the control group received routine nursing care,while those in the trial group received a standardised nursing protocol for multidisciplinary team surgery assisted by a da Vinci surgical system based on systems management theory.Preoperative preparation time,setup time for surgery,surgical time,time of hospital stay,ICU admission rate,rate of surgical complication,and scores of satisfaction from medical staff and patients were compared between the two groups.Results Patients in trial group had a shorter time in preoperative preparation and setup than those in the control group(both P<0.001),However,there was no significant difference in surgical time(P>0.05).Patients in the trial group had shorter time of hospital stay,fewer ICU admission and a lower surgical complication rate(all P<0.05),and with higher satisfaction scores from patients,nurses and surgeons(all P<0.001).Conclusion The developed nursing protocol for the multidisciplinary team surgery assisted by a da Vinci surgical system is scientific.It improves surgical efficiency,patient safety and satisfaction among patients,surgeons and nurses.

Objective:To investigate the incidence, risk factors, and bile acid profile characteristics of Crohn's disease (CD) patients complicated by gallstones.Methods:A retrospective observational study was conducted. Clinical data of CD patients admitted to Zhongda Hospital of Southeast University from January 2020 to December 2023 were collected. Patients were divided into the gallstone group and the non-gallstone group according to the presence of gallstones. Univariate analysis and Logistic multivariate analysis were perfomed to identify the risk factors of CD patients complicated by gallstones. Sixty-eight CD patients in remission were selected, and serum levels of 15 bile acids were compared between patients with and without gallstones.Results:A total of 296 CD patients were enrolled, including 211 males and 85 females, with a mean age of 37.8 ± 14.8 years, disease duration of 2.0 (1.0, 6.0) years, Crohn's disease activity index of 265.3 ± 121.2, and body mass index of 22.4±2.2 kg/m 2. Among them, 44 patients (14.9%) had gallstones and were assigned to the gallstone group, while the remaining 252 patients (85.1%) were assigned to the non-gallstone group. Univariate analysis and multivariate Logistic regression analysis showed that location was an independent risk factor for CD patients complicated by gallstones. Patients with ileocolonic CD have a 3.92-fold higher risk of developing gallstones than those with colonic CD ( OR=3.92, 95% CI: 1.13-13.61, P = 0.031). Analysis of bile acid profiles in 68 CD patients in remission revealed that, compared to those without gallstones ( n = 50), patients with gallstones ( n = 18) had lower levels of ursodeoxycholic acid and an higher ratio of secondary conjugated bile acid/secondary free bile acid, the differences were significant (both P < 0.05) . Conclusions:CD patients have a high incidence of gallstones, which may be associated with abnormal bile acid metabolism. The ileocolonic CD patients are more prone to developing gallstones.

Objective:To explore the application value of the double-low technique of auto-prescription technique combined with iterative reconstruction algorithm in CT pulmonary angiography (CTPA).Methods:A total of 86 patients who were clinically suspected of having pulmonary embolism and underwent CTPA examination in the First Affiliated Hospital of Dalian Medical University were prospectively collected and randomly assigned to a control group ( n = 45) and an observation group ( n = 41) according to the random number table method. In the control group, a tube voltage of 120 kVp was used with a standard iodine contrast agent dose of 60 ml, and images were reconstructed using the 40% adaptive statistical iterative reconstruction algorithm (ASIR-V). In the observation group, the tube voltage was set by auto-prescription technique, and 0.4 ml/kg of personalized low iodine contrast agent was used. Images were reconstructed with 40%, 60%, and 80% ASIR-V, respectively, and designated as observation 1, observation 2, and observation 3 respectively. The volume CT dose index (CTDI vol), dose-length product (DLP), and effective dose ( E) were recorded and compared among the four groups. The CT values and standard deviation (SD) of the main pulmonary artery, left and right pulmonary arteries, as well as the left and right pulmonary lobe arteries were measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of these arteries were calculated. Additionally, the SD value at the contrast medium concentration in the superior vena cava was measured, and the artifact index (AI) was subsequently calculated. Two observers independently assessed the visibility of the pulmonary arteries, image noise, and sclerosis artifacts in the superior vena cava using a blinded method. Results:The E in the observation group was 3.28 (2.08, 3.93) mSv, which was significantly lower than that in the control group [5.03 (4.86, 5.20)] mSv, and the difference was statistically significant ( Z = 174.00, P < 0.05). The contrast agent dosage in the observation group was 28 (25, 30) ml, which was lower than that in the control group (60 ml), and the difference was statistically significant ( Z = 0, P < 0.05). The CT values for the main pulmonary artery and the left and right pulmonary lobe arteries in the observation group were higher than those in the control group, and the differences were all statistically significant ( t = -3.65 to -3.89, P < 0.05). The SNR and CNR of the observation groups 2 and 3 were greater than those of the control group ( t = -9.20 to -2.98, P < 0.05). The consistency of subjective evaluations between the two observers was good ( Kappa = 0.729 - 0.879, P < 0.05). There was no statistically significant difference in the subjective score of pulmonary artery visibility between the control and observation group ( P > 0.05). The subjective scores for image noise in observation group 2 and group 3 were higher than those in the control group ( U =598.50, 654.00, P < 0.05). The presence of artifacts due to sclerosis in the superior vena cava was significantly lower in the observation group compared to the control group ( χ2 = 46.09, P < 0.001). Conclusions:The combination of auto-prescription technique with ASIR-V reconstruction algorithm and low contrast agent imaging protocol can reduce the radiation dose and contrast agent dose without compromising image quality, and enable personalized double low CTPA imaging.

Objective To explore the application value of deep learning image reconstruction(DLIR)algorithm combined with a large reconstruction matrix in lung nodules screening using low-dose computed tomography(LDCT)of the chest.Methods Patients who underwent LDCT scans were prospectively enrolled.The control group(group A)used the iterative reconstruction(IR)algorithm(Karl)with a reconstruction level of Karl 5,reconstructed images of 512×512(group A1)matrix,and 1 024 × 1 024(group A2)matrix.The experimental group employed DLIR combined with 512×512(group B)matrix and 1 024 × 1 024(group C)matrix for image reconstruction at levels 1-5,which were recorded as groups B1-5 and groups C1-5.The CT values and standard deviation(SD)values of the lung parenchyma and tracheal air were measured,and the signal-to-noise ratio(SNR)was calculated.The overall lung image quality was scored on a Likert 5-point scale,and the subgroup with the best lung image quality was selected.The lung nodule detec-tion rate and clarity were compared with group A1.Results Under the same reconstruction matrix,the CT values of the tracheal air and lung parenchyma in the experimental group showed no significant difference compared to the control group,while the SD values were lower and SNR were higher(P＜0.05).Within groups B and C,as the DLIR level increased,the SD values of the tracheal air and lung paren-chyma gradually decreased,and SNR gradually improved(P＜0.05).Subjective scores for the image quality in groups B and C initially increased and then decreased,with group B3 and group C4 showed the best image quality.No difference was observed in objective eval-uation between the two groups,but the subjective image quality score of group C4 was superior to group B3(P＜0.05).Subjective eval-uation of lung nodule display in group C4 was better than in group A1(P＜0.05).Conclusion DLIR algorithm combined with a large reconstruction matrix is feasible for lung nodules screening in chest LDCT,reducing image noise while improving lung nodules clarity,demonstrating significant clinical value.

In proton therapy,prompt gamma-ray imaging is considered as one of the most promising methods for assessing proton beam range.Prompt gamma-ray imaging detector evaluates the proton beam range based on the prompt gamma-ray distribution obtained by the prompt gamma-ray imaging system,which enables high-precision measurement of the proton beam range.Herein a proton beam range verification algorithm is designed for the newly developed prototype of the range verification detector(pixelated prompt gamma-ray imaging detector),which verifies the range estimation accuracy of the prototype for different phantoms and different energies of homogeneous media through Monte Carlo simulation.The results show that the accuracy of the proton beam range verification algorithm is within 0.5 mm of the safety margin error of the Bragg peak,and the measurement accuracy is significantly improved with the increase of the number of protons,indicating that the prototype algorithm is feasible for proton beam range verification.

Objective To explore the application value of deep learning image reconstruction(DLIR)algorithm combined with a large reconstruction matrix in lung nodules screening using low-dose computed tomography(LDCT)of the chest.Methods Patients who underwent LDCT scans were prospectively enrolled.The control group(group A)used the iterative reconstruction(IR)algorithm(Karl)with a reconstruction level of Karl 5,reconstructed images of 512×512(group A1)matrix,and 1 024 × 1 024(group A2)matrix.The experimental group employed DLIR combined with 512×512(group B)matrix and 1 024 × 1 024(group C)matrix for image reconstruction at levels 1-5,which were recorded as groups B1-5 and groups C1-5.The CT values and standard deviation(SD)values of the lung parenchyma and tracheal air were measured,and the signal-to-noise ratio(SNR)was calculated.The overall lung image quality was scored on a Likert 5-point scale,and the subgroup with the best lung image quality was selected.The lung nodule detec-tion rate and clarity were compared with group A1.Results Under the same reconstruction matrix,the CT values of the tracheal air and lung parenchyma in the experimental group showed no significant difference compared to the control group,while the SD values were lower and SNR were higher(P＜0.05).Within groups B and C,as the DLIR level increased,the SD values of the tracheal air and lung paren-chyma gradually decreased,and SNR gradually improved(P＜0.05).Subjective scores for the image quality in groups B and C initially increased and then decreased,with group B3 and group C4 showed the best image quality.No difference was observed in objective eval-uation between the two groups,but the subjective image quality score of group C4 was superior to group B3(P＜0.05).Subjective eval-uation of lung nodule display in group C4 was better than in group A1(P＜0.05).Conclusion DLIR algorithm combined with a large reconstruction matrix is feasible for lung nodules screening in chest LDCT,reducing image noise while improving lung nodules clarity,demonstrating significant clinical value.

In proton therapy,prompt gamma-ray imaging is considered as one of the most promising methods for assessing proton beam range.Prompt gamma-ray imaging detector evaluates the proton beam range based on the prompt gamma-ray distribution obtained by the prompt gamma-ray imaging system,which enables high-precision measurement of the proton beam range.Herein a proton beam range verification algorithm is designed for the newly developed prototype of the range verification detector(pixelated prompt gamma-ray imaging detector),which verifies the range estimation accuracy of the prototype for different phantoms and different energies of homogeneous media through Monte Carlo simulation.The results show that the accuracy of the proton beam range verification algorithm is within 0.5 mm of the safety margin error of the Bragg peak,and the measurement accuracy is significantly improved with the increase of the number of protons,indicating that the prototype algorithm is feasible for proton beam range verification.

Objective To explore the application value of Auto-prescription combined with low-dose contrast and adaptive statisti-cal iterative reconstruction-Veo(ASIR-V)algorithm in the computed tomography angiography(CTA)of thoracodorsal artery(TDA).Methods A total of 100 patients who underwent TDA CTA examination were prospectively selected.A tube voltage of 120 kVp and contrast agent of 1.5 mL/kg were used for group A(50 cases),and images were reconstructed with 40％ post-set ASIR-V.The Auto-prescription for tube voltage and contrast agent of 1.2 mL/kg were used for group B(50 cases),while images were reconstruc-ted with 40％,60％,and 80％ post-set ASIR-V,labeled as subgroups B1 to B3.The objective and subjective evaluation results of the images were compared between and within groups.Results Group A had an effective dose(ED)of 2.98(2.65,4.03)mSv,while group B had an ED of 1.92(1.44,3.33)mSv.The iodine intake in group B was lower than that in group A,and the CT value of the axillary artery in group B was significantly higher than that in group A(P＜0.001).With the increased of ASIR-V level in group B,the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the images gradually increased(P＜0.05).In terms of subjec-tive scores on axial images,both subgroups B2 and B3 were superior to group A(P＜0.001);with the increased of ASIR-V level in group B,subjective scores of axial images increased first and then decreased,among which subjective score of subgroup B2 was the highest and the differences were statistically significant(P＜0.001).In terms of subjective scores on three-dimensional image quality,subgroups B1 to B3 were superior to group A(P＜0.001).Conclusion The use of Auto-prescription combined with low-dose con-trast and 60％ ASIR-V can significantly optimize the display of TDA,and reduce the radiation dose and contrast agent dose to a certain extent.

Objective To develop and evaluate a standardised nursing protocol for multidisciplinary team surgery assisted by a da Vinci surgical system based on systems management theory.Methods With the systems management theory,a nursing protocol was developed for multidisciplinary team surgery assisted by a da Vinci surgical system.Convenience sampling was employed to select 100 patients who received surgery assisted by a da Vinci surgical system between October 2022 and September 2023 at a Tire-ⅢA hospital in Longyan.The patients received the surgery between October 2022 and April 2023(n=50)were assigned to the control group,and those between May 2023 and September 2023(n=50)were assigned to the trial group.The patients in the control group received routine nursing care,while those in the trial group received a standardised nursing protocol for multidisciplinary team surgery assisted by a da Vinci surgical system based on systems management theory.Preoperative preparation time,setup time for surgery,surgical time,time of hospital stay,ICU admission rate,rate of surgical complication,and scores of satisfaction from medical staff and patients were compared between the two groups.Results Patients in trial group had a shorter time in preoperative preparation and setup than those in the control group(both P<0.001),However,there was no significant difference in surgical time(P>0.05).Patients in the trial group had shorter time of hospital stay,fewer ICU admission and a lower surgical complication rate(all P<0.05),and with higher satisfaction scores from patients,nurses and surgeons(all P<0.001).Conclusion The developed nursing protocol for the multidisciplinary team surgery assisted by a da Vinci surgical system is scientific.It improves surgical efficiency,patient safety and satisfaction among patients,surgeons and nurses.

Objective:To investigate the incidence, risk factors, and bile acid profile characteristics of Crohn's disease (CD) patients complicated by gallstones.Methods:A retrospective observational study was conducted. Clinical data of CD patients admitted to Zhongda Hospital of Southeast University from January 2020 to December 2023 were collected. Patients were divided into the gallstone group and the non-gallstone group according to the presence of gallstones. Univariate analysis and Logistic multivariate analysis were perfomed to identify the risk factors of CD patients complicated by gallstones. Sixty-eight CD patients in remission were selected, and serum levels of 15 bile acids were compared between patients with and without gallstones.Results:A total of 296 CD patients were enrolled, including 211 males and 85 females, with a mean age of 37.8 ± 14.8 years, disease duration of 2.0 (1.0, 6.0) years, Crohn's disease activity index of 265.3 ± 121.2, and body mass index of 22.4±2.2 kg/m 2. Among them, 44 patients (14.9%) had gallstones and were assigned to the gallstone group, while the remaining 252 patients (85.1%) were assigned to the non-gallstone group. Univariate analysis and multivariate Logistic regression analysis showed that location was an independent risk factor for CD patients complicated by gallstones. Patients with ileocolonic CD have a 3.92-fold higher risk of developing gallstones than those with colonic CD ( OR=3.92, 95% CI: 1.13-13.61, P = 0.031). Analysis of bile acid profiles in 68 CD patients in remission revealed that, compared to those without gallstones ( n = 50), patients with gallstones ( n = 18) had lower levels of ursodeoxycholic acid and an higher ratio of secondary conjugated bile acid/secondary free bile acid, the differences were significant (both P < 0.05) . Conclusions:CD patients have a high incidence of gallstones, which may be associated with abnormal bile acid metabolism. The ileocolonic CD patients are more prone to developing gallstones.