Objective:To explore the diagnostic reference level(DRL)of computed tomography(CT)based on size-specific dose estimate(SSDE)for child's head,and estimate the SSDE by using tube current time production.Methods:The CT data of head of 1259 pediatric patients who underwent CT examination in Children's Hospital of Nanjing Medical University from January 2023 to December 2023 were retrospectively collected.They were divided into six groups according to different ages:<6 months group,6 months to<1 year group,1 to<3 years group,3 to<6 years group,6 to<12 years group,and≥12 years group.Additionally,they were divided into five groups based on body size:<12.5 cm group,12.5 to<14 cm group,14 to<15 cm group,15 to<16 cm group,and≥16 cm group.The volume CT dose index(CTDIVOL),tube current time production(mAs),left and right diameter(LRD),area(AROI)and CT value(CTROI)of region of interest of different age groups were respectively measured and recorded.The water equivalent diameter(DW),conversion factor(f H16)and SSDE based on DW(SSDEDW)were calculated.The DRLs distribution based on age and body size was analyzed by statistic method,and the correlation between DW and mAs was analyzed by regression analysis,and a regression model between SSDEDW and mAs was further established.The intra-group correlation coefficient(ICC)was used to analyze the consistency.Results:In DRLs of various age groups,the CTDIVOL range and SSDEDW range were respectively(12.32 mGy-21.66 mGy)and(13.47 mGy to 17.83 mGy).In the DRL of various body size groups,the CTDIVOL range and SSDEDW range were(13.52 mGy-21.86 mGy)and(13.91 mGy-17.92 mGy).In different ages group of pediatric patients,the range of deviation rates of local DRL(LDRLs)value of radiation dose on head of CTDIVOL value to SSDEDW was-8.54%-21.48%.There were strong positive correlations between DW and mAs at 100 and 120 kVp(r=0.96,0.89,P<0.001),respectively.There was stronger consistency between the calculated value by using SSDEDW and actual measurement value by using sAs(ICC=0.98).Conclusion:SSDEDW can more accurately reflect radiation dose,and SSDEDW can be more quickly calculated to control the radiation dose by using the regression models between SSDEDW and mAs.

Objective:To explore the diagnostic reference level(DRL)of computed tomography(CT)based on size-specific dose estimate(SSDE)for child's head,and estimate the SSDE by using tube current time production.Methods:The CT data of head of 1259 pediatric patients who underwent CT examination in Children's Hospital of Nanjing Medical University from January 2023 to December 2023 were retrospectively collected.They were divided into six groups according to different ages:<6 months group,6 months to<1 year group,1 to<3 years group,3 to<6 years group,6 to<12 years group,and≥12 years group.Additionally,they were divided into five groups based on body size:<12.5 cm group,12.5 to<14 cm group,14 to<15 cm group,15 to<16 cm group,and≥16 cm group.The volume CT dose index(CTDIVOL),tube current time production(mAs),left and right diameter(LRD),area(AROI)and CT value(CTROI)of region of interest of different age groups were respectively measured and recorded.The water equivalent diameter(DW),conversion factor(f H16)and SSDE based on DW(SSDEDW)were calculated.The DRLs distribution based on age and body size was analyzed by statistic method,and the correlation between DW and mAs was analyzed by regression analysis,and a regression model between SSDEDW and mAs was further established.The intra-group correlation coefficient(ICC)was used to analyze the consistency.Results:In DRLs of various age groups,the CTDIVOL range and SSDEDW range were respectively(12.32 mGy-21.66 mGy)and(13.47 mGy to 17.83 mGy).In the DRL of various body size groups,the CTDIVOL range and SSDEDW range were(13.52 mGy-21.86 mGy)and(13.91 mGy-17.92 mGy).In different ages group of pediatric patients,the range of deviation rates of local DRL(LDRLs)value of radiation dose on head of CTDIVOL value to SSDEDW was-8.54%-21.48%.There were strong positive correlations between DW and mAs at 100 and 120 kVp(r=0.96,0.89,P<0.001),respectively.There was stronger consistency between the calculated value by using SSDEDW and actual measurement value by using sAs(ICC=0.98).Conclusion:SSDEDW can more accurately reflect radiation dose,and SSDEDW can be more quickly calculated to control the radiation dose by using the regression models between SSDEDW and mAs.

Objective:To investigate the role of ferroptosis in testicular injury in adolescent male mice induced by TDCIPP.Methods:In December 2021, 30 healthy 3-week-old male C57BL/6 mice, with a body weight of (13±2) g, were selected and fed adaptive for one week. They were divided into control group, low-dose group, medium-dose group, high-dose group and iron death inhibitor group according to a random number table, with 6 mice in each group. Mice in low, medium and high dose groups were treated with 5, 25 and 125 mg/ (kg·d) TDCIPP for 28 days, respectively, while the control group was treated with the same amount of corn oil for 28 days. The iron death inhibitor group was given 125 mg/ (kg·d) TDCIPP intragastric administration for 28 days, and 30 mg/kg DFO saline solution was intraperitoneally injected three times a week. After the treatment, the mice were killed, the epididymis was separated, and sperm count was performed. HE staining was used to observe the morphological changes of mouse testis, and iron content in testis was detected by tissue iron detection kit. The level of reactive cxygen species, MDA content, and the mitochondrial membrane potential level of mice were detected. Western blot analysis of testicular glutathione peroxidase (GPX4) and internal cyclooxygenase-2 (COX2) protein expression.Results:Compared with the control group, the spermatogenic cells in the testes of mice treated with medium-and high-dose of TDCIPP were disorderly arranged, showing a vacuolar structure. the number of sperm in the epididymis was significantly reduced ( P=0.009, 0.004), while the sperm deformity rate was significantly increased ( P=0.010, 0.000). Moreover, the content of ROS, iron ion and MDA in the testes increased significantly ( P<0.05), and the mitochondrial membrane potential of mouse testicular cells decreased significantly ( P<0.05). The expression of GPX4 proteins decreased ( P<0.05). while the expression of COX2 increased significantly ( P<0.01). Compared with high-dose group group, spermatogenic cells in ferroptosis inhibitor group were closely arranged and normal, and ROS and Fe contents in testicular tissue were significantly decreased ( P<0.01) ; GPX4 protein expression was significantly increased while COX2 protein expression was significantly decreased ( P<0.05) . Conclusion:Ferroptosis is involved in TDCIPP-induced testicular damage in male pubertal mice.

Objective:To investigate the role of ferroptosis in testicular injury in adolescent male mice induced by TDCIPP.Methods:In December 2021, 30 healthy 3-week-old male C57BL/6 mice, with a body weight of (13±2) g, were selected and fed adaptive for one week. They were divided into control group, low-dose group, medium-dose group, high-dose group and iron death inhibitor group according to a random number table, with 6 mice in each group. Mice in low, medium and high dose groups were treated with 5, 25 and 125 mg/ (kg·d) TDCIPP for 28 days, respectively, while the control group was treated with the same amount of corn oil for 28 days. The iron death inhibitor group was given 125 mg/ (kg·d) TDCIPP intragastric administration for 28 days, and 30 mg/kg DFO saline solution was intraperitoneally injected three times a week. After the treatment, the mice were killed, the epididymis was separated, and sperm count was performed. HE staining was used to observe the morphological changes of mouse testis, and iron content in testis was detected by tissue iron detection kit. The level of reactive cxygen species, MDA content, and the mitochondrial membrane potential level of mice were detected. Western blot analysis of testicular glutathione peroxidase (GPX4) and internal cyclooxygenase-2 (COX2) protein expression.Results:Compared with the control group, the spermatogenic cells in the testes of mice treated with medium-and high-dose of TDCIPP were disorderly arranged, showing a vacuolar structure. the number of sperm in the epididymis was significantly reduced ( P=0.009, 0.004), while the sperm deformity rate was significantly increased ( P=0.010, 0.000). Moreover, the content of ROS, iron ion and MDA in the testes increased significantly ( P<0.05), and the mitochondrial membrane potential of mouse testicular cells decreased significantly ( P<0.05). The expression of GPX4 proteins decreased ( P<0.05). while the expression of COX2 increased significantly ( P<0.01). Compared with high-dose group group, spermatogenic cells in ferroptosis inhibitor group were closely arranged and normal, and ROS and Fe contents in testicular tissue were significantly decreased ( P<0.01) ; GPX4 protein expression was significantly increased while COX2 protein expression was significantly decreased ( P<0.05) . Conclusion:Ferroptosis is involved in TDCIPP-induced testicular damage in male pubertal mice.

Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

Objective:To explore the effect of motivational interview combined with feedback teaching on active cycle of breathing technique(ACBT) training in lung cancer patients.Methods:A total of 632 patients with lung cancer undergoing radical resection from September 2017 to March 2019 in Sun Yat-sen University Cancer Center were selected and divided into the experimental group and the control group with 316 cases in each group by operation time. The experimental group received motivational interview combined with feedback teaching education, while the control group received routine education. The patients were followed up for 2 months. The compliance and accuracy of ACBT training, self-care ability, sputum discharge and incidence of pulmonary complications were compared between the two groups.Results:The sputum volume in the control group was (6.25±2.44), (9.28±2.63), (10.33±3.15) g in the control group and (8.74±4.17),(13.87±3.19),(14.18±4.16) g in the experimental group at 1, 2, 3 days after operation, and the differences between the two groups were statistically significant ( t values were -1.149, -2.316, -4.124, P<0.01 or 0.05). There were 56 cases(17.72%) of pulmonary complications in the control group and 33 cases (10.44%) in the experimental group. The difference in the incidence of pulmonary complications between the two groups was statistically significant ( χ2 value was 4.743, P<0.01).Two months after operation, the compliance and accuracy of ACBT training in the experimental group were better than those in the control group ( χ2 values were - 4.57, - 2.15, P<0.01).The improvement in the four dimensions after intervention in the experimental group were better than those in the control group, and the differences were statistically significant ( t values were 8.314-19.719, P<0.01). Conclusions:The motivational interview combined with feedback teaching is an effective method of health education, which is conducive to improving lung cancer patients' compliance and accuracy of postoperative ACBT training, improving patients' self-care ability, promoting the discharge of patients' sputum and reducing the incidence of pulmonary complications to promote the recovery of lung function.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective:To analyze the influence on radiation dose and image quality of children neck CT with anterior flexion of cervical spine using self-made sponge pad with DoseRight technique.Methods:A total of 125 children aged 1-5 years who underwent neck CT examination were consecutively collected prospectively. The patients were divided into control group and test group with computer random number method . The control group was supine on the scanning bed and fixed in the CT skull stent. The test group was supine on the scanning bed with a self-made sponge cushion under the neck to extend the head and droop the shoulder. The data was acquired with Philips Brilliance iCT and CTDI VOL was obtained from the dose report. SSDE ED and SSDE WD were calculated seperately.The image quality by measuring the noise value and signal-to-noise ratio of the paravertebral muscle area at the middle level of the third cervical vertebra and thyroid area. Subjective evaluation of image quality by 5-point scoring systemwas performed. Results:The noise values of paravertebral muscles and thyroid regions in the test group were lower than those in the control group( t=-6.93, -7.41, P<0.05), and the signal-to-noise ratios were higher than those in the control group ( t=5.74, 6.14, P<0.05). The subjective score of the test group (4.32±0.70) was better than that of the control group (3.70±0.66), and the difference was statistically significant ( Z=-4.27, P<0.05). The jaw-pharynx angle and the number of vertebra displayed of the test group were higher than those of the control group ( t=4.94, 5.09, P<0.05). CTDI VOL, and in the control group were 22.1%, 26.0% and 27.1% higher than those in the test group ( t=6.17, 5.11, 4.35, P<0.01). Conclusions: is more accurate to indicate the CT radiation dose of children. The self-made sponge pad keeping the cervical spine in anterior flexion can reduce radiation dose and improve image quality.

Objective: To confirm the effect of the relative position between upper limbs and cervicothoracic vertebrae on image quality and radiation dose while performing airway CT examination of children with airway foreign bodies. Methods: One hundred and three children, aged from 1 to 48 months were enrolled prospectively and divided into 3 groups according to the position of upper limbs.In group A, the upper limbs were raised beside the cervical vertebra, in group B, the upper limbs were placed beside the thoracic vertebra, and in group C, the upper limbs were raised about 45 degrees with sponge pads and placed beside the chest. Data were acquired by Philips 128iCT, and CT dose index (CTDI_vol) and dose-length product (DLP) were recorded and compared among three groups. The image qualities were evaluated subjectively and objectively. Results: Subjective score of cervical image quality in group B (4.33±0.72) and group C (4.19±0.63) were higher than that in group A (3.71±0.66), and the difference was statistically significant (Z=-3.19、-2.61, P<0.05). Subjective score of chest image quality in group A (4.21±0.47) was higher than that in group B (3.71±0.39) and group C (3.92±0.42), and group C was higher than that in group B, the difference was statistically significant (Z= -1.71, -2.08, P<0.05). The difference of DLP in group B (57.7±6.8) mGy·cm was higher than that in group A (51.6±7.6) mGy·cm and group C (51.3±6.3) mGy·cm, the difference was statistically significant (P<0.05), and there was no significant difference between group A and group C (P>0.05). Conclusions Raising upper limbs 45 degrees and placing them beside the chest will improve the CT image quality of airway and reduce the radiation dose.

BACKGROUND:In perioperative period of total knee replacement in elderly patients, it is crucial to maintain the normal function of blood coagulation. However, many factors may influence coagulation function of patients in perioperative period. Of them, anesthesia is an important factor. Different anesthesia methods wil produce different effects on blood coagulation. Appropriate anesthesia methods should be selected in the clinic to maintain the stability of coagulation function. OBJECTIVE:To explore the effect of application of general anesthesia and epidural anesthesia in elderly knee replacement and the effects on the function of blood coagulation. METHODS:A retrospective analysis was performed on clinical data of 135 elderly patients after total knee replacement in Dongying Hospital of Shandong Provincial Hospital Group from September 2012 to September 2013. Al patients were divided into control group (67 cases;general anesthesia) and observation group (68 cases;epidural anesthesia) according to the mode of anesthesia. Coagulation indexes and D-dimer levels were observed before anesthesia, 6 hours after anesthesia, and 1 day after replacement in both groups. The incidence of deep venous thrombosis was measured and compared between the two groups in 12-month fol ow-up.
RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference was detected in blood coagulation indexes at different time points in the two groups (al P>0.05). However, significant differences in D-dimer levels were detectable between the two groups at 6 hours after anesthesia and in the morning at 1 day after replacement. D-dimer levels were significantly lower in the observation group than in the control group (al P<0.05). The incidences of deep venous thrombosis were 3%and 21%in the observation and control groups, respectively, showing significant differences (P<0.05). These results suggest that epidural anesthesia during elderly totak knee replacement obtained good effects, and could maintain stable coagulation function.