Objective To investigate the correlation between dual-energy computed tomography angiography(CTA)parameters of carotid plaques and acute stroke events.Methods A retrospective analysis was conducted on the clinical and imaging data of patients who underwent dual-energy head and neck CTA and brain MRI scans.Utilizing the Siemens workstation(Syngo.Via VB40B),region of interest(ROI)were placed on the thickest slice of the carotid plaque in the axial plane to obtain parameters such as fat fraction(FF),virtual non-contrast(VNC)value,iodine concentration(IC),electron density(Rho),effective atomic number(Zeff),dual energy index(DEI),spectral curve,and corresponding CT values at 40 keV(40 keVHU)and 90 keV(90 keVHU).The slope of the energy spectrum curve(λ)was calculated within the 40 keV-90 keV range.Patients with acute cerebral infarction(ACI)in the ipsilateral anterior circulation territory were classified into the ACI group,while those without were classified into the non-acute cerebral infarction(NACI)(NACI group).Qualitative data were analyzed using the x2 test,and quantitative data were analyzed using the t-test.The predictive performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,and the differences between different ROC curves were compared using the DeLong test.Results A total of 72 patients were included,with 21 in the ACI group and 51 in the NACI group.The mean values of FF,Zeff,and 40 keVHU in the ACI group were greater than those in the NACI group.Statistically significant differences were observed between the groups for Zeff,DEI,40 keVHU,and λ(P＜0.05).40 keVHU demonstrated the highest predictive performance,and the AUC,sensitivity,and specificity was 0.789,81.0％,and 74.5％,respectively.A combined variable constructed through logistic regression analysis yielded an AUC,sensitivity,and specificity of 0.796,85.7％,and 70.6％,respectively,with no significant statistical differences compared to single factor variables.Conclusion Dual-energy CTA parameters of carotid plaques may aid in predicting intraplaque hemorrhage(IPH)and the occurrence of acute stroke events.

Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o'clock,of which 76 cases at 10 and 11 o'clock,accounting for 76%;1 case each at 1 and 2 o'clock,accounting for 2%;2 and 4 cases at7 and 8 o'clock respectively,accounting for6%.The inner diameter of the cystic duct ranged from 3 mm to13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or fever,and their liver function was normal.B-ultrasound showed a diameter of 5-10 mm for the common bile duct,with a median of 7 mm,and no postoperative stenosis.Conclusions Exploring the common bile duct through the cystic duct is feasible,with no or minimal damage to the common bile duct and no damage to the Oddi sphincter.It is the best way and surgical technique for laparoscopic exploration and stone removal via choledochoscope in SCL.

Objective To investigate the correlation between dual-energy computed tomography angiography(CTA)parameters of carotid plaques and acute stroke events.Methods A retrospective analysis was conducted on the clinical and imaging data of patients who underwent dual-energy head and neck CTA and brain MRI scans.Utilizing the Siemens workstation(Syngo.Via VB40B),region of interest(ROI)were placed on the thickest slice of the carotid plaque in the axial plane to obtain parameters such as fat fraction(FF),virtual non-contrast(VNC)value,iodine concentration(IC),electron density(Rho),effective atomic number(Zeff),dual energy index(DEI),spectral curve,and corresponding CT values at 40 keV(40 keVHU)and 90 keV(90 keVHU).The slope of the energy spectrum curve(λ)was calculated within the 40 keV-90 keV range.Patients with acute cerebral infarction(ACI)in the ipsilateral anterior circulation territory were classified into the ACI group,while those without were classified into the non-acute cerebral infarction(NACI)(NACI group).Qualitative data were analyzed using the x2 test,and quantitative data were analyzed using the t-test.The predictive performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,and the differences between different ROC curves were compared using the DeLong test.Results A total of 72 patients were included,with 21 in the ACI group and 51 in the NACI group.The mean values of FF,Zeff,and 40 keVHU in the ACI group were greater than those in the NACI group.Statistically significant differences were observed between the groups for Zeff,DEI,40 keVHU,and λ(P＜0.05).40 keVHU demonstrated the highest predictive performance,and the AUC,sensitivity,and specificity was 0.789,81.0％,and 74.5％,respectively.A combined variable constructed through logistic regression analysis yielded an AUC,sensitivity,and specificity of 0.796,85.7％,and 70.6％,respectively,with no significant statistical differences compared to single factor variables.Conclusion Dual-energy CTA parameters of carotid plaques may aid in predicting intraplaque hemorrhage(IPH)and the occurrence of acute stroke events.

Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o'clock,of which 76 cases at 10 and 11 o'clock,accounting for 76%;1 case each at 1 and 2 o'clock,accounting for 2%;2 and 4 cases at7 and 8 o'clock respectively,accounting for6%.The inner diameter of the cystic duct ranged from 3 mm to13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or fever,and their liver function was normal.B-ultrasound showed a diameter of 5-10 mm for the common bile duct,with a median of 7 mm,and no postoperative stenosis.Conclusions Exploring the common bile duct through the cystic duct is feasible,with no or minimal damage to the common bile duct and no damage to the Oddi sphincter.It is the best way and surgical technique for laparoscopic exploration and stone removal via choledochoscope in SCL.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

OBJECTIVES: This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9,179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status. RESULTS: Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07 to 1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07 to 1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08 to 1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01 to 1.52), emotional abuse (OR, 1.28; 95% CI, 1.12 to 1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09 to 1.43) were associated with diabetes. CONCLUSIONS ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.

Objective:To conduct radiation detection and dose assessment in selective internal radiotherapy with 90Y resin microspheres for the purpose of providing a reference for radiological protection. Methods:The dose rates from radiotherapy with 90Y resin microspheres were detected in the process of each operation at different distances from the body surface of patients the levels of dose to the persons concerned were compared with the relevant national regulations and standards. Results:The estimated dose rates were 1.12-454 μSv/h during 90Y resin microspheres dispensing and 2.06-58.2 μSv/h during surgical procedure. The dose rates at 0.5 h after surgery were 22.7-64.1 μSv/h at 5 cm and 0.82-2.55 μSv/h at 1 m from three patient′s body surface. Assuming treating 200 patients a year, the annual individual effective dose to the radiation workers was 0.12-1.03 mSv/year. The annual individual effective dose to the public, comforters and carers of patients was 0.02-0.24 mSv/year after release of a patient. Conclusions:During the treatment, nursing and release of patients, the radiation doses to workers, carers and the public are lower than the individual dose limit given in the GB18871-2002 basic standards for protection against ionizing radiation and for the safety of radiation sources and the management target value set by of the relevant medical institutions.

Objective:To evaluate 90Y activity concentration in renal excretions during the first 48 hours after being treated with 90Y resin microspheres seleceive internal radiation therapy(SIRI) and to provide advice on the management of patient excreta after surgery. Methods:After surgery, urine excreted from 3 patients during 0-24 h and 24-48 h was collected respectively, and the 90Y activity concentration in urine was tested and analyzed. Results:90Y radioctivity in the urine excreted from 3 patients after surgery was (1 266±258)kBq/GBq during 0-24 h and (140±106) kBq/GBq during 24-48 h, respectively, and 90Y activity concentration were (640±113) kBq/L during 0-24 h and (53±12) kBq/L during 24-48 h. Conclusions:90Y radioactivity in patient′s urine excreted at 1 d was about 10 times higher than that at 2 d. After surgery, patients can accelerate the reduction of free 90Y activity by increasing excretion. Urine excreted by the patients during hospitalization should be handled in accordance with the requirements of the national standard HJ 1188-2021 Radiation protection and safety requirements for nuclear medicine.

Objective:To verify and discuss the consistency and applicability of the semi empirical formula and Monte Carlo simulation method in the radiation shielding calculation for high energy synchrotron radiation source.Methods:The semi empirical formula and Monte Carlo simulation were used to calculate the ambient dose equivalent outside of the shielding.Results:The ratio of Jenkins semi empirical formula result to Monte Carlo simulation result was 111%-153%. The ratio of Sakano semi empirical formula result to Monte Carlo simulation result was 201%.Conclusions:For a single shielding material, the semi empirical formula can be simple and conservative to complete the shielding calculation for high-energy electron accelerator. For a variety of shielding materials, Monte Carlo simulation method should be used.

Objective:To explore the existing issues in radiation protection during the treatment of 131I by means of measuring the ambient dose equivalent rate to patients with thyroid cancer and the dose equivalent to the surface of chest of patients during hospitalization. Methods:The ambient dose equivalent rate (peer) was measured by using gamma ray detector for selected 78 patients who received 131I treatment in a hospital 10 min, 1 d, 2 d, 3 d and 5 d after administration with 131I. The measurements were made at distances of 5 cm, 0.5 m and 1 m from the body surface in front, rear, left and right directions. The photoluminescence dosimeter on the chest of the patients was used to measure the effective dose during hospitalization period (6 d). Results:The ambient dose equivalent rate on the surface of chest of patients was up to 4.81 mSv/h 10 min after administration of medicine. The dose equivalent on the surface of chest of patients before discharge ranged 2.6-64.1 μSv/h. The cumulative dose on chest surface during hospitalization was 15.9-58.8 mGy. There was a significant difference in the dose rate at 5 cm from the body surface between 3.7 GBq group and 5.55 GBq group 10 min after medication ( t=-6.11, P<0.05). There was a significant difference in the dose rate at 5 cm from the body surface between male and female groups 10 min after medication ( t=4.52, P < 0.05). There was no significant difference in other groups ( P > 0.05). Conclusions:During the 131I treatment, patients had high level of radiation around them, so it is necessary to strengthen the protection and management of patients and reduce unnecessary exposure to the public.