Objective To systematically analyze the medical radiation exposure levels in a district of Ningbo City and to provide a scientific basis for the reasonable and effective control of medical radiation exposure. Methods Based on the radiological diagnosis frequency and dose information system, basic medical radiation exposure data were collected, such as radiation doses received by patients in various X-ray diagnostic examinations, from all 13 public medical institutions in a district of Ningbo City from January 1 to December 31, 2020. The data were analyzed for the percentage and collective effective dose of various diagnostic examinations, the distribution of examinations by sex and age, and the number of patients undergoing two or more examinations and their cumulative doses within multiple time intervals. Results Among medical X-ray diagnostic examinations in the district, the percentages of CT examination and routine photography examination were 50.88% and 47.93%, respectively, and the collective effective dose of CT examination accounted for 97.75%. By age and sex, the frequency of examination was the highest in the age group of 45-54 years, and the frequency of examination in the male was higher than that in the female before age 55. The annual effective dose for two patients exceeded 100 mSv. Conclusion In this study, CT examination accounted for up to 50.88% of all medical X-ray diagnostic examinations, and contributed 97.75% of the collective effective dose, highlighting the need for particular attention to the justification of medical radiation exposure from CT.

Objective:To clarify the complex network structure between self-management levels and supportive care needs of patients undergoing maintenance hemodialysis, utilizing network analysis methods to identify the core and bridging nodes among the variables, thereby defining targets for nursing interventions to implement more precise care strategies.Methods:A cross-sectional survey was conducted from May to November 2023 among 302 outpatient maintenance hemodialysis patients at the hemodialysis centers of two healthcare institutions in Harbin (the Second Affiliated Hospital of Harbin Medical University and Heilongjiang Changjiang Nephrology Specialist Hospital). This involved the use of general information questionnaires, the Hemodialysis Patient Self-Management Scale, and the Supportive Care Needs Scale for Hemodialysis Patients. R language was employed for the network analysis.Results:A total of 300 valid questionnaires were collected, including 186 males and 114 females, with an age range of 23 to 88 years (mean age 55.00 ± 13.78 years). The scores for the dimensions of self-management among dialysis patients were as follows: problem-solving (3.38 ± 0.63), execution of self-care (3.16 ± 0.52), partnership (2.56 ± 0.69), and emotional processing (1.89 ± 0.63). The scores for the dimensions of supportive care needs among dialysis patients were: physiological needs (2.82 ± 1.08), psychological needs (1.51 ± 1.02), social needs (1.97 ± 1.07), emotional needs (1.67 ± 1.12), spiritual needs (2.22 ± 0.77), informational needs (2.83 ± 1.08), and practical needs (2.82 ± 1.03). In network analysis, the strongest intensity was found in the execution of self-care (1.753), and the highest closeness was in psychological needs (0.017). The top three dimensions ranked by bridge strength were social needs (1.463), partnership (1.462), and execution of self-care (1.384). The root mean square error was lowest for psychological needs (0.518) and emotional needs (0.538). The stability and accuracy of the network structure were found to be good.Conclusions:The key intervention targets for nursing care in maintenance hemodialysis patients were identified as executing self-care, psychological needs, emotional needs, and social needs. Among these, executing self-care served as the core intervention focus, while psychological and emotional needs had dominant influences, and social needs exhibited the strongest bridging role. Nursing staff should prioritize these key targets and tailor personalized comprehensive nursing intervention plans to enhance patients′self-management levels and fully meet their care needs.

Objective To investigate the impact of the artificial intelligence iterative reconstruction (AIIR) algorithm on image quality in chest computed tomography (CT) at different radiation doses, and assess its value in reducing radiation dose during chest CT examinations. Methods A simulated chest phantom was scanned with 12 groups of tube voltages and milliampere-seconds, and the radiation dose was recorded for each group. The images of each group were reconstructed using seven methods: AIIR with noise levels 1-5, KARL iterative reconstruction, and filtered back projection (FBP). The CT values and standard deviations of soft tissue, thoracic vertebrae, pulmonary nodules, and the mediastinum were measured, with standard deviation representing image noise. Subjective evaluation of image quality was performed. The Friedman test was used to compare CT values among the seven reconstruction groups, a linear mixed model was employed for statistical analysis of image noise, and the Friedman test was also used for comparing subjective evaluation scores. Results The reconstruction algorithm, tube voltage, milliampere-seconds, and their interactions all showed statistically significant effects on image noise for the four tissues (F = 2.041-391.283, P < 0.05). Among the reconstruction algorithms, noise reduction capability decreased in the following order: AIIR levels 1-5, KARL, and FBP. The interaction between the reconstruction algorithm and tube voltage or milliampere-seconds indicated that AIIR exhibited improved noise reduction efficacy under low tube voltage and low milliampere-second conditions (|t| = 1.892-8.245, P < 0.05). In terms of subjective evaluation of image quality, there was no statistically significant difference among AIIR levels 3-5 (|Z| ≤ 0.567, P > 0.05), and the score of AIIR level 3 was significantly higher than those of AIIR level 1, AIIR level 2, FBP, and KARL level 2 (|Z| = 3.449-5.906, P < 0.05). Conclusion The AIIR reconstruction algorithm significantly reduced image noise in chest CT examinations. For improving image quality while maintaining image realism, AIIR level 3 is recommended, which can reduce the radiation dose by more than 75%. Furthermore, AIIR showed superior performance in noise reduction under low tube voltage and low milliampere-second conditions, demonstrating significant potential for reducing radiation dose.

Objective To investigate the correlation between serum TNF super family 15(TNFSF15),growth differentiation factor 11(GDF11)and in-stent restenosis(ISR)in patients with unstable angina pectoris(UAP)undergoing percutaneous coronary intervention(PCI).Methods A total of 350 UAP patients who underwent PCI treatment in the Second Hospital of Qinhuangdao from January 1,2020 to January 1,2021 were collected as observation subjects,and they were separated into non-ISR group(n=246)and ISR group(n=104)based on whether they had experienced ISR.ELISA was applied to determine the levels of serum TNFSF15 and GDF11,ROC curve was applied to analyze the predictive value of serum TNFSF15 and GDF11 levels for postoperative ISR in UAP patients after PCI,and multivariate Logistic regression was used to analyze the factors affecting the occurrence of ISR in UAP patients after PCI.Results Compared with the non-ISR group,the ISR group showed an increase in blood glucose,smoking history and LDL-C levels(t/χ2=22.908,18.869,47.337),as well as elevated serum TNFSF15 levels(16.97±1.51 pg/ml vs 18.35±1.62pg/ml)and GDF11 levels(157.72±16.13pg/ml vs 174.11±18.65 pg/ml)decreased(t=7.429,7.811),and the differences were statistically significant(all P<0.001).The AUC(95%CI)of serum TNFSF15 and GDF11 in dependently and jointly predicting ISR after PCI in UAP patients were 0.764(0.716～0.808),0.781(0.734～0.823)and 0.849(0.807～0.885),respectively,and the joint prediction of the two was higher than the individual prediction(Z=4.365,3.257,all P<0.001).Multivariate Logistic regression analysis of serum TNFSF15,the level of GDF11 was a protective factor for ISR in UAP patients after PCI(Wald χ2=11.000,36.321,all P<0.05).Conclusion The serum levels of TNFSF15 and GDF11 decreased in UAP patients with postoperative ISR after PCI,which have good predictive value for the occurrence of ISR in UAP patients after PCI.

Objective To investigate the correlation between serum TNF super family 15(TNFSF15),growth differentiation factor 11(GDF11)and in-stent restenosis(ISR)in patients with unstable angina pectoris(UAP)undergoing percutaneous coronary intervention(PCI).Methods A total of 350 UAP patients who underwent PCI treatment in the Second Hospital of Qinhuangdao from January 1,2020 to January 1,2021 were collected as observation subjects,and they were separated into non-ISR group(n=246)and ISR group(n=104)based on whether they had experienced ISR.ELISA was applied to determine the levels of serum TNFSF15 and GDF11,ROC curve was applied to analyze the predictive value of serum TNFSF15 and GDF11 levels for postoperative ISR in UAP patients after PCI,and multivariate Logistic regression was used to analyze the factors affecting the occurrence of ISR in UAP patients after PCI.Results Compared with the non-ISR group,the ISR group showed an increase in blood glucose,smoking history and LDL-C levels(t/χ2=22.908,18.869,47.337),as well as elevated serum TNFSF15 levels(16.97±1.51 pg/ml vs 18.35±1.62pg/ml)and GDF11 levels(157.72±16.13pg/ml vs 174.11±18.65 pg/ml)decreased(t=7.429,7.811),and the differences were statistically significant(all P<0.001).The AUC(95%CI)of serum TNFSF15 and GDF11 in dependently and jointly predicting ISR after PCI in UAP patients were 0.764(0.716～0.808),0.781(0.734～0.823)and 0.849(0.807～0.885),respectively,and the joint prediction of the two was higher than the individual prediction(Z=4.365,3.257,all P<0.001).Multivariate Logistic regression analysis of serum TNFSF15,the level of GDF11 was a protective factor for ISR in UAP patients after PCI(Wald χ2=11.000,36.321,all P<0.05).Conclusion The serum levels of TNFSF15 and GDF11 decreased in UAP patients with postoperative ISR after PCI,which have good predictive value for the occurrence of ISR in UAP patients after PCI.

Objective:To clarify the complex network structure between self-management levels and supportive care needs of patients undergoing maintenance hemodialysis, utilizing network analysis methods to identify the core and bridging nodes among the variables, thereby defining targets for nursing interventions to implement more precise care strategies.Methods:A cross-sectional survey was conducted from May to November 2023 among 302 outpatient maintenance hemodialysis patients at the hemodialysis centers of two healthcare institutions in Harbin (the Second Affiliated Hospital of Harbin Medical University and Heilongjiang Changjiang Nephrology Specialist Hospital). This involved the use of general information questionnaires, the Hemodialysis Patient Self-Management Scale, and the Supportive Care Needs Scale for Hemodialysis Patients. R language was employed for the network analysis.Results:A total of 300 valid questionnaires were collected, including 186 males and 114 females, with an age range of 23 to 88 years (mean age 55.00 ± 13.78 years). The scores for the dimensions of self-management among dialysis patients were as follows: problem-solving (3.38 ± 0.63), execution of self-care (3.16 ± 0.52), partnership (2.56 ± 0.69), and emotional processing (1.89 ± 0.63). The scores for the dimensions of supportive care needs among dialysis patients were: physiological needs (2.82 ± 1.08), psychological needs (1.51 ± 1.02), social needs (1.97 ± 1.07), emotional needs (1.67 ± 1.12), spiritual needs (2.22 ± 0.77), informational needs (2.83 ± 1.08), and practical needs (2.82 ± 1.03). In network analysis, the strongest intensity was found in the execution of self-care (1.753), and the highest closeness was in psychological needs (0.017). The top three dimensions ranked by bridge strength were social needs (1.463), partnership (1.462), and execution of self-care (1.384). The root mean square error was lowest for psychological needs (0.518) and emotional needs (0.538). The stability and accuracy of the network structure were found to be good.Conclusions:The key intervention targets for nursing care in maintenance hemodialysis patients were identified as executing self-care, psychological needs, emotional needs, and social needs. Among these, executing self-care served as the core intervention focus, while psychological and emotional needs had dominant influences, and social needs exhibited the strongest bridging role. Nursing staff should prioritize these key targets and tailor personalized comprehensive nursing intervention plans to enhance patients′self-management levels and fully meet their care needs.

Objective:To estimate and analyze the levels of occupational exposure of aircrews in China, and to provide scientific basis for strengthening occupational health management.Methods:Through the FlightAware website, the flight data were collected of a total of 104 routes flying between airports with large passenger volume in China. Four kinds of cosmic radiation dose estimation programs CARI, SIEVERT, PCAIRE, and JISCARD-EX were compared and analyzed from the aspects of covering the number of airports in China, program user experience and example calculation of airline effective dose. Based on route logs, CARI-7A was applied to estimate the levels of occupational exposure of Chinese aircrews to cosmic radiation.Results:The difference in the effective doses calculated by use of these four cosmic radiation dose estimation programs for the routes with different solar activity levels was statistically significant ( M=7.52-180.98, P<0.05). The annual effective dose estimated by PCAIRE for 68 routes from 2014 to 2021 was significantly higher than that estimated by CARI-7A ( Z=2.52, P<0.05). Based on CARI-7A, the annual effective doses from cosmic radiation to aircrews in China from 2014 to 2021 were estimated, being 1.26 (0.57-2.35) mSv for flight attendants and 1.03 (0.47-1.92) mSv for pilots. The effective dose from cosmic radiation to aircrews on a single flight on some high-frequency routes in China ranged from 0.57 to 6.88 μSv. Conclusions:The level of occupational exposure of Chinese aircrews to cosmic radiation meets the requirements of national standards, but is higher than that of occupational exposure from medical and industrial applications of radiation, so it is still necessary to further strengthen the mamagememt of occupational exposure and occupational health of aircrews.

Objective To develop a Psychological Birth Trauma Assessment Scale and to test its reliability and validity.Methods Through literature review,semi-structured interview,expert conference,Delphi expert enquiry and preliminary investigation,a pre-test scale was formed.From March to May 2023,postpartum women from 38 hospitals of different levels in 15 provinces(Jiangsu,Anhui,Zhejiang,Fujian,Tibet,and Shanghai,etc.)were conveniently selected for investigation.The sample size of the first-round survey was 547,which was used for reliability and validity test.The sample size of the second-round survey was 550,which was used for confirmatory factor analysis.Results The psychological birth trauma assessment scale consisted of 2 parts,with a total of 29 items in 6 dimensions.The intrapartum feeling part included 4 dimensions,with a cumulative variance contribution rate of 63.992％,and the postpartum effect part included 2 dimensions,with a cumulative variance contribution rate of 68.208％.The content validity index of the scale was 0.947,and the content validity index of each item was 0.809～1.000.The total score of the scale and the scores of each dimension were significantly negatively correlated with the total score of the calibration scale(r=-0.784～-0.533,P＜0.001).The total Cronbach's α coefficient was 0.941,and the split-half reliability coefficient was 0.883.Confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range.Conclusion The Psychological Birth Trauma Assessment Scale has good reliability and validity,and it can be used as an assessment tool for the degree of maternal psychological birth trauma.

Objective To propose a method for correcting the attenuation of positron emission tomography (PET) data in PET/magnetic resonance (MR) based on transmission scan, and to improve image quality, diagnostic accuracy, and lesion location accuracy. Methods In this study, the head phantom in the national standard GB/T 18988.1—2013 was used as the experimental model. The head phantom contained three 50 mm diameter cylindrical inserts filled with air, water, and solid teflon. The attenuation correction coefficients were calculated and analyzed based on transmission scan. Results With slice = 33 and theta = 0, the attenuation correction coefficient was the largest (about 7.5) when the coincidence line passed through the axis of the phantom. The spatial distribution of the attenuation correction coefficients clearly showed the positions of air insert and teflon insert, indicating that the attenuation correction coefficients calculated from transmission scan data were accurate. In the clinical verification experiment, the attenuation correction method based on transmission scan significantly improved the image quality and showed efficient attenuation correction. Conclusion This paper studied the attenuation correction method for PET data in PET/MR based on transmission scan. This method can improve the image quality. In the future work, the attenuation correction method of PET/MR will be further studied and optimized to facilitate clinical applications.

ObjectiveTo evaluate the clinical effectiveness and safety of Lianling Formula （连苓方） in the treatment of adolescent atopic dermatitis （AD） exacerbation stage with heart fire and spleen deficiency syndrome. MethodsNinety-two patients were randomly divided into a treatment group and a control group， with 46 cases in each group. Patients in the control group took oral ebastine tablets， and patients in the treatment group took Lianling Formula orally， and both groups used 0.03% topical tacrolimus for 4 weeks. Before and after treatment， the improvement of scoring atopic dermatitis index by 50% （SCORAD50） and 75% （SCORAD75）， scoring atopic dermatitis index （SCORAD）， visual analog scale （VAS）， traditional Chinese medicine （TCM） symptom score， the children's dermatology life quality index （CDLQI）， Athens insomnia scale （AIS） score of both groups were evaluated， and the adverse reactions in both groups were recorded. ResultsFour cases in the treatment group and five cases in the control group were dropped， and intention-to-treat analysis was used. Finally 46 cases in each group were included in the statistics. The SCORAD scores after treatment were lower than those before treatment， and the scores in treatment group were lower than those of the control group （P＜0.01）； the attainment rates of SCORAD50 and SCORAD75 after treatment in the treatment group were 80.43% and 47.83%， which were significantly higher than those in the control group of 63.04% and 26.09%， respectively （P＜0.05）. VAS scores， TCM symptom scores， CDLQI scores， and AIS scores were lower than those before treatment （P＜0.01）， and VAS scores， TCM symptom scores， and CDLQI scores of the treatment group were lower than those of the control group after treatment （P＜0.05 or P＜0.01）， while AIS scores were higher than those of the control group （P＜0.05）. The erythema， papule/edema， oozing/crusting， epidermal peeling， and dryness in the SCORAD scores of the treatment group after treatment were lower than those before treatment （P＜0.05 or P＜0.01）， and the erythema， papule/edema， oozing/crusting， and dryness of children in the control group were lower than those before treatment （P＜0.05 or P＜0.01）. The scores of erythema， oozing/crusting， and epidermal peeling in the treatment group after treatment were all lower than those in the control group （P＜0.05）. The scores of vexation， itching， dry mouth， poor appetite and irregular bowel movements in terms of TCM symptoms in the treatment group after treatment were lower than those before treatment （P＜0.01）， and the scores of itching， vexation， dark urine in the control group were lower than those before treatment （P＜0.05 or P＜0.01）. The scores of itching， dry mouth， poor appetite， irregular bowel movements， and dark urine in the treatment group after treatment were all lower than that in the control group （P＜0.05 or P＜0.01）. No adverse reactions occurred in both groups of children during treatment. ConclusionLianling Formula combined with topical tacrolimus can effectively improve the clinical symptoms of adolescent AD exacerbation with heart fire and spleen deficiency syndrome， and the formula is effective and safe in improving the children's skin lesions， reducing itching， relieving the accompanied TCM symptoms， and improving the quality of life.