Objective To assess and understand the service capabilities and existing problems of radiation health technical service institutions in Jiangsu Province, China, and provide a basis for improving in-process and post-process supervision as well as enhancing radiation health technical service capabilities. Methods Thirty radiation health technical service institutions in Jiangsu Province were selected as quality monitoring objects from the National Occupational Health Technical Service Institution Management Information System. Evaluations were conducted using a standardized national assessment checklist, and a comprehensive risk assessment was performed by combining the results of laboratory test capability comparisons. Results The 30 institutions all passed the quality monitoring, with an average score of （76.62 ± 5.07）. Comprehensive risk assessment identified 8 (26.67%) high-risk institutions, 22 (73.33%) medium-risk institutions, and 0 (0%) low-risk institutions. Conclusion The overall service quality of radiation health technical service institutions in Jiangsu Province is acceptable. However, further training and supervision are needed to improve technical service capacity and reduce service risks.

Objective To analyze the external radiation dose rate and radiation protection measures during treatment of a patient with hepatocellular carcinoma (HCC) who underwent ⁹⁰Y selective internal radiotherapy (⁹⁰Y-SIRT). Methods A male HCC patient who received ⁹⁰Y-SIRT with an activity of 4.65×10⁹ Bq was selected as the research subject using retrospective analysis. External radiation dose rate meters were used to detect ambient dose equivalent rates around the radiation worker, the HCC patient, and the workplace during treatment. Surface contamination meters were used to detect surface contamination levels of the radiation worker and the workplace. Results The ambient dose equivalent rate around the interventional radiology staff during treatment ranged from 3.7 to 39.0 μSv/h. The patient's ambient dose equivalent rate of surgical site at distances of 30, 100, and 200 cm ranged from 45.0 to 5.6, 4.4 to 0.4, and 0.4 to 0.1 μSv/h respectively without protection, and 14.0 to 3.4, 3.2 to 0.3, and 0.4 to 0.1 μSv/h respectively when the surgical site was covered with a 1.0 mmPb lead rubber drape after 0.0 to 161.0 hours of the surgery. In the nuclear medicine department, ambient dose equivalent rate of the workplace ranged from 0.4 to 740.0 μSv/h. The ambient dose equivalent rate around all monitoring points in the digital subtraction angiography operating room accounted at 0.1 μSv/h, and the observation ward ranged from 0.1 to 0.2 μSv/h. The β surface contamination levels of the radiation worker and workplace were below the minimum detection limit (0.16 Bq/cm²). Conclusion Radiation doses for both HCC patients and radiation worker remained within acceptable limits when appropriate protective equipment was used. A well-designed workplace layout is essential to ensure effective implementation of radiation protection.

Hepatocellular carcinoma(HCC)is the most common type of liver cancer and a leading cause of cancer-related deaths worldwide.While early detection significantly improves prognosis,patients with alpha-fetoprotein-negative hepatocellular carcinoma(ANHCC)often face diagnostic challenges due to the lack of reliable biomarkers.This review systematically explores the potential of various circulating biomarkers in the early diagnosis of ANHCC,including AFP-L3,PIVKA-Ⅱ,lymphocyte-to-monocyte ratio,exosomes,circulating cell-free DNA(cfDNA),circulating tumor cells,osteopontin,paraoxonase 1,autoantibodies,and RNA-related biomarkers.The combined use of these markers,particularly AFP-L3 and PIVKA-Ⅱ,demonstrates enhanced diagnostic accuracy and specificity compared to single markers.Emerging evidence also highlights the diagnostic potential of exosomes,cfDNA,and RNA markers due to their non-invasive nature and high stability.Despite promising results,further large-scale,multicenter studies are needed to validate these findings,address challenges such as standardization of detection methods,and elucidate underlying mechanisms.These advances are anticipated to significantly improve early detection and personalized management of ANHCC.

Hepatocellular carcinoma(HCC)is the most common type of liver cancer and a leading cause of cancer-related deaths worldwide.While early detection significantly improves prognosis,patients with alpha-fetoprotein-negative hepatocellular carcinoma(ANHCC)often face diagnostic challenges due to the lack of reliable biomarkers.This review systematically explores the potential of various circulating biomarkers in the early diagnosis of ANHCC,including AFP-L3,PIVKA-Ⅱ,lymphocyte-to-monocyte ratio,exosomes,circulating cell-free DNA(cfDNA),circulating tumor cells,osteopontin,paraoxonase 1,autoantibodies,and RNA-related biomarkers.The combined use of these markers,particularly AFP-L3 and PIVKA-Ⅱ,demonstrates enhanced diagnostic accuracy and specificity compared to single markers.Emerging evidence also highlights the diagnostic potential of exosomes,cfDNA,and RNA markers due to their non-invasive nature and high stability.Despite promising results,further large-scale,multicenter studies are needed to validate these findings,address challenges such as standardization of detection methods,and elucidate underlying mechanisms.These advances are anticipated to significantly improve early detection and personalized management of ANHCC.

Objective:To compare the clinical effects of ultrasound-guided intra-articular and coracohumeral ligament glucocorticoid injections versus ultrasound-guided intra-articular glucocorticoid injections alone on frozen shoulder in the elderly.Methods:A total of 44 patients with frozen shoulder admitted to the rehabilitation department of the Affiliated Hospital of Sichuan Nursing Vocational College from September 2019 to June 2020 were enrolled.They were randomly divided into the experimental group and the control group, with 22 patients in each group.The experimental group received two consecutive ultrasound-guided intra-articular injections and two coracohumeral ligament injections, while the control group received two consecutive ultrasound-guided intra-articular injections.The shoulder's passive range-of-motion(PROM), the 11-point numeric rating scale(NRS)as well as the Shoulder Pain and Disability Index(SPADI)were conducted before treatment, 1 week after the first treatment(1 week), 1 week after the second treatment(2 weeks)and 10 weeks after the second treatment(12 weeks).Results:There was no significant difference in baseline characteristics between the two groups(all P>0.05). Flexion, abduction, extension and external rotation increased whereas NRS and SPADI decreased after treatment, compared with pre-treatment in the experimental group( F=11.341, 20.965, 20.403, 32.470, 82.970 and 102.154, all P<0.05)and in the control group( F=7.012, 8.937, 23.265, 31.966, 52.500 and 41.356, all P<0.05). Compared with the control group, extension( t=0.365, 0.143 and 0.236, all P<0.05)and external rotation( t=0.205, 0.620 and 2.751, all P<0.05)increased at 1, 2 and 12 weeks after treatment.SPADI scores were lower in the experimental group than in the control group at 12 weeks after treatment( t=2.063, P=0.045). There was no significant difference in NRS, flexion or abduction between the two groups at any time point after treatment(all P>0.05). No serious adverse reactions occurred during treatment in either group. Conclusions:Both ultrasound-guided intra-articular injections plus coracohumeral ligament injections and ultrasound-guided intra-articular injections can effectively alleviate pain and improve function in elderly patients with frozen shoulder, but the former has better effects on extension.For patients with clear restricted extension and external rotation, ultrasound-guided intra-articular injections combined with coracohumeral ligament injections may achieve better clinical effects.

BACKGROUND/AIMS: Microvascular invasion (MVI) is an established risk factor for hepatocellular carcinoma (HCC). However, prediction models that specifically focus on the individual prognoses of HCC patients with MVI is lacking. METHODS: A total of 385 HCC patients with MVI were randomly assigned to training and validation cohorts in a 2:1 ratio. The outcomes were disease-free survival (DFS) and overall survival (OS). Prognostic nomograms were established based on the results of multivariate analyses. The concordance index (C-index), calibration plots and Kaplan-Meier curves were employed to evaluate the accuracy, calibration and discriminatory ability of the models. RESULTS: The independent risk factors for both DFS and OS included age, tumor size, tumor number, the presence of gross vascular invasion, and the presence of Glisson's capsule invasion. The platelet-to-lymphocyte ratio was another risk factor for OS. On the basis of these predictors, two nomograms for DFS and OS were constructed. The C-index values of the nomograms for DFS and OS were 0.712 (95% confidence interval [CI], 0.679 to 0.745; p<0.001) and 0.698 (95% CI, 0.657 to 0.739; p<0.001), respectively, in the training cohort and 0.704 (95% CI, 0.650 to 0.708; p<0.001) and 0.673 (95% CI, 0.607 to 0.739; p<0.001), respectively, in the validation cohort. The calibration curves showed optimal agreement between the predicted and observed survival rates. The Kaplan-Meier curves suggested that these two nomograms had satisfactory discriminatory abilities. CONCLUSIONS: These novel predictive models have satisfactory accuracy and discriminatory abilities in predicting the prognosis of HCC patients with MVI after hepatectomy.
Calibration ; Carcinoma, Hepatocellular ; Cohort Studies ; Disease-Free Survival ; Hepatectomy ; Humans ; Multivariate Analysis ; Nomograms ; Prognosis ; Risk Factors ; Survival Rate

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

BACKGROUND:After arthroscopic knee surgery, deep vein thrombosis easily occurs. Currently, there were no specific clinical manifestations in deep vein thrombosis, so a fast, convenient and reliable risk assessment tool was needed to evaluate the clinical high-risk groups for prevention and intervention. The effectiveness of Caprini Risk Assessment Scale used in thrombosis risk assessment has been confirmed by a large number of researches, but the current domestic research is less.
OBJECTIVE:To verify the validity of Caprini risk assessment scale in evaluations of high deep venous thrombosis risk patients among knee arthroscopy patients, and to explore effective strategies for prevention of deep vein thrombosis in patients undergoing knee arthroscopic surgery.
METHODS: A case-control study design was used to colect 49 deep vein thrombosis patients admitted to the Department of Orthopedics, Renhe Hospital of Three Gorges University from January 2008 to June 2015 as case group, and randomly selected 98 patients admitted during the same period of non-deep vein thrombosis patients as control group. Caprini risk assessment scale was used to assess risk assessment and risk grading of deep venous thrombosis, and to explore the correlation between risk classification and risk of deep vein thrombosis.
RESULTS AND CONCLUSION: (1) Basic conditions comparison: application time of tourniquet, the proportion of smoking patients, and proportion of deep venous thrombosis and (or) the history of pulmonary thromboembolism were higher in the case group than in the control group (P < 0.05). (2) Caprini score was significantly higher in the case group than in the control group (P < 0.001). In the case group, the proportion of very high risk patients (53%) was highest, folowed by high risk (25%), totaly 78%. In the control group, the proportion of high risk patients (32%) was highest, folowed by low risk (29%). Significant differences in above risk degree analysis were identified between the two groups (P< 0.001). (3) Deep venous thrombosis and (or) the history of pulmonary thromboembolism was positively correlated with Caprini score in the case and control groups (P < 0.05). Caprini score was positively associated with application time of tourniquet in the case group (P< 0.05). (4) Logistic regression analysis of Caprini risk classification and the risk of deep vein thrombosis: with increased caprini risk classification, the risk of deep vein thrombosis increased significantly. The risk of deep venous thrombosis in patients with high risk and very high risk was 2.130 and 11.786 times of patients with low risk, respectively. (5) These results indicate that Caprini risk assessment model can effectively assess the risk of deep vein thrombosis among patients receiving knee arthroscopy.

Objective:To explore the correlation between liver shear wave velocity(Vs) measured with acoustic radiation force impulse (ARFI) imaging technique and serum fibrosis indexes and its application in the diagnosis of liver cirrhosis and Child‐Pugh scoring for cirrhosis .Methods:The liver Vs value measured with ARFI technique of 150 patients with liver cirrhosis (ob‐servation group) and 50 healthy volunteers(control group) who visited Shanghai Dahua Hospital in Xuhui District during Jul 2013 and Jul 2014 were analyzed retrospectively .The 150 patients with liver cirrhosis were set as observation group and further divided into Class A(n=50) ,Class B(n=50) and Class C(n=50) according to Child‐Pugh scoring system .The 50 healthy vol‐unteers were set as control group .Serum fibrosis indexes testing ,including hyaluronic acid(HA) and laminin(LN) ,procollagenⅢ(PCⅢ) and collagenⅣ (Ⅳ‐C) ,were performed in all subjects .Differences between the observation group and the control group regarding indexes were compared by using independent sample t‐test .Pearson correlation analysis and receiver operator characteristic(ROC)curve analysis were conducted between Vs and four serum indexes in the observation group .Results:The values of Vs ,HA ,LN ,PCⅢ and Ⅳ‐C in the observation group were higher than those in the control group(P<0 .01) .Fur‐thermore ,the Vs value in the observation group demonstrated positive correlation with HA ,LN ,PCⅢ and Ⅳ‐C ,and the corre‐lation coefficients were 0 .672 ,0 .672 ,0 .765 and 0 .568 ,respectively(P<0 .01) .Area under ROC curve of the values of Vs and serum inedxes were 0 .85 0 .65 ,0 .71 ,0 .63 ,0 .73 in Class A ,0 .93 ,0 .83 ,0 .86 ,0 .84 ,0 .80 in Class B ,and 0 .99 ,0 .94 ,0 .85 , 0 .95 ,0 .94 in Class C ,respectively .Conclusions:Vs ,a non‐invasive marker for liver elasticity and stiffness ,is significantly correlated with serum fibrosis indexes .Its sensitivity and specificity are superior to those of four serum fibrosis indexes .It could provide qualitative analysis for evaluating the severity of liver cirrhosis ,so as to offer valuable evidence for further clinical treat‐ment .

Background and purpose:The incidence of liver cancer is high in China. Primary liver cancers usually occur in patients with liver cirrhosis, which is a challenge for the early diagnosis of liver cancer. Our purpose is to investigate the efifcacy of contrast-enhanced ultrasonography (CEUS) in the early identiifcation and diagnosis of small hepatocellular carcinoma (HCC) by regularly tracking and supervising the high risk population. Methods:A total of 320 high risk patients of HCC admitted in our hospital from February 2011 to November 2013 were enrolled in this prospective study. All patients underwent conventional ultrasound and hepatic CEUS. The differential diagnosis of malignant HCCs from benign ones was based on the enhancement patterns of hepatic lesions in different phases on CEUS. Results:Twenty patients were diagnosed as small HCC among 320 HCC high risk patients who were under regular surveillance using CEUS and all were pathologically conifrmed. Seven of the 20 HCC cases were smaller than 1.0 cm and 13 measured 1.1-2.0 cm. There were 6 (30.0%) HCCs presented as“early wash-in and slow wash-out”atypical pattern of HCC. The small size of the lesion and iso-echogenicity were the main factors of atypical pattern of HCC on CEUS.Conclusion:Ultrasonography and CEUS surveillance is a useful strategy for the early detection of small HCCs in high risk patients, which can help them to receive proper therapeutic management in time.