Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective To comparatively observe the value of 131I whole-body scanning(WBS)and 131I-SPECT/CT for evaluating residual thyroid tissue,lymph node and distant metastasis,as well as risk of recurrence of differentiated thyroid cancer(DTC)after surgical resection and initial radioactive iodine(RAI)treatment.Methods Totally 367 DTC patients who underwent initial RAI treatment after surgical resection and then 131I-WBS and 131I SPECT/CT scanning were retrospectively collected.131I-WBS and 131I SPECT/CT were compared for identifying residual thyroid,lymph node and distant metastases.According to follow-up results,the risk of DTC recurrence was evaluated based on 131I-WBS and 131I-SPECT/CT,respectively.Results Residual thyroid was detected in 353 cases and suspected in 3 cases with 131 I-WBS,which was diagnosed in 349 cases with 131I-SPECT/CT,and no significant difference was found between 2 methods(P=0.289).131I-WBS detected 36 cases with and suspected 67 cases with lymph node metastases,312 without distant metastases,while 131I-SPECT/CT diagnosed lymph node metastases in 52 cases;131I-WBS detected 20 cases with and suspected 35 cases with distant metastases,while 131I-SPECT/CT diagnosed 60 cases with distant metastases but could not diagnose in 3 cases,304 without distant metastases.The detection rate of 131I-SPECT/CT for lymph node and distant metastasis were both higher than that of 131I-WBS(P=0.018,P＜0.001).During follow-up period,there were 94 cases with low risk,155 with medium risk and 118 with high risk of DTC recurrence according to 131I-SPECT/CT,while 116 cases of low risk,137 of medium risk and 114 of high risk based on 131I-SPECT/CT,and the evaluating results were different between 2 methods in 40 cases(40/367,10.90％).Conclusion Compared with 131I-WBS,131I-SPECT/CT had better clinical value for evaluating lymph node and distant metastases and assessing recurrence risk of DTC after initial RAI treatment.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective To comparatively observe the value of 131I whole-body scanning(WBS)and 131I-SPECT/CT for evaluating residual thyroid tissue,lymph node and distant metastasis,as well as risk of recurrence of differentiated thyroid cancer(DTC)after surgical resection and initial radioactive iodine(RAI)treatment.Methods Totally 367 DTC patients who underwent initial RAI treatment after surgical resection and then 131I-WBS and 131I SPECT/CT scanning were retrospectively collected.131I-WBS and 131I SPECT/CT were compared for identifying residual thyroid,lymph node and distant metastases.According to follow-up results,the risk of DTC recurrence was evaluated based on 131I-WBS and 131I-SPECT/CT,respectively.Results Residual thyroid was detected in 353 cases and suspected in 3 cases with 131 I-WBS,which was diagnosed in 349 cases with 131I-SPECT/CT,and no significant difference was found between 2 methods(P=0.289).131I-WBS detected 36 cases with and suspected 67 cases with lymph node metastases,312 without distant metastases,while 131I-SPECT/CT diagnosed lymph node metastases in 52 cases;131I-WBS detected 20 cases with and suspected 35 cases with distant metastases,while 131I-SPECT/CT diagnosed 60 cases with distant metastases but could not diagnose in 3 cases,304 without distant metastases.The detection rate of 131I-SPECT/CT for lymph node and distant metastasis were both higher than that of 131I-WBS(P=0.018,P＜0.001).During follow-up period,there were 94 cases with low risk,155 with medium risk and 118 with high risk of DTC recurrence according to 131I-SPECT/CT,while 116 cases of low risk,137 of medium risk and 114 of high risk based on 131I-SPECT/CT,and the evaluating results were different between 2 methods in 40 cases(40/367,10.90％).Conclusion Compared with 131I-WBS,131I-SPECT/CT had better clinical value for evaluating lymph node and distant metastases and assessing recurrence risk of DTC after initial RAI treatment.

Objective To analyze the prognosis and influencing factors in patients with radioiodine-refractory differentiated thyroid cancer (RAIR-DTC). Methods A retrospective analysis was conducted on 52 patients with RAIR-DTC who underwent ineffective ¹³¹I therapy at the Department of Nuclear Medicine, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to January 2020. Patients were categorized into progression and stable groups based on disease progression within five years post-treatment. Differences between groups were analyzed using chi-square test and logistic regression. Independent prognostic risk factors were identified using a Cox proportional hazards model. The Kaplan-Meier method with log-rank test was used to evaluate the impact of treatment on the prognosis of the progression group. Results The 3-year and 5-year survival rates of the 52 patients with RAIR-DTC were 88.5% and 73.1%, respectively. In the progression group, the rates were 81.8% and 57.6%. In the stable group, the rates were 100% and 100%. There were significant differences between the two groups in terms of age, presence of extrathyroidal extension, and the initial ¹³¹I treatment dose (P < 0.05). Univariate analysis indicated that the age, pre-ablation stimulated thyroglobulin level before the first ¹³¹I treatment, the neutrophil-to-lymphocyte ratio before the first treatment, and the sites of recurrence and metastasis were significantly associated with overall survival (P < 0.05). Multivariate analysis showed that age > 55 years (HR=12.40, 95% CI= 2.09-73.57, P=0.001) and distant metastasis (HR=24.47, 95% CI=4.17-143.75, P < 0.001) were independent risk factors for poor prognosis. Kaplan-Meier curve analysis showed that local surgery and/or targeted therapy significantly prolonged progression-free survival in the progression group (P < 0.001). Conclusion The prognosis for RAIR-DTC is poor, with advanced age and distant metastasis significantly associated with unfavorable outcomes. In elderly patients and those with extrathyroidal invasion, the treatment dose during initial ¹³¹I therapy may be appropriately increased to delay disease progression. For patients with disease progression, prompt local surgical intervention and/or targeted therapy is recommended.

Objective To analyze the prognosis and influencing factors in patients with radioiodine-refractory differentiated thyroid cancer (RAIR-DTC). Methods A retrospective analysis was conducted on 52 patients with RAIR-DTC who underwent ineffective ¹³¹I therapy at the Department of Nuclear Medicine, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to January 2020. Patients were categorized into progression and stable groups based on disease progression within five years post-treatment. Differences between groups were analyzed using chi-square test and logistic regression. Independent prognostic risk factors were identified using a Cox proportional hazards model. The Kaplan-Meier method with log-rank test was used to evaluate the impact of treatment on the prognosis of the progression group. Results The 3-year and 5-year survival rates of the 52 patients with RAIR-DTC were 88.5% and 73.1%, respectively. In the progression group, the rates were 81.8% and 57.6%. In the stable group, the rates were 100% and 100%. There were significant differences between the two groups in terms of age, presence of extrathyroidal extension, and the initial ¹³¹I treatment dose (P < 0.05). Univariate analysis indicated that the age, pre-ablation stimulated thyroglobulin level before the first ¹³¹I treatment, the neutrophil-to-lymphocyte ratio before the first treatment, and the sites of recurrence and metastasis were significantly associated with overall survival (P < 0.05). Multivariate analysis showed that age > 55 years (HR=12.40, 95% CI= 2.09-73.57, P=0.001) and distant metastasis (HR=24.47, 95% CI=4.17-143.75, P < 0.001) were independent risk factors for poor prognosis. Kaplan-Meier curve analysis showed that local surgery and/or targeted therapy significantly prolonged progression-free survival in the progression group (P < 0.001). Conclusion The prognosis for RAIR-DTC is poor, with advanced age and distant metastasis significantly associated with unfavorable outcomes. In elderly patients and those with extrathyroidal invasion, the treatment dose during initial ¹³¹I therapy may be appropriately increased to delay disease progression. For patients with disease progression, prompt local surgical intervention and/or targeted therapy is recommended.

Objective:To perform acceptance test and performance assessment for Siemens Biograph Vision 600 positron-emission tomography/computed tomography(PET/CT)according to the national health industry standard WS 817-2023.Methods:Spatial resolution,sensitivity,scatter fraction,count loss and random coincidence,correction accuracy of count loss and random coincidence,time-of-flight(TOF)resolution of the PET component within the PET/CT system were tested through the measurement program(NU2-2018)of National Electrical Manufacturers Association(NEMA),which was installed inside of the equipment,in accordance with the requirement of national health industry standard WS 817-2023.The PET/CT registration accuracy was measured through Gantry_offset acquisition program that was built into the equipment.Results:The transversely and axially spatial resolutions of Biograph Vision 600 PET/CT were respectively 3.69 mm and 4.10 mm at 1 cm away from the center of visual field,and were respectively 4.26 mm and 4.89 mm at 10 cm away from the center of visual field,and were respectively 4.68 mm and 4.89 mm at 20 cm away from the center of visual field.The sensitivity of 10 cm away from center and radial of visual field were respectively 16.12 kcps/MBq and 16.00 kcps/MBq.The peak value of noise equivalent count rate(NECR)was 281.60 kcps,and the corresponding radioactivity concentration of peak value was 30.69 kBq/ml.The NECR peak value,scatter fraction and maximum value of the error of relative count rate were respectively 38.17% and 4.0%.The TOF resolution was 209.87 ps when the radioactivity concentration was 5.3 kBq/mL.The registration accuracy values of Biograph Vision 600 PET/CT were 0.347 mm,-0.226 mm and 3.659 mm at the directions of x,y and z axis.Conclusion:It is feasible to perform the acceptance test according to the WS 817-2023 standard through uses the NEMA NU2-2018 standard measurement program that is installed inside of the equipment.The performance indicators can meet requirement of standard as the current national standard GB/T 18988.1-2013 and the health industry standard WS 817-2023 that will being implemented in the test of Biograph Vision 600 PET/CT,which can pass acceptance.

Objective:To investigate the spatial resolution and image quality of positron emission tomography and X-ray computed tomography (PET/CT) based on the next-generation silicon photomultiplier (SiPM) and the conventional photomultiplier tube (PMT) and to explore the effects of different PET photoelectric transducers (PMT and SiPM) and the Q. Clear algorithm on the spatial resolution, quantitative accuracy, and image quality of PET/CT.Methods:GE Discovery Elite PET/CT (PMT PET/CT) and GE Discovery Meaningful Insights (MI) PET/CT (SiPM PET/CT) were employed to scan the elliptical resolution phantom and NEMA NU2-2018 image quality phantom. Using the OSEM+ PSF+ TOF (VPFX-S) algorithm, image reconstruction was performed based on raw data of both phantoms. For the MI-acquired phantom data, additional reconstructions were conducted using the Q. Clear algorithm, with β values ranging from 150 to 550 and an increment of 100. For the elliptical resolution phantom, the radial, tangential, and axial full-width at half-maximum (FWHM) values of five line sources in three slices were calculated and averaged. For the image quality phantom, the recovery coefficient (RC), contrast recovery coefficient (CRC), contrast-to-noise ratio (CNR), percentage of background variability (PBV), background coefficient of variability (BCV) of the spheres, as well as the residual error (RE) of lung inserts at different image slices, were calculated.Results:Compared to Elite, MI (VPFX-S) showed decreases in the radial, tangential, and axial FWHM of 4.25%-13.58%, 7.00%-13.22%, and 6.02%-36.14%, respectively; no significant difference in RCmax for the spheres; increases in spheres′ CRC and CNR of 10.17%-38.89% and 38.31%-94.95%, respectively, and decreases in spheres′ PBV and BCV of 26.20%-33.82% and 31.29%-35.97%, respectively. When compared to MI (VPFX-S), MI (Q.Clear) showed decreases in the radial, tangential, and axial FWHM of 6.49%-45.02%, 7.80%-35.60%, and 13.31%-36.80%, respectively; an increase in spheres′ CNR of 38.31%-94.95%; decreases in spheres′ PBV and BCV of 26.20%-33.82% and 6.64%-10.31%, respectively, and no significant difference in spheres′ RC. With an increase in the β value, the CNR, RE, and FWHM in radial, tangential, and axial directions derived from MI (Q.Clear) increased, while RC, CRC, PBV, and BCV decreased. Conclusions:Under image reconstruction using VPFX-S, the next-generation SiPM PET/CT exhibits elevated spatial resolution, hot lesion contrast, detectability, and background noise compared to the PMT PET/CT. Compared to OSEM, the Q. Clear algorithm improves spatial resolution, quantitative accuracy, and image quality, with such improvement related to the β value. The β value affects the outcomes of the Q. Clear algorithm, especially the maximum quantitative value of small lesions. This is particularly important for improving clinical diagnostic capabilities.

Objective:To investigate the serum levels of soluble growth stimulation expression gene 2 protein (sST2) and inflammatory factors in patients with acute left ventricular ejection fraction reduction heart failure (HFrEF) treated with sacubitril/valsartan.Methods:Ninety six patients with acute HFrEF admitted in The Affiliated Hospital of Qingdao University from March 2020 to March 2021 were enrolled. The patients were treated with sacubitril/valsartan,the dose was gradually increased from 50 mg b.i.d to the target dose of 200 mg b.i.d according to hemodynamics. After 12 weeks, the target dose was achieved in 72 cases (compliance group), and did not achieved in 24 cases (non-compliance group). The serum levels of sST2, IL-1β, IL-6, TNF-αand IL-10 were measured and compared between the two groups. The changes in left atrial anteroposterial diameter (LA), left ventricular end-diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) values were assessed with echocardiography. The adverse reactions, readmission rate and all-cause death within 3 months after discharge were compared between the two groups.Results:A total of 96 patients with acute HFrEF completed the follow-up, including 72 patients (75.0%) in the compliance group and 24 (25.0%) in the non-compliance group; aged 50-75 (66.1±6.7) years old, and 68 (70.8%) males. After treatment, the serum levels of sST2, IL-1β, IL-6 and TNF-α were decreased, and the IL-10 level was increased in both groups ( P<0.05); while the improvement of serum indicators in the compliance group was more marked ( P<0.05). Echocardiography showed that the LA, LVDd, and LVEF were significantly increased after treatment ( P<0.05) in compliance group, while there was no significant changes before and after treatment in the non-compliance group. SST2, inflammatory factors and echocardiographic measurements of patients in the standard group had statistical significance before and after treatment ( P<0.05), and the difference showed a downward trend. No deterioration of renal function and angioedema were observed in both groups, and there was no significant difference in hyperkalemia (two in compliance group and one in non-compliance group), symptom hypotension (each in two groups) between the two groups (χ 2=0.12, 0.68; P>0.05). In the non-compliance group, 10 patients (41.7%) were readmitted due to heart failure, and 6 patients (25.0%) died; while there were no readmitted cases or fatal cases in compliance group (χ 2=33.49, 19.20; P<0.05). Conclusion:Early application of sacubitril and valsartan sodium in patients with acute HFrEF after hemodynamic stabilization can significantly improve left ventricular remodeling, for those with earlier escalation to the target dose, it is more beneficial. The changes of serum sST2 and inflammatory factor level after treatment may predict the efficacy of sacubitril/valsartan therapy.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.