Objective To analyze the expression level of triggering receptor expressed on myeloid cells-1(TREM-1)in serum and ascites of patients with cirrhotic ascites,and to investigate its correlation with clinical features and inflammatory markers and its role in the diagnosis of infection and prognostic evaluation.Methods A total of 110 patients with cirrhotic ascites who were hospitalized in The Fifth Hospital of Shijiazhuang from January 2019 to December 2020 were enrolled,and according to the presence or absence of intra-abdominal infection,they were divided into infection group with 72 patients and non-infection group with 38 patients.The patients with infection were further divided into improvement group with 38 patients and non-improvement group with 34 patients.Clinical data and laboratory markers were collected from all patients.Serum and ascites samples were collected,and ELISA was used to measure the level of TREM-1.The independent-samples t test was used for comparison of normally distributed continuous data between two groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups;the chi-square test was used for comparison of categorical data between two groups.A Spearman correlation analysis was used to investigate the correlation between indicators.A multivariate Logistic regression analysis was used to identify the influencing factors for the prognosis of patients with cirrhotic ascites and infection.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic and prognostic efficacy of each indicator,and the Delong test was used for comparison of the area under the ROC curve(AUC).Results The level of TREM-1 in ascites was significantly positively correlated with that in serum(r=0.50,P<0.001).Compared with the improvement group,the non-improvement group had a significantly higher level of TREM-1 in ascites(Z=-2.391,P=0.017)and serum(Z=-2.544,P=0.011),and compared with the non-infection group,the infection group had a significantly higher level of TREM-1 in ascites(Z=-3.420,P<0.001),while there was no significant difference in the level of TREM-1 in serum between the two groups(P>0.05).The level of TREM-1 in serum and ascites were significantly positively correlated with C-reactive protein(CRP),procalcitonin(PCT),white blood cell count,and neutrophil-lymphocyte ratio(r=0.288,0.344,0.530,0.510,0.534,0.454,0.330,and 0.404,all P<0.05).The ROC curve analysis showed that when PCT,CRP,and serum or ascitic TREM-1 were used in combination for the diagnosis of cirrhotic ascites with infection,the AUCs were 0.715 and 0.740,respectively.The multivariate Logistic regression analysis showed that CRP(odds ratio[OR]=1.019,95%confidence interval[CI]:1.001-1.038,P=0.043)and serum TREM-1(OR=1.002,95%CI:1.000-1.003,P=0.016)were independent risk factors for the prognosis of patients with cirrhotic ascites and infection,and the combination of these two indicators had an AUC of 0.728 in predicting poor prognosis.Conclusion The level of TREM-1 is closely associated with the severity of infection and prognosis in patients with cirrhotic ascites,and combined measurement of TREM-1 and CRP/PCT can improve the diagnostic accuracy of infection and provide support for prognostic evaluation.

Objective:To explore age-related variations in the angle of the cochlear basal turn using temporal bone CT, providing a reference for selecting the optimal Stenvers position radiographic projection angle in children and adults.Methods:The retrospective study included children and adults who underwent temporal bone CT scans at Beijing Tongren Hospital from November 2014 to April 2023. A total of 620 participants were included, including 368 males and 252 females. Patients were divided into 20 age-ralated groups: infants under one year old (3 to 11 months) were divided into monthly subgroups (9 groups); children and adolescents aged 1 to 18 years were grouped biennially (9 groups); adults were divided into two groups: 19 to 29 years and 30 to 40 years. Using multiplanar reconstruction (MPR) techniques, the CT images of the temporal bone were reformatted into oblique transverse sections to maximize the visibility of the cochlear basal turn.The cochlear basal turn angle was defined as the angle between the vertical axis of the cochlear basal turn and the mid-sagittal plane of the skull. Statistical analysis was performed to compare age-related differences in cochlear basal turn angles. Two additional patients were included to compare Stenvers position X-ray images with corresponding temporal bone CT scans, assessing the visibility of cochlear implant electrodes post-implantation.Results:Among infants aged 3 to 11 months, the cochlear basal turn angle was 29.4°±4.5°, with no significant differences observed between subgroups ( P>0.05). However, significant differences were found between infants (<1 year old) and the 1-2-year-old group compared to each age group from 3 to 40 years ( P<0.05). Additionally, the angles differed significantly between the 3-14-year-old groups and the 19-40-year-old groups ( P<0.05), whereas no significant differences were found among the remaining groups ( P>0.05). The visibility of the cochlear implant electrodes, appearing round in shape on standard Stenvers position X-ray images, closely resembled that observed in temporal bone CT scans. Conclusion:Age-related variations in the cochlear basal turn angle provide a valuable reference for optimizing Stenvers position radiography angles after cochlear implantation, improving the accuracy and quality of post-implantation imaging.

Objective:To investigate the status and diagnostic reference levels (DRLs) of adult CT radiation dose based on survey result from some hospitals in Beijing.Methods:From September to December 2023, the survey results for 50 hospitals were collected in Beijing, including 47 tertiary hospitals and 3 second grade general hospitals. The CT data sets in total of 20 items including head (sequential scanning), head (spiral scanning), head perfusion, sinus, neck, chest, chest (low dose scanning), abdomen, pelvis, abdomen-pelvis, chest-abdomen-pelvis, lumbar spine, CT urography, coronary CTA (retrospective), coronary CTA (prospective), head CTA, neck CTA, aorta CTA, leg CTA and knee were collected on clinical commonly used CT scanners with annual qualified state inspection. For each item, radiation dose data was collected continuously and randomly for up to 50 cases for every CT scanner. Using the volume CT dose index (CTDI vol) and dose length product (DLP) as dose parameters, the median value of each item in each hospital was obtained. The median CTDI vol and DLP values of all hospitals were arranged, and the local DRL of each item was set as the 75th percentile of the median values. The obtained DRLs were compared with the DRLs issued by domestic and international radiological protection organizations. Results:A total of 26 031 dose values of adult patients were collected and 25 996 dose values were left while 35 invalid values removed.For different CT users, CTDl vol, DLP and scanning phases were different for the same item. The five items with the highest CTDI were head perfusion, head sequential scanning, head spiral scanning, coronary CTA (retrospective mode), and sinus. The five items with the highest DLP were CTU, head perfusion, leg CTA, chest-abdomen-pelvis and aortic CTA. The CTDI vol of CTU was only 16.9 mGy (75th percentile), while the DLP was as high as 2 394.9 mGy·cm (75th percentile). The survey showed that the DRLs of most items in Beijing was lower than the national DRLs of domestic and foreign standards, and the DRLs of a small number of items were slightly higher. Conclusion:The current CT dose level in Beijing is not consistent with national DRLs released at home and abroad, so it is necessary to establish local DRLs according to the clinical status in Beijing.

Objective:To investigate the radiation dose levels of digital radiography (DR) in adult patients and explore the diagnostic reference level (DRL) of radiation dose in Beijing.Methods:Radiation dose data were collected from 39 medical institutions in Beijing on 18 930 DR examinations of chest anterior and lateral view, abdomen anterior and posterior view, abdomen standing view, cervical spine anterior and lateral view, lumbar spine anterior and lateral view, knee joint anterior and lateral view as well as 5 266 digital mammography (CC view and MLO view). For ordinary DR examinations, the incident air kinetic energy ( Ka, i), incident air specific kinetic energy area product ( PKA) and effective dose ( E) to the examined individuals were used for the investigation and estimation of radiation dose. For digital mammography, the average glandular dose (AGD) was calculated. DRLs should be set at the 75 th percentile of median values obtained in each medical institution. Results:The Ka, i, PKA and E of DRL for Chest (PA), Chest (lateral), abdominal(PA), abdominal (AP), Pelvic(AP), Cervical (AP), Cervical (lateral), Lumbar (AP), Lumbar (lateral), Knee joint (AP) and Knee joint (lateral) of conventional DR were 0.14, 0.31, 1.25, 2.18, 1.86, 0.51, 0.14, 2.97, 8.39, 0.37, 0.37 mGy, 159, 259, 1 917, 2 336, 2 867, 312, 301, 3 500, 3 359, 269, 255 mGy·cm 2, 0.03, 0.05, 0.20, 0.43, 0.23, 0.03, 0.02, 0.47, 0.35, <0.001, <0.001 mSv. The DRLs for digital mammography were calculated to be 1.87 mGy (CC view), 1.94 mGy (MLO view) and 3.99 mGy (accumulated for one examination). Conclusions:The radiation dose from DR examinations is relatively low. In clinical practice, the selection of imaging parameters should be further standardized on the basis of the local DRL.

Objective:To investigate devices for radiodiagnosis used in medical institutions in Beijing, China, as well as radiation workers and the devices′ application frequencies, in order to provide data support for determining radiation protection measures and allocating resources for clinical radiodiagnosis.Methods:In October 2023, questionnaires were distributed to the members of the Radiation Technology Branch of the Beijing Medical Association who work in medical institutions at different levels across varying districts of Beijing. The collected data included information about devices for radiodiagnosis and radiation workers, as well as the application frequencies of various medical X-ray imaging devices during 2018-2022, in 38 medical institutions of Level 3 Grade A, Level 3, and Level 2 in 14 municipal districts of Beijing. Then, the collected data were organized using the Microsoft Power BI software to form report models, followed by the statistical analysis of data on the devices, radiation workers, and application frequencies were using the RStudio software.Results:The 38 medical institutions in Beijing possess 591 devices for radiodiagnosis and 2 018 staff in the departments of radiology, including 1 037 radiologic technologists and 738 physicians, with 1.77 technologists and 1.26 physicians arranged for a single device on average. From 2018 to 2022, among all examinations of radiodiagnosis, computed tomography (CT) scans showed the highest frequencies, with total and average annual growth rates of 138.06% and 108.40%, respectively. Specifically, chest CT scans exhibited total and average annual growth rates of 225.20% and 122.50%, respectively. X-ray imaging ranked second in application frequency, with total average annual growth rates of 70.20% and 91.53%, respectively. Notably, chest X-ray imaging showed total and average annual growth rates of 63.89% and 89.41%, respectively.Conclusions:From 2018 to 2022, X-ray imaging examinations displayed significantly fluctuating frequencies with an overall decline trend in the 38 medical institutions. In contrast, the CT scans showed increased frequencies, with chest CT scans displaying an increased frequency and proportion. This necessitates ensuring the justification of CT scans.

As the number of CT scans continues to rise, the contribution rate of CT to the cumulative radiation dose to the public has exceeded 60%. During CT scanning, a shorter distance to the surface of the human body result in a higher radiation dose. Both the development of new CT imaging techniques and the selection of scanning parameters influence the dosage to superficial radiosensitive organs (e.g., eye lens, thyroid, and mammary glands). Effectively reducing the radiation dose to superficial radiosensitive organs has emerged as a hot research topic. This review aims to summarize the factors influencing the radiation dose to superficial radiosensitive organs and the dose reduction strategies, thus providing a reference for clinical practice and research on dose optimization.

There exist risks of ionizing radiation in radiodiagnosis examinations. Implementing shielding protection following the optimization and as low as reasonably achievable (ALARA) principles represents a measure to reduce radiation doses to patients. The implementation of shielding protection in clinical practices should meet high requirements due to variations in the modalities and items in radiodiagnosis examinations, the characteristics and irradiation method of X-ray beams, the method of automatic selection of image quality and radiation dose-related parameters by imaging equipment, the radiation sensitivity of human tissues and organs. This review introduced the shielding products, methods and effects in various radiodiagnosis examinations, as well as the current status and challenges in their applications, aiming to provide a reference for future related research and clinical practices.

The lumbar intervertebral disc exhibits a complex physiological structure with interactions between various segments, and its components are extremely complex. The material properties of different components in the lumbar intervertebral disc, especially the water content (undergoing dynamic change as influenced by age, degeneration, mechanical loading, and proteoglycan content) - critically determine its mechanical properties. When the lumbar intervertebral disc is under continuous pressure, water seeps out, and after the pressure is removed, water re-infiltrates. This dynamic fluid exchange process directly affects the mechanical properties of the lumbar intervertebral disc, while previous isotropic modeling methods have been unable to accurately reflect such solid-liquid phase behaviors. To explore the load-bearing mechanism of the lumbar intervertebral disc and establish a more realistic mechanical model of the lumbar intervertebral disc, this study developed a solid-liquid biphasic, fiber-reinforced finite element model. This model was used to simulate the four movements of the human lumbar spine in daily life, namely flexion, extension, axial rotation, and lateral bending. The fluid pressure, effective solid stress, and liquid pressure-bearing ratio of the annulus fibrosus and nucleus pulposus of different lumbar intervertebral discs were compared and analyzed under the movements. Under all the movements, the fluid pressure distribution was closer to the nucleus pulposus, while the effective solid stress distribution was more concentrated in the outer annulus fibrosus. In terms of fluid pressure, the maximum fluid pressure of the lumbar intervertebral disc during lateral bending was 1.95 MPa, significantly higher than the maximum fluid pressure under other movements. Meanwhile, the maximum effective solid stress of the lumbar intervertebral disc during flexion was 2.43 MPa, markedly higher than the maximum effective solid stress under other movements. Overall, the liquid pressure-bearing ratio under axial rotation was smaller than that under other movements. Based on the solid-liquid biphasic modeling method, this study more accurately revealed the dominant role of the liquid phase in the daily load-bearing process of the lumbar intervertebral disc and the solid-phase mechanical mechanism of the annulus fibrosus load-bearing, and more effectively predicted the solid-liquid phase co-load-bearing mechanism of the lumbar intervertebral disc in daily life.
Humans ; Finite Element Analysis ; Intervertebral Disc/physiology* ; Lumbar Vertebrae/physiology* ; Weight-Bearing/physiology* ; Biomechanical Phenomena ; Stress, Mechanical ; Computer Simulation ; Models, Biological

ObjectiveTo analyze the expression level of triggering receptor expressed on myeloid cells-1 （TREM-1） in serum and ascites of patients with cirrhotic ascites， and to investigate its correlation with clinical features and inflammatory markers and its role in the diagnosis of infection and prognostic evaluation. MethodsA total of 110 patients with cirrhotic ascites who were hospitalized in The Fifth Hospital of Shijiazhuang from January 2019 to December 2020 were enrolled， and according to the presence or absence of intra-abdominal infection， they were divided into infection group with 72 patients and non-infection group with 38 patients. The patients with infection were further divided into improvement group with 38 patients and non-improvement group with 34 patients. Clinical data and laboratory markers were collected from all patients. Serum and ascites samples were collected， and ELISA was used to measure the level of TREM-1. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate the correlation between indicators. A multivariate Logistic regression analysis was used to identify the influencing factors for the prognosis of patients with cirrhotic ascites and infection. The receiver operating characteristic （ROC） curve was used to evaluate the diagnostic and prognostic efficacy of each indicator， and the Delong test was used for comparison of the area under the ROC curve （AUC）. ResultsThe level of TREM-1 in ascites was significantly positively correlated with that in serum （r=0.50， P<0.001）. Compared with the improvement group， the non-improvement group had a significantly higher level of TREM-1 in ascites （Z=-2.391， P=0.017） and serum （Z=-2.544， P=0.011）， and compared with the non-infection group， the infection group had a significantly higher level of TREM-1 in ascites （Z=-3.420， P<0.001）， while there was no significant difference in the level of TREM-1 in serum between the two groups （P>0.05）. The level of TREM-1 in serum and ascites were significantly positively correlated with C-reactive protein （CRP）， procalcitonin （PCT）， white blood cell count， and neutrophil-lymphocyte ratio （r=0.288， 0.344， 0.530， 0.510， 0.534， 0.454， 0.330， and 0.404， all P<0.05）. The ROC curve analysis showed that when PCT， CRP， and serum or ascitic TREM-1 were used in combination for the diagnosis of cirrhotic ascites with infection， the AUCs were 0.715 and 0.740， respectively. The multivariate Logistic regression analysis showed that CRP （odds ratio ［OR］=1.019， 95% confidence interval ［CI］： 1.001‍ ‍—‍ ‍1.038， P=0.043） and serum TREM-1 （OR=1.002， 95%CI： 1.000‍ ‍—‍ ‍1.003， P=0.016） were independent risk factors for the prognosis of patients with cirrhotic ascites and infection， and the combination of these two indicators had an AUC of 0.728 in predicting poor prognosis. ConclusionThe level of TREM-1 is closely associated with the severity of infection and prognosis in patients with cirrhotic ascites， and combined measurement of TREM-1 and CRP/PCT can improve the diagnostic accuracy of infection and provide support for prognostic evaluation.

Objective:To investigate the effects of red laser versus plasma transurethral enucleation of the prostate (TUEP) on urinary and sexual function in patients under 65 years of age with benign prostatic hyperplasia (BPH).Method:This study was a retrospective analysis. Eighty BPH patients under 65 years old, admitted to the Affiliated Hospital of Yan'an University between January 2020 and January 2023 were selected. Among them, 40 patients who underwent 980 nm semiconductor red laser TUERP with pre-resection of the urethral mucosa 1 cm proximal to the verumontanum at the prostatic apex and preservation of bladder neck integrity were assigned to the Red Laser Group. Another 40 patients who underwent conventional TURP with a plasma resectoscope were assigned to the Plasma Group. Clinical data and 6-month postoperative follow-up data were collected. Changes in the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), International Index of Erectile Function-5 (IIEF-5) score, ejaculatory function score, and ejaculatory discomfort score before and after surgery were compared between the two groups. The incidence rates of decreased semen volume, retrograde ejaculation, and painful ejaculation at 6 months postoperatively were also compared.Results:At 6 months postoperatively, IPSS decreased in both groups compared to preoperative levels and was lower in the Red Laser Group than in the Plasma Group [(4.7±1.3) points vs. (6.3±2.2) points, t=-4.46, P<0.001]. Qmax increased in both groups compared to preoperative levels and was higher in the Red Laser Group than in the Plasma Group [(25.7±1.3) ml/s vs. (22.6±1.2) ml/s, t=10.76, P<0.001]. The ejaculatory function score in the Plasma Group was lower than its own preoperative level [(5.9±0.7) points vs. (11.1±1.6) points, t=5.33, P<0.001] and lower than that in the Red Laser Group [(5.9±0.7) points vs. (11.4±0.9) points, t=7.56, P<0.001]. The ejaculatory discomfort score in the Plasma Group was higher than its own preoperative level [(3.0±1.5) points vs. (0.8±0.6) points, t=4.26, P<0.001] and higher than that in the Red Laser Group [(3.0±1.5) points vs. (0.8±0.6) points, t=5.83, P<0.001]. The incidence rates of decreased semen volume and retrograde ejaculation in the Red Laser Group were lower than those in the Plasma Group [12.5% (5/40) vs. 50.0% (20/40), 10.0% (4/40) vs. 45.0% (18/40), χ2=15.84, 12.65, respectively, both P<0.001]. Conclusions:Using 980 nm semiconductor red laser TUERP with pre-resection of the urethral mucosa 1 cm proximal to the verumontanum and preservation of bladder neck integrity can improve urinary and sexual function in BPH patients under 65 years of age.