Objective To evaluate the current radiation doses in pediatric non-cardiac interventional procedures, and analyze the associated clinical factors, and to provide data references for reducing pediatric radiation exposure. Methods We conducted a retrospective analysis of the radiation doses of children who had undergone non-cardiac interventional procedures at the interventional department of a tertiary pediatric hospital in Jinan from January 2022 to October 2024. The collected data included basic demographic information, surgical date, anatomical site, disease type, and radiation dose parameters (cumulative fluoroscopy time, cumulative dose area product in cine mode, cumulative air kerma, and the number of images acquired). The Kruskal-Wallis H test was used for comparative analysis between groups (P < 0.05 was considered statistically significant). Results Among the 475 included children, 99 cases (20.8%) had infantile hemangioma (median P_ka, 0.136 Gy·cm²; median K_a,r, 0.38 mGy), 235 cases (49.5%) had venous malformation (median P_ka, 9.82 Gy·cm²; median K_a,r, 40.99 mGy), 75 cases (15.8%) had lymphatic malformation (median P_ka, 0.06 Gy·cm²; median K_a,r, 0.18 mGy), 32 cases (6.7%) had retinoblastoma (median P_ka, 6.58 Gy·cm²; median K_a,r, 52.34 mGy), 12 cases (2.5%) had arteriovenous malformation (median P_ka, 42.3 Gy·cm²; median K_a,r, 162.87 mGy), and 22 cases (4.6%) had other vascular malformations (median P_ka, 21.7 Gy·cm²; median K_a,r, 89.1 mGy). There were significant differences between children with different disease types in the cumulative fluoroscopy time, cumulative dose area product in cine mode, cumulative air kerma at the patient entrance reference point, and the number of images acquired during non-cardiac interventional procedures (all P < 0.01). Conclusion This study presented the types and proportions of pediatric non-cardiac interventional procedures, evaluated the radiation dose levels of different surgical types, and analyzed the effects of weight and anatomical site on radiation exposure, which can be useful for preliminary assessment of radiation doses in pediatric non-cardiac interventional procedures.

Objective To observe changes in genetic material in the peripheral blood of pediatric patients with vascular malformations after interventional procedures. Methods A total of 108 children with vascular malformations who underwent interventional procedures at Shandong University Affiliated Children’s Hospital between February 2021 and January 2024 were selected as the research subjects. Clinical data and peripheral venous blood samples before and after the interventional procedures were collected from the children. Two biological indicators, γ-H2AX and peripheral blood lymphocyte chromosomal aberration (CA), were used to determine the levels of genetic material damage in children with vascular malformations before and after interventional procedures. Results The median age of the children was 7 years and the median body weight was 27 kg. The median dose-area product (DAP) was 24.20 Gy·cm² and the median DAP/kg was 1.04 Gy·cm²/kg. The incidence rates of both γ-H2AX foci and CA in children with vascular malformations significantly increased after the interventional procedures (Z = 5.924, P < 0.001; Z = 8.515, P < 0.001). The incidence of postoperative CA in 7 children were significantly higher than that in others, approaching or exceeding 4%. The incidence rates of postoperative γ-H2AX foci and CA in children with DAP/kg ≥ 1 Gy·cm²/kg were significantly higher than those in children with DAP/kg < 1 Gy·cm²/kg (U = 7.586, P = 0.031; U = 6.835, P = 0.009). No significant differences were observed in the incidence rates of postoperative γ-H2AX foci and CA among subgroups based on age, body weight, or surgical site. A positive correlation was observed between the difference in the incidence rates of γ-H2AX foci before and after the procedure and DAP/kg (R = 0.493, P = 0.027). Conclusion Ionizing radiation exposure during interventional procedures can increase peripheral blood genetic material damage levels in children with vascular malformations, and the damage levels show a correlation with the radiation dose, with some children being abnormally sensitive. Further research is needed to explore the influencing factors for genetic material damage in children with vascular malformations after interventional procedures, which is of great significance for reducing long-term cancer risks and achieving personalized treatment strategies.

Objective:To explore the applied value of three-dimensional(3D)image reconstruction in laparoscopic partial nephrectomy(LPN).Methods:A total of 80 patients who underwent LPN due to renal tumors at Linyi Central Hospital between May 2019 and December 2022 were retrospectively selected.The patients were divided into an observation group and a control group,with 40 cases in each group,according to different preoperative imaging examination methods.After computed tomography urography(CTU)examination,the obtained DICOM data of observation group were used to reconstruct 3D images by 3D image reconstruction system.The planning and intraoperative positioning were conducted through auxiliary surgery plan with 3D model,and patients'conditions were informed to their family members through 3D image model.The size and location of the tumor,and the relationship between the tumor,blood vessels and surrounding tissues and organs were observed.Then,the LPN was performed.The control group used CT images to assist LPN after CTU examination.The differences in variously perioperative clinical indicators between the two groups were compared.Blood creatinine levels of two groups were measured before,after,and during follow-up.Additionally,a questionnaire survey was used to score the understanding level of patients'families for the informed content items.Results:There were no significant differences between the two groups in gender,age,difference of tumor side,maximum tumor diameter,body mass index,the score of R.E.N.A.L score system of renal tumor[maximum diameter?,external convexity rate(E),the closest distance(N),difference of side(A)and longitudinal position(L)],preoperative serum creatinine,and other general data(P>0.05).The occlusion time(21.70±6.39)min of renal artery,the time(9.25±2.95)min of seeking target artery,the operation time(122.55±42.57)min,and the resection time(6.47±2.25)min of tumor in the observation group were all shorter than those in the control group,and the differences of them between two groups were statistically significant(t=-2.87,-4.49,-3.60,-3.41,P<0.05),respectively.The scores of understanding levels of patients'families in the observation group for renal structure,site and size of tumor,the relationship between tumor and their surrounding tissue,and surgical plan and purpose were higher than those in the control group,and the differences of them between the two groups were statistically significant(t=-10.07,-13.86,-2.97,-17.57,-17.12,P<0.05),respectively.There were no significant differences between the observation group and the control group in terms of the volume of intraoperative blood loss,hospital stay duration,positive rate of resection margin,incidence of complication,and levels of postoperative serum creatinine during follow-up(P>0.05).Conclusion:The application of 3D image reconstruction that assists LPN can shorten the time of surgical operation,occlusion time of renal artery,time of resecting tumor and time of seeking target artery,which can improve preoperative communication satisfaction between doctors and patients.

Objective:To explore the applied value of three-dimensional(3D)image reconstruction in laparoscopic partial nephrectomy(LPN).Methods:A total of 80 patients who underwent LPN due to renal tumors at Linyi Central Hospital between May 2019 and December 2022 were retrospectively selected.The patients were divided into an observation group and a control group,with 40 cases in each group,according to different preoperative imaging examination methods.After computed tomography urography(CTU)examination,the obtained DICOM data of observation group were used to reconstruct 3D images by 3D image reconstruction system.The planning and intraoperative positioning were conducted through auxiliary surgery plan with 3D model,and patients'conditions were informed to their family members through 3D image model.The size and location of the tumor,and the relationship between the tumor,blood vessels and surrounding tissues and organs were observed.Then,the LPN was performed.The control group used CT images to assist LPN after CTU examination.The differences in variously perioperative clinical indicators between the two groups were compared.Blood creatinine levels of two groups were measured before,after,and during follow-up.Additionally,a questionnaire survey was used to score the understanding level of patients'families for the informed content items.Results:There were no significant differences between the two groups in gender,age,difference of tumor side,maximum tumor diameter,body mass index,the score of R.E.N.A.L score system of renal tumor[maximum diameter?,external convexity rate(E),the closest distance(N),difference of side(A)and longitudinal position(L)],preoperative serum creatinine,and other general data(P>0.05).The occlusion time(21.70±6.39)min of renal artery,the time(9.25±2.95)min of seeking target artery,the operation time(122.55±42.57)min,and the resection time(6.47±2.25)min of tumor in the observation group were all shorter than those in the control group,and the differences of them between two groups were statistically significant(t=-2.87,-4.49,-3.60,-3.41,P<0.05),respectively.The scores of understanding levels of patients'families in the observation group for renal structure,site and size of tumor,the relationship between tumor and their surrounding tissue,and surgical plan and purpose were higher than those in the control group,and the differences of them between the two groups were statistically significant(t=-10.07,-13.86,-2.97,-17.57,-17.12,P<0.05),respectively.There were no significant differences between the observation group and the control group in terms of the volume of intraoperative blood loss,hospital stay duration,positive rate of resection margin,incidence of complication,and levels of postoperative serum creatinine during follow-up(P>0.05).Conclusion:The application of 3D image reconstruction that assists LPN can shorten the time of surgical operation,occlusion time of renal artery,time of resecting tumor and time of seeking target artery,which can improve preoperative communication satisfaction between doctors and patients.

The thyroid gland is an endocrine organ sensitive to ionizing radiation. Long term exposure to low dose radiation (LDR) among radiation workers in work may lead to thyroid dysfunction or the formation of thyroid nodules. The influencing factors of these outcomes are various and multifaceted, including but not limited to environmental factors (iodine intake levels), occupational factors (length of service, personal dose), and individual factors (gender, age, smoking, alcohol consumption, obesity, blood pressure, blood glucose). Currently, there is no consensus on the specific trends of thyroid nodule development and thyroid function indicators in radiation workers caused by long-term LDR exposure. Therefore, molecular epidemiological investigations should be conducted to explore its pathogenesis in the future, and long-term epidemiological investigations with multiple centers and large samples can be conducted to further verify existing findings. Furthermore, strengthening occupational health training of radiation workers and standardizing personal dose measurement are beneficial for comprehensive prevention of thyroid diseases, and ensuring occupational health of radiation workers.

Computed tomography (CT) examination may expose patients to a high radiation dose. The reduction of radiation dose in pediatric CT examinations is becoming increasingly important. The diagnostic reference level (DRL) is a practical tool that can achieve optimization of protection and reduce radiation dose in pediatric CT examinations. This article provides a brief summary of the concept, development methods, current situations by country, and issues related to the DRL in pediatric CT examinations, aiming to provide a references for radiation protection optimization in pediatric CT examinations in China.

At present, the incidence and mortality of tumors are increasing, and the treatment of tumors has attracted much attention. Radiotherapy is a key method for tumor treatment; however, its effectiveness is often constrained by radioresistance. During tumor radiotherapy, DNA damage response (DDR) is a key factor in the radioresistance of tumor cells. Research has shown that the radiosensitivity of tumor cells can be effectively improved by regulating the expression of key proteins in the DDR pathway. Targeting the DDR signaling pathway has become an effective strategy to reduce tumor radioresistance. This article focuses on the mechanisms, clinical research status, limitations, and current challenges associated with the key DDR proteins DNA-PKcs, ATM, ATR, and PARP as therapeutic targets for tumor radiotherapy sensitization, in order to provide a reference for the development of radiotherapy sensitization agents.

The number of interventional procedures has increased significantly due to the advantages of minor trauma, rapid recovery, and low incidence of complications. In 2018, there were approximately 24 million interventional procedures worldwide, representing a six-fold increase compared with 3.6 million procedures in 2008. From 2020 to 2021, the percentage of medical institutions with independent interventional departments in China increased from 50.49% to 63.18%. Interventional procedures inherently involve exposure to ionizing radiation, which poses a greater risk of radiation-related harm to the pediatric population due to their increased sensitivity, Consequently, the radiation dose levels experienced by children undergoing these procedures have become a growing concern, emerging as a focus of research both nationally and internationally. This article summarizes the reports published by the International Commission on Radiological Protection (ICRP), the National Council on Radiation Protection and Measurements (NCRP), and the International Atomic Energy Agency (IAEA) as well as academic articles, and reviews the dose optimization measures in the interventional procedures for pediatric patients. Regular radiation safety training for interventional radiation workers, enhancing radiation safety awareness, optimizing intraoperative techniques, and timely updating imaging equipment can effectively reduce the radiation dose received by pediatric patients. This approach helps reduce the doses to an acceptable range while still meeting interventional procedural requirements, thereby protecting the physical health of pediatric patients.

Background::Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.Methods::This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied.Results::At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs. placebo, 95% CI 31%–69%) and 45% (low vs. placebo, 95% CI 26%–64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator’s Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310. Conclusion::CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.Trial Registration::ClinicalTrials.gov, NCT04805411.

Objective To evaluate the radiation dose of interventional procedure for children with congenital heart disease, and to analyze the differences in radiation dose and influencing factors. Methods A total of 94 children who underwent interventional procedure for congenital heart disease at a grade A tertiary hospital in Jinan, Shandong Province, China from June 2021 to September 2022 were included in this study. The patients were divided into three groups according to the type of procedure: ventricular septal defect occlusion group (VSD, 48 cases), patent ductus arteriosus occlusion group (PDA, 29 cases), and atrial septal defect occlusion group (ASD, 17 cases). The basic information of patients and postoperative dose reports were recorded. A statistical analysis was performed using SPSS software. Results The median cumulative air kerma (CAK) of VSD, PDA, and ASD was 100.5, 43.7, and 12.1 mGy, respectively. The median air kerma area product (KAP) of VSD, PDA, and ASD was 3.309, 1.313, and 0.540 Gy·cm², respectively. The median KAP·kg⁻¹ of VSD, PDA, and ASD was 0.179, 0.088, and 0.031 Gy·cm²·kg⁻¹, respectively. There were significant differences in fluoroscopy time, number of cine images, CAK, KAP, and KAP·kg⁻¹ among the three types of interventional procedures (P<0.05). Compared with PDA and ASD, VSD showed significantly higher fluoroscopy time, number of cine images, CAK, KAP, and KAP·kg⁻¹ (P<0.05). Multiple linear regression analysis found that age (B=52.445, P<0.05), weight (B=13.077, P<0.05), fluoroscopy time (B=0.425, P<0.05), tube current (B=0.872, P<0.05), and number of cine images (B=0.660, P<0.05) were positively correlated with KAP, while there was no significant association between height and KAP (P>0.05). Conclusion There are differences in radiation dose among the three types of procedures. Reducing fluoroscopy time, tube current, and number of cine images while meeting the procedure requirements is of great significance for reducing the radiation dose received by children.