OBJECTIVE: To investigate the influence of different scanning conditions on the image quality of medical electron accelerator cone-beam computed tomography (CBCT) and provide a reference for the selection of scanning conditions for different body parts. Methods Set different scanning conditions, the Catphan 503 phantom was scanned using CBCT parameters to analyze the influence of spatial resolution, noise, uniformity, spatial geometric accuracy, and low-contrast resolution on the image quality of CBCT. RESULTS: For the head, chest, and abdomen, with the increase in scanning parameter values, the noise value decreased by 47.4%, 26.1%, and 51.3% respectively, and the uniformity values decreased by 30.2%, 26.6%, and 47.9% respectively. The low-contrast resolution values decreased by 50.6%, 34.2%, and 12.0%. The influence of different scanning conditions on spatial geometric accuracy and spatial resolution is not significant. CONCLUSION Different scanning parameters have a certain influence on the image quality of medical electron accelerator CBCT. Lower scanning parameters can be selected based on individual patients to reduce the additional radiation dose, providing a reference for the safe application of CBCT image guidance in radiotherapy.
Cone-Beam Computed Tomography/instrumentation* ; Phantoms, Imaging ; Particle Accelerators

Objective:To compare and analyze the differences in positioning errors and placement outside the target area between two different image-guided systems(Halcyon and Synergy)in radiotherapy for cervical cancer.Methods:The data of 40 patients with cervical cancer who received treatment in Dezhou People's Hospital from March 2023 to June 2023 were retrospectively selected.Each patient was treated respectively with Halcyon linear accelerator and Synergy linear accelerator,with 20 cases for each treatment method.All patients underwent cone beam computed tomography(CBCT)at kV level to conduct image scanning before radiotherapy,and the obtained CBCT images were matched with the positioned CT images by online.The registration results of left and right(x),head and foot(y)and front and back(z)of three translation direction,and pitch(Rx),rotation(Ry)and deflection(Rz)directions of rotation direction were respectively obtained.The margin of planning target volume(MPTV)was calculated according to positioning expansion formula.The differences of positioning errors and target area expansion between Halcyon and Synergy image-guided systems were compared and analyzed.Results:Halcyon and Synergy image-guided systems obtained respectively 479 and 447 sets of CBCT images.The translational errors of Halcyon image-guided system on x,y,and z directions were respectively(-0.03±0.21),(0.12±0.63)and(0.02±0.15)cm,and the rotational errors of that on Rx,Ry and Rz directions were respectively(0.38±1.26)°,(-0.40±1.02)°,and(0.07±1.07)°.The translational errors of Synergy image-guided system were respectively(-0.07±0.18),(0.08±0.49)and(0.11±0.22)cm on the three directions,and the rotational errors of that were respectively(0.28±1.29)°,(-0.29±1.29)° and(-0.16±1.20)°.The translational error values on the y direction of both image-guided system were larger than that on x and z directions,and the absolute values of the range of translational errors of them were basically within 5 mm.There were no statistically significant difference in the positioning errors of rotation on Rx and Ry directions between Halcyon and Synergy image-guided systems(P＞0.05),while there was a statistically significant difference in the positioning error of rotation on Rz direction between them(t=-3.06,P＜0.05).The MPTV values of Halcyon image-guided system on x,y and z directions were respectively 0.4,1.4 and 0.3 cm,and those of Synergy image-guided system were respectively 0.4,0.9 and 0.5 cm.The expansion boundary of target area of Halcyon image-guided system on the y direction was larger than that of Synergy image-guided system,and that on other directions were all less or equal to 0.5 cm.Conclusion:The MPTV values of Halcyon and Synergy image-guided systems can meet clinical requirements in radiotherapy.The positioning errors and the tube current of the scan of Halcyon image-guided system were larger than those of Synergy image-guided system,but the scanning time and treatment time of that were significantly lower than those of Synergy image-guided system.Different treatment systems can be selected individually for patients according to their different conditions.

Objective To identify key acoustic features associated with the progression of Alzheimer's disease(AD)through voice analysis combined with machine learning and feature selection techniques,thereby constructing classification models that serve as candidate tools for the early screening of AD.Methods Voice samples from AD,mild cognitive impairment(MCI)and healthy(HC)elderly individuals were obtained from the NCMMSC2021 AD voice dataset.The voice samples underwent data preprocessing,followed by feature extraction from the eGeMAPS feature set via the OpenSmile toolkit.Classification models were obtained utilizing random forest and support vector machine(SVM)algorithms.Significance testing and feature importance ranking were conducted using Python,and the further selection of the optimal features was performed through sequential forward selection(SFS).The classification performance before and after feature selection was compared and evaluated using accuracy and the area under the receiver operating characteristic curve(AUC).Results The significant acoustic features in the classification models primarily derived from spectral slope,formant,fundamental frequency,and loudness.The optimal classification performance was achieved with the SVM model following SFS feature selection,with recognition accuracies of 0.926(AUC=0.974)for AD/MCI group,0.875(AUC=0.956)for AD/HC group,and 0.879(AUC=0.904)for MCI/HC group.Conclusion SVM model performs better than random forest model,and the use of SFS for feature selection can effectively enhance model performance.Voice analysis has the potential to serve as a valuable supplementary tool for the rapid AD assessment and screening.

Objective To identify key acoustic features associated with the progression of Alzheimer's disease(AD)through voice analysis combined with machine learning and feature selection techniques,thereby constructing classification models that serve as candidate tools for the early screening of AD.Methods Voice samples from AD,mild cognitive impairment(MCI)and healthy(HC)elderly individuals were obtained from the NCMMSC2021 AD voice dataset.The voice samples underwent data preprocessing,followed by feature extraction from the eGeMAPS feature set via the OpenSmile toolkit.Classification models were obtained utilizing random forest and support vector machine(SVM)algorithms.Significance testing and feature importance ranking were conducted using Python,and the further selection of the optimal features was performed through sequential forward selection(SFS).The classification performance before and after feature selection was compared and evaluated using accuracy and the area under the receiver operating characteristic curve(AUC).Results The significant acoustic features in the classification models primarily derived from spectral slope,formant,fundamental frequency,and loudness.The optimal classification performance was achieved with the SVM model following SFS feature selection,with recognition accuracies of 0.926(AUC=0.974)for AD/MCI group,0.875(AUC=0.956)for AD/HC group,and 0.879(AUC=0.904)for MCI/HC group.Conclusion SVM model performs better than random forest model,and the use of SFS for feature selection can effectively enhance model performance.Voice analysis has the potential to serve as a valuable supplementary tool for the rapid AD assessment and screening.

Objective:To compare and analyze the differences in positioning errors and placement outside the target area between two different image-guided systems(Halcyon and Synergy)in radiotherapy for cervical cancer.Methods:The data of 40 patients with cervical cancer who received treatment in Dezhou People's Hospital from March 2023 to June 2023 were retrospectively selected.Each patient was treated respectively with Halcyon linear accelerator and Synergy linear accelerator,with 20 cases for each treatment method.All patients underwent cone beam computed tomography(CBCT)at kV level to conduct image scanning before radiotherapy,and the obtained CBCT images were matched with the positioned CT images by online.The registration results of left and right(x),head and foot(y)and front and back(z)of three translation direction,and pitch(Rx),rotation(Ry)and deflection(Rz)directions of rotation direction were respectively obtained.The margin of planning target volume(MPTV)was calculated according to positioning expansion formula.The differences of positioning errors and target area expansion between Halcyon and Synergy image-guided systems were compared and analyzed.Results:Halcyon and Synergy image-guided systems obtained respectively 479 and 447 sets of CBCT images.The translational errors of Halcyon image-guided system on x,y,and z directions were respectively(-0.03±0.21),(0.12±0.63)and(0.02±0.15)cm,and the rotational errors of that on Rx,Ry and Rz directions were respectively(0.38±1.26)°,(-0.40±1.02)°,and(0.07±1.07)°.The translational errors of Synergy image-guided system were respectively(-0.07±0.18),(0.08±0.49)and(0.11±0.22)cm on the three directions,and the rotational errors of that were respectively(0.28±1.29)°,(-0.29±1.29)° and(-0.16±1.20)°.The translational error values on the y direction of both image-guided system were larger than that on x and z directions,and the absolute values of the range of translational errors of them were basically within 5 mm.There were no statistically significant difference in the positioning errors of rotation on Rx and Ry directions between Halcyon and Synergy image-guided systems(P＞0.05),while there was a statistically significant difference in the positioning error of rotation on Rz direction between them(t=-3.06,P＜0.05).The MPTV values of Halcyon image-guided system on x,y and z directions were respectively 0.4,1.4 and 0.3 cm,and those of Synergy image-guided system were respectively 0.4,0.9 and 0.5 cm.The expansion boundary of target area of Halcyon image-guided system on the y direction was larger than that of Synergy image-guided system,and that on other directions were all less or equal to 0.5 cm.Conclusion:The MPTV values of Halcyon and Synergy image-guided systems can meet clinical requirements in radiotherapy.The positioning errors and the tube current of the scan of Halcyon image-guided system were larger than those of Synergy image-guided system,but the scanning time and treatment time of that were significantly lower than those of Synergy image-guided system.Different treatment systems can be selected individually for patients according to their different conditions.

The concept of"one qi peripheral flow"originates from the ancient Chinese philosophy of"qi monism"and the theory of yin and yang chi chemistry in the Yellow Emperor's Classic of Internal Medicine,and was formally proposed in Huang Yuanyu's The Origin of the Four Sacred Hearts,which elaborates on the theory of one qi circumference in which the earth pivots on four signs and the left rises and the right descends.Based on this theory,this paper discusses the diagnosis and treatment of thyroid nodules,believes that the development of thyroid nodules is closely related to the deficiency of the earth and qi,and the disorder of the liver and lungs,and combines the evidence of modern research to argue that the deficiency of the earth and qi,and the disorder of the liver and lungs are the important pathomechanisms of the thyroid nodules,proposes to refer to the results of ultrasound elasticity imaging of the thyroid gland for staging and typing treatment of thyroid nodules.It also summarizes the clinical use of medicines in different stages and types,aiming at estoring the"one qi peripheral flow"in the body,and provides a new diagnostic and therapeutic idea for the clinical diagnosis and treatment of thyroid nodules.

Objective:To develop multiplex cytokine detection reagents to analyze expression levels of cytokines,angiogene-sis and bone remodeling proteins in relapse/refractory multiple myeloma(RRMM).Methods:Multiplex bead-based immunoassay by flow cytometry was used to develop quantitative detection reagents of multiplex cytokines,which were applied to detect serum samples from 55 RRMM patients and 22 healthy controls.Expression levels of cytokines,angiogenesis,and bone remodeling proteins in pa-tients,and their correlation with clinical characteristics were analyzed.Results:Detection reagents of 10-plex cytokine immunoassay were successfully developed in this study,with average sensitivity of 7.1 pg/ml,average recovery rate of 97.4%,average intra-assay CV of 4.8%,and average inter-assay CV of 9.0%.In addition,results of RRMM samples found that levels of IL-2,IL-17,DKK1,RANKL and OPG were positively correlated with the level of IgG monoclonal protein,and TIMP1 was positively correlated with levels of IgG and IgA monoclonal protein.Conclusion:In this study,ten kinds of cytokine detection reagents with high sensitivity and speci-ficity are developed,and we found that IL-2,IL-17,DKK1,RANKL,OPG and TIMP1 have potential value in tracking disease pro-gression in RRMM.The established development process of multiplex cytokine reagents has important reference significance for ex-panding the development and application of multiplex detection reagents for protein markers in the future.

Objective:To assess the effects of the scanning parameters of cone beam computed tomography(CBCT)on image quality,positioning error and additional radiation dose for patients with cervical cancer after tube voltage was reduced,so as to explore scanning conditions that was suitable to patients with cervical cancer.Methods:Seventy-two patients with cervical cancer who received radiotherapy in Deyang People's Hospital from January 2020 to August 2022 were selected.According to different scanning parameters,they were divided into low-dose group A(120 kV,154.4 mAs),low-dose group B(120 kV,228.8 mAs)and conventional group[adopted business-supplied scan sequences(120 kV,675.8 mAs)].The CBCT scan image was obtained by decreasing the tube voltage and tube current,and reducing scanning angle.The registration results of positioning error of low-dose group A,B and conventional group on three directions included left and right(x-axis),head and foot(y-axis)and abdominal and back(z-axis)were respectively obtained,and the results were analyzed by variance analysis.The Catphan503 phantom of X-ray volumetric imaging(XVI)was used to measure the image quality of the corresponding 3 groups,and the further comparison was conducted.Results:There were no significant differences between the three groups in the scanning parameters on x,y and z axis directions for positioning error of patients with cervical cancer(P＞0.05).The scanning times of low-dose group A and B were approximately 1 minute,and the scanning time of conventional group was approximately 2 minutes.The noises of low-dose group A and B,and conventional group were respectively 36.51％,26.09％and 18.37％,and the radiation dose that was generated by CBCT image scanning in group A was correspondingly reduced.Conclusion:The reductions of scanning speed and collimator size of CBCT scanning parameters do not affect the positioning error and image quality,and it can decrease the scanning time and additional radiation dose of patients in undergoing radiotherapy.

Objective To observe the effect of applying PDCA cycle method to promote the management of key monitoring drug, and provide a basis for the management of key monitoring drug in medical institutions. Methods To compare the consumption of drugs and prescription reviews before and after the adoption of PDCA management in a hospital. The control group was the inpatients with traditional management method in 2019, and the observation group was the inpatients with PDCA method in 2020. Results After the implementation of PDCA cycle, the consumption amount of key monitoring drugs decreased significantly (P<0.001); The problems of irrational prescription such as drug use without indication, repeated drug use, inappropriate dosage and route of administration, and long course of treatment were effectively controlled (P<0.05). The qualified rate of prescription increased from 65.96% to 90.76% (χ²=27.010, P<0.001). The incidence of adverse reactions was significantly decreased (χ² =37.044, P<0.001). Conclusion PDCA method aims at continuous closed-loop management of key monitoring drugs in medical institutions, which can control drug costs to the greatest extent, reduce the economic burden of patients, promote rational drug use, reduce the incidence of adverse reactions, and ensure the quality of medical care.

Objective:To evaluate the efficacy of oral levothyroxine on abortion rate and preterm birth rate in pregnant women with thyroid autoimmunity (TAI) and normal thyroid function.Methods:The relevant studies of oral levothyroxine tablets in the treatment of TAI pregnant women were systematically searched in Pubmed, Cochrane, CBM, CNKI, VIP and Wanfang databases. The retrieval period was established until August 2020. Two researchers independently screened the literatures, extracted the data and evaluated the risk of bias in the included study. Meta-analysis was performed using Revman5.3 software.Results:1) Totally six eligible studies were all randomized controlled studies, involving 1427 patients. 2) Compared with control group, the meta-analysis suggests oral levothyroxine tablets cannot effectively reduce the preterm delivery rate and the abortion rate. 3) Further subgroup analysis of the data according to the natural pregnancy group and assisted reproduction group found that oral levothyroxine tablets in natural pregnancy women with TAI can effectively reduce the preterm delivery rate ( RR=0.54, 95% CI=0.31-0.95, P=0.03), but not reduce the abortion rate ( RR=0.86, 95% CI=0.69-1.06, P=0.15). However, oral levothyroxine tablets cannot reduce the abortion rate for TAI women conceived by reproductive technology ( RR=0.80, 95% CI=0.47-1.36, P=0.41). Conclusion:Oral levothyroxine tablets can effectively reduce the premature delivery rate of TAI women who are naturally pregnant, but it is not beneficial to reduce the abortion rate. There is only one study on TAI women who are pregnant with reproductive technology, so it is impossible to evaluate whether this population can benefit from taking levothyroxine tablets. In view of the above results, it is recommended that the two groups of patients be managed separately.