Objective: To investigate the prevalence, awareness, treatment and control rates of diabetes among residents in Fangshan District, Bejing Municipality, so as to provide reference for strengthening the prevention and control of diabetes. Methods: The residents aged 18 to 79 years were selected in Fangshan District using multistage stratified cluster sampling method from March to June 2023. Demographic information, lifestyle, body mass index, fasting blood glucose, and blood lipid were collected through questionnaire surveys, physical examinations and laboratory tests. The prevalence, awareness, treatment and control rates of diabetes among residents were analyzed and their influencing factors were identified using a multivariable logistic regression model. Results: A total of 4 438 residents were enrolled, including 2 367 males (53.33%) and 2 071 females (46.67%), and had a mean age of (44.99±14.90) years. The prevalence, awareness, treatment and control rates of diabetes were 15.75%, 57.37%, 56.22% and 22.90%, respectively. Multivariable logistic regression analysis showed that age (aged 30 to 39 years, OR=1.624, 95%CI: 1.011-2.609; aged 40 to 49 years, OR=3.469, 95%CI: 2.163-5.561; aged 50 to 59 years, OR=4.202, 95%CI: 2.595-6.803; aged 60 to 69 years, OR=7.229, 95%CI: 4.406-11.862; aged 70 to 79 years, OR=7.929, 95%CI: 4.665-13.479), obesity (OR=1.368, 95%CI: 1.071-1.748), hypertension (OR=1.943, 95%CI: 1.601-2.359) and dyslipidemia (OR=2.754, 95%CI: 2.287-3.317) were the factors affecting the prevalence of diabetes. Sex (women, OR=1.529, 95%CI: 1.019-2.293), age (aged 40 to 49 years, OR=4.971, 95%CI: 1.681-14.698; aged 50 to 59 years, OR=6.070, 95%CI: 2.045-18.020; aged 60 to 69 years, OR=6.902, 95%CI: 2.287-20.832; aged 70 to 79 years, OR=6.954, 95%CI: 2.191-22.070) and hypertension (OR=1.906, 95%CI: 1.337-2.718) were the factors affecting the awareness of diabetes. Age (aged 40 to 49 years, OR=4.699, 95%CI: 1.594-13.855; aged 50 to 59 years, OR=5.990, 95%CI: 2.023-17.732; aged 60 to 69 years, OR=7.134, 95%CI: 2.370-21.470; aged 70 to 79 years, OR=6.639, 95%CI: 2.102-20.964) and hypertension (OR=1.857, 95%CI: 1.304-2.645) were the factors affecting the treatment of diabetes. Age (aged 40 to 49 years, OR=2.948, 95%CI: 1.349-6.438; aged 60 to 69 years, OR=2.344, 95%CI: 1.049-5.234) was the factor affecting the control of diabetes. Conclusions The prevalence rate of diabetes among residents in Fangshan District was high, and the improvements of awareness rate, treatment rate and control rate were not obvious. Health education and management of diabetes should be strengthened for elderly, hypertensive and dyslipidemic residents.

Objective:To compare the diagnostic performance in the hepatocellular carcinoma(HCC) with cirrhosis between the 2017 version of liver imaging reporting and data system (LI-RADS v2017) and 2018 version of LI-RADS (LI-RADS v2018) based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI.Methods:Clinical data of 213 patients with 246 hepatic lesions with cirrhosis who underwent Gd-EOB-DTPA enhanced MRI in the Third Affiliated Nantong Hospital of Nantong University from October 2015 to July 2020 were retrospectively collected. The MRI major features and LR categories of lesions were respectively reviewed by two radiologists according to LI-RADS v2017 and LI-RADS v2018, respectively. Taking postoperative histopathological results or follow-up imaging as references, with the LR-5 and LR-4+LR-5 as the diagnosis of HCC, the sensitivity, specificity and accuracy of the LI-RADS v2017 and LI-RADS v2018 were evaluated, respectively. The McNemar test or Fisher exact test was used to compare the diagnostic performance between the two LI-RADS versions.Results:In 246 hepatic lesions, 165 were HCCs, 31 were non-HCC malignancies and 50 were benign lesions. Due to the threshold growth and more simplified definition and changes in the LR-5 classification criteria in LI-RADS v2018, the categories of 38 (15.4%, 38/246) lesions were changed. The threshold growths of 84.6% (33/39) lesions in v2017 were reclassified to subthreshold growth in v2018. Using LI-RADS v2018, 10 lesions were down-categorized compared with LI-RADS v2017, including LR-5 to LR-4 in 7 lesions and LR-4 to LR-3 in 3 lesions, and 28 lesions were up-categorized LR-4 to LR-5, in which 25 were small HCC. With LR-5 as the diagnosis criteria of HCC, the sensitivity and accuracy of LI-RADS v2018 were 66.7% (110/165) and 73.6% (181/246); and the sensitivity and accuracy of LI-RADS v2017 were 55.8% (92/165) and 67.5% (166/246), both with statistical differences (χ2=4.13, P=0.001, χ2=6.20, P<0.001). No significant difference was found in the specificity values of LI-RADS v2018 and v2017 [87.7% (71/81) vs. 91.4% (74/81)], χ2=0.59, P=0.442). Compared with v2017, LI-RADS v2018 increased the sensitivity in the diagnosis of small HCC lesions (10-19 mm) [62.9% (56/89) vs. 40.4% (36/89), χ2=9.00, P<0.001]. With LR-4+LR-5 as the diagnostic criteria of HCC, there was no significant difference in the sensitivity, specificity and accuracy of LI-RADS v2017 and v2018 in the diagnosis of HCC (all P>0.05). Conclusions:Based on Gd-EOB-DTPA enhanced MRI, LI-RADS v2018 has higher sensitivity and similar specificity in the diagnosis of HCC compared to v2017, especially in the diagnosis of small HCC (10-19 mm).

The adverse health effects of air pollution remains a daunting public health problem globally. The research of the health effects of air pollution provides important evidence for ambient air quality standard establishments and air pollution interventions. In recent years, causal inference has been gradually introduced into the observational study of environmental epidemiology, which provides more statistical method options for the study of causal relationships between air pollution and population health effects. Controlling confounders in observational studies is a major challenge for causal inference. This study introduces the causal inference methods for the identification and control of confounding factors currently used in the study of air pollution and population health effects, in order to provide methodological reference and basis for the causal inference study of air pollution and population health effects in China.

The adverse health effects of air pollution remains a daunting public health problem globally. The research of the health effects of air pollution provides important evidence for ambient air quality standard establishments and air pollution interventions. In recent years, causal inference has been gradually introduced into the observational study of environmental epidemiology, which provides more statistical method options for the study of causal relationships between air pollution and population health effects. Controlling confounders in observational studies is a major challenge for causal inference. This study introduces the causal inference methods for the identification and control of confounding factors currently used in the study of air pollution and population health effects, in order to provide methodological reference and basis for the causal inference study of air pollution and population health effects in China.

Objective To analyze the quality control data of linear accelerator detected by Daily QA3 and to evaluate this quality control process using statistical process control.Methods After the calibrations of the accelerator and Daily QA3,Daily QA3 device was used to perform daily quality control by technicians and physicists and 100 groups and 30 groups of daily quality control data were collected.After the accelerator and Daily QA3 were re-calibrated,Daily QA3 device was utilized to perform daily quality control by technicians and 100 groups of the daily quality control data were repeatedly collected.The variations of normalized signal-to-noise ratio of quality control data collected after two calibrations were analyzed.The first 30 groups of daily quality control data measured by technicians and physicists were adopted to calculate the I-MR control chartsand compare the location of CL and the range of UCL and LCL.The process capability indices were calculated for three different quality control processes bytechnicians and physicists,respectively.Results For twice calibrations,normalized signal-to-noise ratio of quality control data significantly changed before 6 weeks,became stable between 6 and 8 weeks,and the changes became smaller after 8 weeks.For dose output measured by physicists,the rang of UCL and LCL was more narrow.In terms of flatness and symmetry,the location of CL was closer to zero.Regarding dose output and flatness,the process capability indices of three different quality control process were all satisfied ≥ 1,whereas unsatisfied for transverse symmetry.Conclusions The first 30-40 data points should be adopted to delineate I-MR control chart of the linear accelerator in daily quality control process.The quality control process should be completed by a fixed and small group of personnel and an optimal tolerance level should be customized.

Objective: To investigate the effect of simple artifacts on the calculation of radiation dose in actual clinical operations by the aid of artificially caused CT artifacts. Methods: The phantom was scanned using CT before and after replacing the titanium alloy component. Then, the CT values were measured at different distances before and after replacement. After correcting the CT value of the titanium alloy region to the CT value of the water phantom, the doses to the phantom were calculated by using Varian′s AAA algorithm, AXB algorithm and Pinnacle system′s CCC algorithm. The absolute dose values at different distances were furtherly analyzed. Results: Varian system was consistent with Pinnacle system in evaluating the CT values. When the CT value deviated by less than 30 HU for a uniform phantom, the dose deviations of the three different algorithms were within 6.0 %-12.0 % at a distance of 0.5 cm from the body surface, and less than 1.0% at a distance of more than 1.5 cm from the body surface. When the CT value deviated by 15 HU for the lung phantom, both Varian′s AAA algorithm and Varian′s AXB algorithm showed about 1.0% dose deviation. However, the CCC algorithm of the Pinnacle system had a significant difference (5.0%) in dose values under the same conditions. Conclusions CT artifacts have noticeable effects on the calculation of radiation dose and change tissue dose distribution which may result in insufficient or excessive exposure doses.

Objective To evaluate the category modifications and prognosis of cirrhotic nodules depending on MRI imaging report and data system of LR-2,LR-3 and LR-4.Methods Clinical data of 109 patients(151 lesions)with cirrhosis who underwent two or more MRI examinations in the Third People's Hospital of Nantong City from September 2012 to February 2017 were retrospectively collected. All the patients were diagnosed as LR-2, LR-3 and LR-4 lesions for the first time without biopsy or operation. Among all the lesions, 40 were LR-2,71 were LR-3 and 32 were LR-4.Routine liver MRI scanning,DWI and multiphase dynamic contrast-enhanced MRI were performed on all patients. The follow-up time and category modifications were recorded for each lesion. The single-factor analysis was used to analyze the follow-up time of LR-2, LR-3 and LR-4 lesions. The incidence of up-regulation of LR-2, LR-3 and LR-4 nodules were analyzed by Kaplan-Meier curve. Log-Rank test was used to compare the results. Results The mean follow-up time of LR-2, LR-3 and LR-4 was (17.4 ± 9.2), (16.3 ± 8.5) and (12.4 ± 9.3) months respectively,the difference were statistically significant(F=3.30,P=0.041).Among 48 index LR-2 lesions, 1 upgraded to LR-5 after 52.3 months of follow-up, 4 upgraded to LR-3, 29 remained stable, and 14 decreased to LR-1. Among 71 index LR-3 lesions, 13 upgraded to LR-5, among which 12 demonstrated threshold growth, 9 developed newly enriched pleural signs, 7 showed capsules and 3 demonstrated hypervascular transformation;6 upgraded to LR-4,34 remained stable and 18 decreased to LR-1.Among 32 index LR-4 lesions, 14 upgraded to LR-5, among which 11 demonstrated threshold growth, 1 developed newly enriched pleural signs,6 showed capsules and 1 demonstrated hypervascular transformation;1 leision developed to LR-5V with portal vein thrombosis, 15 remained stable and 2 decreased to LR-1. The cumulative incidence of LR-4 nodules up-regulated to LR-5 was higher than that of LR-2 and LR-3 nodules (all P<0.01). The cumulative incidence of LR-4 nodules at 3, 6, 12 months to LR-5 were 6.3%, 18.8%, 34.4%, and LR-3 nodules were 0, 4.2%, 5.6%. LR-2 nodules are 0. The cumulative incidence of LR-3 nodules classified as LR≥4 was higher than that of LR-2 nodules(P<0.01).Conclusion LR-2,LR-3,and LR-4 nodules have different prognostic outcomes based on the LI-RADS classification criteria for MRI,and the cumulative incidence of LR-4 progression to LR-5 was higher.

Objective To evaluate the influences of various field-defining method of Varian accelerator on radiation dosimetry parameters, and provide theoretical basis for the beam modeling of the treatment planning system ( TPS ) . Methods The percentage depth dose ( PDD ) , the off-axis ratio ( OAR ) and the total scattering factors ( Scp ) of radiation fields were measured in three different conditions, including collimators (JAW), multileaf collimator(MLC) and JAW +MLC. The measured data was analyzed and compared with each other. Results The PDD of central axis was marginally influenced by three field-defining method. In both directions, the MLC-defined field sizes were larger by a maximum of 2. 9 mm ( left-right) or 1. 7 mm ( gun-target) than the JAW-defined ones. In the left-right direction, the width of field penumbra shaped by MLC was larger than the field of the same size as defined by JAW. The result of gun-target direction was to the contrary. In both directions, the field penumbra and size displayed no significant differences as defined by JAW+MLC or JAW. Conclusions The field size, penumbra width, and the total scattering factors were influenced by field-defining method, which indicates that special attention should be paid to the dosimetric parameters of MLC during TPS beam modeling for IMRT planning.

Objective To investigate the application of a self-made positioning device in CT-MRI image fusion in patients with laryngeal tumor,as well as the precision of image fusion and the changes in target volume delineation after fusion.Methods A total of 10 patients with laryngeal cancer were enrolled,and a self-made positioning device was used to collect CT and MRI images in a fixed position.These images were fused by mutual information combined with manual fusion.The precision of image fusion was assessed by the positional deviation of internal and external markers and degree of gross tumor volume (GTV) overlap (PCT-MRI) between CT and MRI images.GTV was contoured based on CT images (VCr),MRI images (VMRI),and fused images (VCT+MRI).The overlapped volume of VCT and VMRI(VCT-MRI) Was calculated,and the target volume was analyzed and compared.Results The positional deviations of three external markers in the three directions were 0.996±0.222 mm,1.146±0.291 mm,and 1.368±0.298 mm (P=0.000),respectively,while those of the internal markers were 0.476±0.151 mm,0.561±0.083 mm,and 0.724± 0.125 mm (P=0.000),respectively.VCT,VMRI,VCT+MRI,and VCT-MRI were 26.355±7.876 cm3,33.556± 7.407 cm3,40.036±7.627 cm3,19.875±8.588 cm3(P=0.000),respectively.PCT-MRI was 73.7％±9.8％.Conclusions The self-made positioning device can improve the consistency of position during the collection of CT and MRI images,and fused CT-MRI images can provide more information and improve the precision of target volume delineation.

Objective To study the clinical application of Compass (R) system,a novel 3D quality assurance system for the verification of esophageal carcinoma intensity-modulated radiotherapy (IMRT) plan.Methods 12 esophageal carcinoma IMRT plans were optimized with Eclipse 8.6 treatment planning system (TPS),and then Compass (R) reconstructed 3D dose distributions with the patient anatomy.Comparison was performed among the reconstructed and calculated with TPS,Dose-volume parameters (γ pass rate、average dose deviation) to the planning target volume (PTV) and critical structures were quantitative valuated.Furthermore two-dimensional dose verification were performed use MatriXX,γ pass rate were evaluated with 3％/3 mm criteria.Results The γ pass rate of actual gantry angle was found generally declined seemingly compared with 0 degree gantry angle in two dimensional verification,difference was statistically significant (P =0.018-0.001).In 3D dose verification,the γvolume of PTV were exceed 93％,the deviation of D95,D50,D2 were less than 3％;The γvolume of lungs and heart were exceed 95％,the average dose deviation were less than 3％;The γ pass rate of spinal cord and trachea were exceed 98％.The independent check verified more conformed with the TPS calculated.Dose deviations appeared in the radiation field edge area.Conclusions 3D dose verification can provide more information to comprehensively evaluate the plan which is benefit for evaluating the clinical value of verification.