Objective To explore and establish a technical pathway for size-specific dose estimate (SSDE) in pediatric CT patients of different age groups based on structured dose files and DICOM files, and to provide an effective method for precise monitoring of medical radiation exposure in pediatric CT scans. Methods Structured radiation dose reports (SR files) for pediatric patients aged 15 and under, who underwent CT scans between January and December 2023, were exported from the hospital information system. Scanning parameters and dose information were extracted using specialized software, and SSDE was calculated based on the patient body size parameters. The data were grouped by age (0- < 1 year, 1- < 5 years, 5- < 10 years, and 10-15 years) for statistical analysis. Results From January to December 2023, a total of 2706 pediatric CT scans were performed at the hospital, including 385 (14.23%) head scans, 1990 (73.54%) chest scans, 143 (5.28%) abdominal scans, 112 (4.14%) limb scans, and 76 (2.81%) other scans. The typical volume CT dose index (CTDI_vol) for head CT in the age groups of 0- < 1 year, 1- < 5 years, 5- < 10 years, and 10-15 years were 36.21, 35.29, 37.27, and 41.18 mGy, respectively; the corresponding SSDE values were 41.27, 32.82, 30.56, and 28.41 mGy, respectively. For chest CT scans, the typical CTDI_vol for the age groups of 1- < 5 years, 5- < 10 years, and 10-15 years were 1.91, 2.11, and 2.51 mGy, respectively; the corresponding SSDE values were 2.36, 2.21, and 3.50 mGy, respectively. For abdominal CT scans, the typical CTDI_vol for the age groups of 1- < 5 years, 5- < 10 years, and 10-15 years were 3.94, 4.33, and 6.26 mGy, respectively; the corresponding SSDE values were 5.77, 7.10, and 9.79 mGy, respectively. Conclusion This study developed a technical pathway to estimate the medical radiation doses of pediatric CT patients of different ages based on structured dose files and DICOM files. The feasibility of this approach was validated using data collected over a one-year period.

Objective:To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Xinjiang Uygur Autonomous Region (Xinjiang).Methods:Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis were collected between January 1,2017 and December 31,2019. The effects of different genders, age groups, clinical stages, and comorbidities on patients' health care utilization and medical costs were analyzed by nonparametric tests. The median was used to describe the outpatient and inpatient costs of patients with Brucellosis.Results:A total of 13 532 patients (8 113 outpatient and 5 419 inpatient cases) were included in the analysis. A total of 67.8% (9 176/13 532) were male, with an average age of (42.7±15.4 ) years; age between 18-44 years (46.6%, 6 304/13 532) and 45-59 years (34.2%,4 622/13 532) were the dominant groups. The mean age of inpatients [(43.3±15.7) years] was higher than that of outpatients [(42.3±15.1) years, Z=-3.85, P<0.001]. When hospitalized patients are treated,systemic symptoms were common with fever (36.9%, 1 997/5 419) and fatigue (36.6%, 1 983/5 419), and with joint/muscle pain (68.9%, 3 735/5 419) being the highest proportion of local symptoms. A total of 79.1% (4 289/5 419) of inpatients were diagnosed with acute Brucellosis. A total of 46.5% (2 519/5 419) of inpatients had complications;skeletal system complications ranked the highest. The average number of outpatient visits per outpatient was (1.6±1.4) times. The duration of hospitalization was (11.3±4.2) days, with longer days for patients in the chronic phase and with complications ( P<0.05). A total of 89.3% (4 840/5 419) of inpatients had outpatient records in the same year,and the average number of outpatient visits per patient was (3.6±2.6) times. Outpatient medical costs were dominated by laboratory and drug costs (75.1%), and inpatient costs were dominated by drug, laboratory, and other costs (74.4%). Outpatient medical expenses M( Q1, Q3) were 61(52, 497) Yuan, 61 (51, 346) Yuan and 58 (46, 318) Yuan,respectively. Inpatients' medical expenses M ( Q1, Q3) were 8 214 (6 355, 10 721) Yuan,9 095 (7 018, 12 155) Yuan and 9 492 (7 530, 12 351) Yuan, respectively. For patients, age, clinical stages,complications,and joint/muscle pain symptoms were influential factors for hospitalization costs ( P<0.001). Conclusions:The economic burden was higher for inpatients, especially those in the high age group, with chronic phases and skeletal and neurological complications. Improving patients' awareness of early treatment, standardized treatment, and reducing chronicity and complications are the main points in reducing the economic burden caused by Brucellosis diagnosis and treatment.

Objective:To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Datong of Shanxi province.Methods:Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis between January 1, 2017, and December 31, 2019, were collected. Health care utilization and medical costs were analyzed from different genders, age groups, underlying diseases, clinical stages, and comorbidities.Results:A total of 2 289 patients (1 715 outpatient and 574 inpatient cases) were included in the analysis. 72.0% (1 649/2 289) were male, with an average age of (49.6±15.5) years; age between 45-59 years was the dominant group (36.2%,829/2 289). The mean age of inpatients (51.4±16.0) was higher than that of outpatients (49.0±15.2)( Z=-4.01, P<0.001). The average number of outpatient visits per outpatient was (1.6±1.5) times. The duration of hospitalization was (14.6±9.9) and (20.8±11.4) days for patients with central nervous system complications and (16.6±9.5) days for vascular system complications. Of the inpatients, 51.0% (293/574) had underlying diseases, and 30.3% (174/574) had endocrine and metabolic diseases. 54.0% (310/574) of inpatients were diagnosed with acute Brucellosis, and 46.0% (264/574) were diagnosed with chronic Brucellosis. A total of 64.3% (369/574) of inpatients had complications, 30.3% (174/574) of digestive system complications, followed by skeletal system complications (29.1%, 167/574). Among outpatients, age significantly affected medical costs ( P<0.001). For inpatients, age and complications and treatment effect were influential factors ( P<0.05). Patients with the combined skeletal system and central nervous system complications had significantly higher medical costs ( P<0.001). Conclusions:The medical costs for outpatient cases of Brucellosis were moderate. However, the economic burden was higher for inpatients, especially those with skeletal and neurological complications. Early detection, diagnosis, and treatment of cases were essential to avoid chronic Brucellosis and its complications and reduce medical costs.

Objective:To investigate the application value of transversus abdominis muscle release technique in giant ventral hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 72 patients with giant ventral hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2017 to January 2020 were collected. There were 47 males and 25 females, aged from 29 to 79 years, with a median age of 56 years. All patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) hernia-related quality of life. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative complications at postoperative 1, 6 and 12 months. Follow-up was up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: all 72 patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement successfully. The operation time, volume of intraoperative blood loss and mesh size of the 72 patients were (105±46)minutes, (55±15)mL and (680±225)cm 2, respectively. (2) Postoperative complications: 72 patients were followed up for 12 to 48 months, with a median follow-up time of 16 months. During the follow-up, 7 of the 72 patients were diagnosed with seroma by abdominal computed tomography (CT) scan at postoperative 1 week, the size of which was (460±130)mm 2. The 7 patients with seroma were followed up and results of abdominal CT scan at postoperative 6 months showed that the seroma was completely absorbed. Two of the 72 patients had postoperative intestinal obstruction, which was considered as postoperative paralytic ileus. After conservative treatment, the 2 patients were improved 2 weeks after operation. None of the 72 patients had surgical site infection, intestinal fistula or hernia recurrence. (3) Hernia-related quality of life: the score of hernia-related quality of life of 72 patients before operation and at postoperative 12 months were 40±12 and 73±17, respectively, showing a significant difference ( t=12.527, P<0.05). Conclusion:Transversus abdominis muscle release technique in the giant ventral hernia repair is safe and effective, which can improve hernia-related quality of life of patients.

Objective:To investigate the surgical treatment strategies of mesh infection after tension-free repair of inguinal hernia.Methods:The retrospective and descriptive study was conducted. The clinical data of 88 patients with mesh infection after tension-free inguinal hernia repair who were admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from March 2013 to May 2018 were collected. There were 85 males and 3 females, aged from 14-84 years, with an average age of 58 years. All patients underwent debridement. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect wound healing, recurrence of inguinal hernia, postoperative pain and reinfection after operation up to July 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data was described as absolute numbers. Results:(1) Surgical and postoperative situations: 88 patients underwent debridement successfully. Of the 88 patients, 71 cases underwent laparoscopic exploration before undergoing debridement, and 17 cases underwent open debridement directly. Of the 71 patients who underwent laparoscopic exploration, 63 cases had intact peritoneum with no infection observed in intestine and bladder after laparoscopic abdominal exploration, and then were transferred to open debridement. Four cases with small bowel fistula confirmed by laparoscopic exploration were transferred to open debridement combined with small bowel resection and anastomosis after separating tissue adhesion. Three cases with mesh infection confirmed by laparoscopic exploration underwent the treatment of opening peritoneum and removing the infection mesh through posterior approach under laparoscopy. One case with bladder fistula confirmed by laparoscopic exploration underwent bladder repair after removing infection mesh under laparoscopy. Of the 88 patients, 82 cases had mesh infection including 31 cases with mesh completely removed, 51 cases with the infected part of mesh removed; 28 cases had the sutures co-infected removed. Six of the 88 patients who only suffered from superficial infection underwent the treatment of removal of infected sinus tract. Of the 84 patients who underwent open debridement, 65 cases underwent primary suture after indwelling drainage tube, 19 cases kept incision opening including 13 cases undergoing continuous drainage with vacuum sealing drainage device after postoperative dressing change and 6 cases undergoing the treatment of dressing change. The operation time, volume of intraoperative blood loss and duration of postoperative hospital stay of 88 patients were 60 minutes(range, 15-175 minutes), 14 mL(range, 2-200 mL) and 22 days (range, 1-101 days), respectively. All patients underwent postoperative extubation successfully. There were 56 cases of class A healing, 15 cases of class B healing and 17 cases of class C healing in 88 patients. Seventy-one of 88 patients underwent bacterial culture examination of intraoperative pyogenic fluid and sutures, of which 27 cases had negative results, 32 cases had staphylococcus aureus infection, 5 cases had staphylococcus haemolyticus infection, 5 cases had pseudomonas aeruginosa infection, 5 cases had enterococcus faecium infection, 4 cases had staphylococcus hominis subsp infection, 3 cases had proteus mirabilis infection, 2 cases had serratia marcescens infection, 2 cases had streptococcus agalactiae infection, 2 cases had escherichia coli infection and 1 case had achromobacter xylose oxidation subsp infection. There were some cases undergoing more than 2 kinds of bacterial infection. (2) Follow-up: 88 patients underwent postoperative follow-up for 14 to 76 months, with a media follow-up time of 32 months. Of the 88 patients, 5 cases underwent postoperative recurrence of inguinal hernia including 3 undergoing transabdominal preperitoneal inguinal hernia repair, 1 undergoing open preperitoneal inguinal hernia repair and 1 undergoing partial extraperitoneal inguinal hernia repair. One case had postoperative pain with the visual simulation score of 2-4 and received no special treatment. Seventeen cases had postoperative reinfection, in which 3 achieved wound healing after dressing change and 14 achieved wound healing after surgical removal of the infected tissue completely including 7 cases with residual mesh infection and 2 cases with residual suture infection.Conclusions:Surgical strategy of mesh infection after tension-free repair of inguinal hernia is complicated. Removal of the infected mesh by surgery is an effective treatment.

Objective To summarize CT and MRI features of hyaline vascular type localized Castleman disease(LCD)and analyze the causes of misdiagnosis,to improve the preoperative diagnosis rate.Methods The clinical and imaging data of 7 patients with hyaline vascular type LCD confirmed by operation and pathology were analyzed retrospectively.Results (1)6 cases were misdiagnosed before operation,1 case was misdiagnosed as pancreatic neuroendocrine tumor,1 case as thymoma,1 case as neurogenic tumor,1 case as pheochromocytoma, 1 case as clear cell renal cell carcinoma and 1 case as small mesenteric stromal tumor.(2)1 case was located in the right neck,1 case in the anterior superior mediastinum,1 case in the neck of the pancreas,1 case in the upper part of the left kidney,2 cases in the retroperitoneum and 1 case in the lower abdomen.(3)3 cases were scaned by dynamic enhanced MRI,3 cases were scaned by dynamic enhanced CT, and 1 case was checked by plain CT and enhanced MRI.CT and MRI showed that 7 cases had a round or elliptical soft tissue mass, and 4 cases with well defined margin,3 cases were not clear in edge,2 cases with spot or strip calcification on CT images,4 cases had slightly longer T1 and longer T2 signal,4 cases were restricted of diffusion and had higher signal on DWI.All the lesions were enhanced in arterial phase,and went on in the delayed phase.There were 5 cases with distorted vascular shadow in the middle and/or around of the mass, 3 cases with strips,spoke-like low-density areas or low-signal areas,and some lesions were filled in delayed phase.Conclusion CT and MRI features of hyaline vascular type LCD have certain characteristics such as rich blood supply,enhancement in persistent,tortuosity of peripheral vascular,with some short strip calcification and high signal on DWI,which may be helpful for preoperative diagnosis.

Objective To evaluate the diagnostic value of six-slice coronal reformations in patients with acute midepigastric pain. Methods A total of 974 patients with acute midepigastric pain were included in this study and divided into group A(coronal reformation)and group B(non-coronal reformation).For group A,reconstructed coronal and oblique-coronal images were acquired.A comprehensive diagnosis was made based on coronal reformations and axial planes.Anatomical nomenclature was adopted,including kidney-ureter plane,abdominal aorta plane,superior mesenteric artery plane,ascending colon-appendix plane,stomach-cholecyst plane and colon-small intestine plane.For group B,the diagnosis was made based on axial planes.Finally,a comprehensive analysis was made,missed cases in these two groups were counted and compared,and statistical analysis was performed using the SPSS software(version SPSS V17).Results For group A,the missed diagnosis was made in 12 cases(1.23%)and it was 53 cases(6.58%)for group B.There was a statistically significant difference between two groups(P<0.05).Conclusion Combined with axial planes or oblique coronal reformations,six-sclice coronal reformation can reduce the the rate of missed diagnosis of acute midepigastric pain.

Objective To establish an accuracy test method for MDCT dose assessment based on information in DICOM images.Methods The type of MDCT studied in this paper was widely used in clinical practice.A software package developed by java language was used to automatically read doserelated information from DICOM files of MDCT.The CTDIvol and DLP of each pectoral or abdominal scan was calculated based on these information and the basic scan parameters such as collimation,mAs and pitch.The calculated values were compared with the displayed values.Results For pectoral scans,the difference between the calculated and displayed values was between-2％-8％ for CTDIvol,and-2％-5％ for DLP.For abdominal scan,the difference between the calculated and displayed values was 0-2％ for CTDIvol,and-2％-3％ for DLP.Conclusions This method is useful for MDCT dose assessment and is worth disseminating its application for general use.

Objective To explore the effect of individualized chemotherapy plans which was designed depend on secific genetic characters in patients with advanced cancer.Methods The surgery or biopsy specimen samples from 25 patients with advanced recurrent tumors (study group) were analyzed.Different gene mRNA expressions were detected by PCR and sequencing.According to detection results,the most appropriate chemotherapy would be applied on 25 cases patients of study group.The chemotherapy from traditional experience and evidence-based medical evidence were applied for 20 cases patients of control group.The difference of RR and disease control rate (DCR) between two groups were compared.Results The DCR and RR were 84 ％ (21/25) and 44 ％ (11/25) in study group,35 ％ (7/20) and 15 ％ (3/20) in control group.The DCR and RR in study group were significantly higher than those in control group (P ＜ 0.01).Conclusion Individualized chemotherapy could improve the efficient and prolong the survival period of the patients with advanced recurrent tumors.

Objective To evaluate the immunogenicity of a recombinant adenovirus containing the porin IB (PIB) gene and Neisseria surface protein A (NspA) gene of N.gonorrhoeae in BALB/c mice.Methods A recombinant adenovirus containing the PIB gene and NspA gene of N.gonorrhoeae (pAdEasy-1-PN) was constructed in previous studies.Thirty BALB/c mice were randomly and equally divided into 5 groups:low-,medium-and high-dose experiment group intramuscularly immunized with 104,106,and 108 50％ tissue culture infective dose (TCID50) of the recombinant adenovirus pAdEasy-1-PN,respectively,pAdEasy-1 control group immunized with 106 TCID50 of pAdEasy-1,blank control group immunized with sodium chloride physiological solution.Immunization was carried out twice at a 4-week interval.Serum samples were collected at 0,3 and 5 weeks after the first immunization,and spleens were removed at 5 weeks followed by the isolation of spleen lymphocytes.Enzyme linked immunosorbent assay (ELISA) was performed to determine the serum levels of PIB-specific and NspA-specific antibodies,methyl thiazolyl tetrazolium (MTT) assay to evaluate the proliferaton activity of spleen lymphocytes after stimulation by the recombinant PIB and NspA antigens.A slide agglutination test was used to estimate the anti-bacterial activity of murine serum.The complement-dependent bacteriolytic activity of murine serum was also evaluated.Statistical analysis was carried out by t test.Results Both humoral and cellular immune response specific to PIB and NspA were elicited by the recombinant adenovirus in mice.At 3 and 5 weeks after the immunization,significant differences were observed in the serum levels of PIB-specific (F =285.72,564.83,respectively,both P ＜ 0.01) and NspA-specific (F =521.57,542.61,respectively,both P ＜ 0.01)antibodies.Also,the proliferation index was statistically different among these groups in spleen lymphocytes stimulated with PIB and NspA (F =171.61,233.96,respectively,both P ＜ 0.01).The vaccination efficiency was positively correlated with the inoculation dose of recombinant pAdEasy-1-PN,and 108 TCID50 per dose proved to be the optimal dose for immunization.The sera from mice immunized with pAdEasy-1-PN could agglutinate N.gonorrhoeae and kill it in the presence of complement.Conclusions The recombinant adenovirus pAdEasy-1-PN containing PIB and NspA genes could induce specific humoral and cellular immune response in mice,and may be a potential vaccine against N.gonorrhoeae.