Objective To obtain the protective performance parameters of barium sulfate mortar against positron nuclide γ-rays, provide reference data for precise shielding calculations, and guide the design, evaluation, and construction of radiation shielding. Methods The FLUKA program was used to build a model for simulating the dose equivalent rate variation around points of interest under the irradiation of the most commonly used positron nuclide ¹⁸F with changes in the thicknesses of lead and barium sulfate mortar. The transmission curves of lead and barium sulfate mortar were fitted, and the half-value layer (HVL) and lead equivalence of barium sulfate mortar were calculated based on the fitted curves. Results The ambient dose equivalent rate coefficient of positron nuclide ¹⁸F was 1.339 4×10⁻¹ μSv·m²/MBq·h and the HVL for lead was 4.037 mm, with deviations of 0.043% and 1.53% compared to the values provided in the AAPM Report No. 108, respectively. The HVLs for γ-rays produced by ¹⁸F, using barium sulfate mortar with apparent densities of 4.20, 4.00, and 3.90 g/cm³ mixed with 35.2-grade cement in a 4∶1 mass ratio, were 2.914, 2.969, and 3.079 cm, respectively. The lead equivalences were 0.1385, 0.1360, and 0.1311 mmPb/mm, respectively. Conclusion The three types of barium sulfate mortar can provide good protection against γ-rays in positron imaging locations. As the apparent density of barium sulfate increases, its protective effect improves slightly but remains significantly better than common construction materials like concrete and solid bricks.

ObjectiveTo investigate the influence of platelet-albumin-bilirubin （PALBI） score on the textbook outcome （TO） of patients with hepatocellular carcinoma （HCC） after hepatectomy， as well as the association of different PALBI scores before surgery with the achievement of TO after hepatectomy in HCC patients. MethodsA retrospective analysis was performed for the data of HCC patients who underwent hepatectomy in West China Hospital of Sichuan University and Ziyang Central Hospital from January 2013 to January 2022. TO was defined as no serious complication within 30 days after surgery， no death within 90 days， no rehospitalization within 30 days after discharge， no blood transfusion in the perioperative period， RO resection， and no prolongation of hospital stay. The chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for the achievement of TO after hepatectomy in HCC patients. The Kaplan-Meier method was used to plot the survival curves of HCC patients， and the Log-rank test was used for comparison. ResultsA total of 3 599 patients were included in this study， among whom 2 369 （65.8%） achieved TO. The multivariate Logistic regression analysis showed that PALBI grade （PALBI grade 2： odds ratio ［OR］=1.562， 95% confidence interval ［CI］： 1.308‍ ‍—‍ ‍1.864， P<0.001； PALBI grade 3： OR=2.216， 95%CI： 1.463‍ ‍—‍ ‍3.359， P<0.001） was an independent risk factor for achievement of TO after surgery in HCC patients. The proportion of patients achieving TO decreased with the increase in PALBI grade. Among the patients with PALBI grade 1， 2 or 3， the patients achieving TO accounted for 70.2%， 54.2%， and 38.4%， respectively （χ²=106.295， P<0.001）. The incidence rate of serious complications within 30 days， the mortality rate of patients within 90 days after hepatectomy， readmission rate within 30 days after discharge， perioperative blood transfusion rate， and the rate of prolonged hospital stay all increased with the increase in PALBI grade （all P<0.05）. For the patients achieving TO， the 1-， 3-， and 5-year relapse-free survival rates were 79.5%， 60.6%， and 51.5%， respectively， and the overall survival rates were 92.1%， 80.0%， and 71.1%， respectively； for those who did not achieve TO， the 1-， 3-， and 5-year relapse-free survival rates were 68.5%， 52.7%， and 46.2%， respectively， and the overall survival rates were 83.3%， 66.0%， and 57.1%， respectively. The patients who achieved TO had significantly better relapse-free survival rate and overall survival rate than those who did not achieve TO （χ²=18.936 and 79.371， both P<0.001）. ConclusionPreoperative PALBI grade can affect the achievement of TO after hepatectomy in HCC patients， and it is more difficult for patients with a higher PALBI grade to achieve TO. Preoperative PALBI score can be used to early identify the patients with a high risk of postoperative complications， provide early intervention， and enhance perioperative management， thereby improving the perioperative safety and long-term prognosis of HCC patients after hepatectomy.

Objective:To investigate the expression of Toll-like receptor 4(TLR4)and extracellular signal-regulated protein kinase 1/2(ERK1/2)in decidua tissue of patients with unexplained spontaneous abortion and their correlation.Methods:The expres-sions of TLR4,ERK1/2 and p-ERK1/2 in decidua tissues of 32 patients with unexplained spontaneous abortion(abortion group)and 32 normal pregnancy(control group)were detected by immunohistochemistry and Western blot,respectively.The correlation between TLR4 and p-ERK1/2 in abortion group were analyzed by Pearson hierarchical correlation analysis.Results:In immunohistochemical experiments,the cytoplasm of decidua cells in the two groups is the expression locus of TLR4,ERK1/2 and p-ERK1/2,the expression of the three proteins were different,and the expressions of TLR4 and p-ERK1/2 in abortion group were significantly higher than that in control group(P<0.01).There was no significant difference in ERK1/2 expression between abortion group and control group(P>0.05);In decidua tissue samples of abortion group,the protein level of TLR4 was higher than that of control group(P<0.05);the pro-tein level of p-ERK1/2 was significantly higher than that of control group(P<0.01),and the protein level of ERK1/2 in decidua tissue of abortion group was not statistically different from that of control group(P>0.05).TLR4 was positively correlated with p-ERK1/2 expression in abortion group(r=0.890,P<0.01).Conclusion:Abnormal activation of TLR4/ERK1/2 signaling pathway may be one of the mechanisms of unexplained spontaneous abortion.

Humans ; Gastrointestinal Microbiome ; Constipation/therapy* ; Probiotics/therapeutic use* ; Patients

Objective To simulate and analyze the dose distribution from external exposure and its influencing factors of induced radioactivity in proton therapy site. Methods Referencing a domestically under-construction proton therapy facility, a geometric model of the proton therapy site was constructed, and the FLUKA program was used to simulate the distribution of the induced radioactive dose of the proton therapy site under the conditions of different energies, beam angles, irradiation time, cooling time and medium of the treatment site. Results For a 230 MeV proton beam with a current of 3.0 nA, directed along the negative Z-axis and irradiating a phantom for two minutes, at the shutdown moment, the ambient dose equivalent rates in air and vacuum 5, 30, and 50 cm away from the phantom surface were (1 039.02±5.82)-(127.86±1.20) and (1 037.96±4.38)~(127.35±0.93) μSv/h, respectively. The mean difference was 0.51~1.06 μSv/h, and the air-immersed external irradiation accounted for <1% of the total irradiation, which rapidly decreased to 1/15 of the shutdown moment value after cooling for 10 minutes. Under the condition of 130~250 MeV, the ambient dose equivalent rates at the shutdown moments 5, 30 and 50 cm away from the surface of the phantom were (427.49±3.12)-(1 058.41±4.66), (100.36±0.92)-(259.70±1.69) and (50.15±0.68)-(131.93±1.11) μSv/h, respectively. Irradiation for one-five minutes, and at the moment of shutdown at 5, 30, and 50 cm from the surface of the phantom were (688.19±3.33)-(1 594.04±8.08), (167.60±1.35)-(388.24±2.96) and (84.73±0.69)-(195.94±1.56) μSv/h. The peripheral dose-equivalent rate of the sensed radioactivity decreases with the irradiation time, the energy of the beam, and the distance from the model. The peak dose equivalent rate around the induced radioactivity exists in the beam direction, which is significantly larger than that in the non-beam direction. Conclusion Proton therapy sites are characterized by relatively large levels of induced peripheral radioactive dose equivalent rates, mainly originating from patients. In actual practice, a suitable working position can be chosen according to the direction of the beam current, especially the direction of the final irradiation field beam current, in the non-beam current direction and as far away from the patient as possible. Within 10 minutes after the end of treatment, staff should try to avoid close contact with the patients.

Objectives:To establish a risk prediction model for gastrointestinal bleeding after cardiopulmonary bypass heart surgery,and to verify the prediction efficacy. Methods:A total of 1 002 patients who underwent cardiopulmonary bypass heart surgery in the department of cardiac great vascular surgery of our hospital from January 2019 to November 2023 were collected by convenient sampling method.They were divided into gastrointestinal bleeding group(n=47)and non-gastrointestinal bleeding group(n=955).Logistic regression analysis was used to establish the risk prediction model,and the area under ROC curve test and Hosmer-Lemeshow χ2 test were used to compare the two groups of data Model prediction effect.Bootstrap method was used for internal validation. Results:The risk prediction model of gastrointestinal bleeding after cardiopulmonary bypass heart surgery included four predictors:time of aortic occlusion(OR=1.021,95%CI:1.012-1.030),history of digestive disease(OR=5.710,95%CI:1.697-19.212),use of intra-aortic balloon counterpulsation(OR=22.180,95%CI:5.870-83.808),and continuous kidney replacement therapy(OR=12.159,95%CI:5.066-29.181).Model formula:Logit(P)=-5.821+0.021×time of aortic occlusion+1.742×history of digestive disease+3.099×whether intra-aortic balloon counterpulsation was used+2.498×whether continuous renal replacement therapy was used.The area under ROC curve was 0.812(95%CI:0.746-0.877),sensitivity was 64.6%,specificity was 85.7%,and Youden index was 0.503.After internal validation by Bootstrap method,the consistency index after correction is 0.813. Conclusions:The risk prediction model constructed in this study cohort has a good auxiliary prediction performance for the occurrence of gastrointestinal bleeding after cardiopulmonary bypass surgery,which is helpful for risk stratification for gastrointestinal bleeding after cardiopulmonary bypass surgery and facilitate clinical decision-making in daily clinical work.

Objective:To assess the consistency of ultrasound and dual-energy computed tomography (DECT) in the diagnosis of gouty arthritis(GA), reasons of the differences were further analyzed.Methods:The ultrasound and DECT images of 150 knee joints from 147 patients diagnosed with gout at the Gout Specialty Clinic of Qingdao University Affiliated Hospital from February 2022 to October 2023 were retrospectively analyzed. According to anatomy, the knee joint was anatomically segmented into five regions: intra-articular, anterior, posterior, medial, and lateral.Location of monosodium urate (MSU) deposition was meticulously recorded. The Kappa consistency test was employed to assess the consistency of the two examination results in different regions of the knee joint. The McNemar chi-square test was utilized to conduct a differential analysis between DECT and ultrasound results.Results:Double contour sign(DCS) (81.2%, 92/112) was the most common intra-articular ultrasound sign in knee joints with GA. In the extra-articular region, MSU was commonly deposited in and around the popliteal tendon (ultrasound: 51.6%, 66/128; DECT: 54.7%, 70/128). Corresponding MSU deposits on DECT were found in 9 of 92 joints with DCS and in 9 of 49 joints with aggregates detected on ultrasound.In the assessment of MSU deposits, ultrasound showed an overall higher positive rate than DECT (87.3% vs. 72.3%, P=0.001), with poor consistency between the two examinations (Kappa=0.153). In distinct anatomical regions, ultrasound and DECT showed high consistency in the medial (Kappa=0.697) and lateral (Kappa=0.718) sides and the difference was not statistically significant ( P>0.05). Intra-articular (Kappa=0.289) and anterior (Kappa=0.303) regions exhibited only fair consistency, with statistically significant diagnostic differences ( P<0.05). When exclusively assessing cases with tophus, ultrasound and DECT demonstrated high consistency in the medial and lateral aspects(Kappa=0.685, 0.748) without statistical difference ( P>0.05). In the anterior region, the consistency between the two examinations was moderate (Kappa=0.256), while in the intra-articular region, the consistency of the two methods was lower (Kappa=0.147), and the differences was statistically significant ( P<0.001). Conclusions:Both ultrasound and DECT exhibit good diagnostic capabilities for gouty knee arthritis.However, the consistency between the two techniques varies in different anatomical locations. Clinical assessment should be tailored based on the specific anatomical position. DECT has an advantage in evaluating intra-articular MSU deposits, while ultrasound is more sensitive to detect early and scattered MSU deposits.

Objective:To assess the discriminatory value of the Thyroid Follicular Tumor Ultrasound Risk Stratification System (F-TIRADS) in differentiating follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), and to compare its performance with other risk stratification systems(RSS).Methods:A retrospective analysis was conducted on 325 patients (327 thyroid nodules) diagnosed postoperatively as FTC or FTA at Affiliated Hospital of Qingdao University from January 2016 to December 2023. The cases were divided into FTC group (81 nodules) and FTA group (246 nodules). The nodules were classified based on F-TIRADS, the 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS), the 2015 American Thyroid Association guidelines (ATA guidelines), and the 2017 European Thyroid Association Thyroid Imaging Reporting and Data System (EU-TIRADS) by two ultrasound physicians. Multivariate Logistic regression analysis was used to identify independent predictors associated with FTC. Diagnostic performance of the 4 RSS was compared using postoperative pathological results as the gold standard.Results:Multivariate Logistic regression analysis showed maximum diameter, solid composition, hypoechogenicity, unclear or angular margins, marginal or ring calcifications, trabecular structure, and central blood flow were independent predictors of FTC( OR=1.914, 3.427, 9.926, 9.163, 45.918, 3.191, 8.936, respectively; all P<0.05). Within each RSS, the actual malignancy rate increased with higher risk categories, aligning closely with the recommended malignancy rates (except for ATA guidelines). The optimal cut-off values for distinguishing FTC from FTA were FTC risk 50%-90% in F-TIRADS, C-TIRADS 4B, moderately suspicious nodules in ATA guidelines, and EU-TIRADS 4, with areas under the curve of 0.916, 0.808, 0.827, and 0.836, respectively. F-TIRADS demonstrated the best overall performance (sensitivity: 82.72%, specificity: 82.93%), with significant differences compared with C-TIRADS, ATA guidelines, and EU-TIRADS (all P<0.05). Conclusions:F-TIRADS is highly effective in distinguishing FTA from FTC, outperforming C-TIRADS, ATA Guidelines, and EU-TIRADS. Clinicians should pay close attention to solid hypoechoic nodules with unclear or angular margins, marginal or ring calcifications, central blood flow, or a trabecular structure.

Objective:To explore any effect of kinesio taping on the head and neck mobility of children with congenital muscular torticollis.Methods:A total of 52 children with congenital muscular torticollis were randomly divided into a treatment group and a control group, each of 26. All were given 20 minutes of routine rehabilitation training daily, 5 days a week for 4 weeks. The treatment group was additionally taped up with kinesio tape for no more than 48 hours once every 3 days for 4 weeks. Before and after the treatment the angles of head tilt and neck lateral flexion and the gaps in left and right neck rotation were measured for both groups.Results:Significant improvement was observed in both groups but there was significantly more improvement among the treatment group. The treatment had a cure rate (46.15%) and an improvement rate (50.00%) significantly superior to those of the control group and a significantly lower rate of ineffectiveness.Conclusion:Kinesio taping along with routine rehabilitation training can better improve the head and neck mobility of children with congenital muscular torticollis.

Diabetic retinopathy (DR) is one of the most serious complications of diabetes mellitus. Severe diabetic macular edema or proliferative retinopathy may lead to impaired vision or even blindness in diabetic patients. The glucagon-like peptide-1 receptor agonist (GLP-1RA) is now commonly used as novel glucose-lowering agents in the clinical management of type 2 diabetes, but the rapid glycaemic changes associated with the use of the GLP-1RA may aggravate the risk of an increase in the occurrence of short-term potential DR. Potential effects and mechanisms of DR include oxidative stress, vascular endothelial growth factor, inflammation, retinal neurodegeneration, and other cytokines.Whether GLP-1RA leads to the increased risk of DR remains controversial. More basic and clinical studies are needed with the aim of further clarifying the correlation between GLP-1RA and DR risk.