Nitrogen(N)and potassium(K)are two key mineral nutrient elements involved in rice growth.Accurate diagnosis of N and K status is very important for the rational application of fertilizers at a specific rice growth sta...Nitrogen(N)and potassium(K)are two key mineral nutrient elements involved in rice growth.Accurate diagnosis of N and K status is very important for the rational application of fertilizers at a specific rice growth stage.Therefore,we propose a hybrid model for diagnosing rice nutrient levels at the early panicle initiation stage(EPIS),which combines a convolutional neural network(CNN)with an attention mechanism and a long short-term memory network(LSTM).The model was validated on a large set of sequential images collected by an unmanned aerial vehicle(UAV)from rice canopies at different growth stages during a two-year experiment.Compared with VGG16,AlexNet,GoogleNet,DenseNet,and inceptionV3,ResNet101 combined with LSTM obtained the highest average accuracy of 83.81%on the dataset of Huanghuazhan(HHZ,an indica cultivar).When tested on the datasets of HHZ and Xiushui 134(XS134,a japonica rice variety)in 2021,the ResNet101-LSTM model enhanced with the squeeze-and-excitation(SE)block achieved the highest accuracies of 85.38 and 88.38%,respectively.Through the cross-dataset method,the average accuracies on the HHZ and XS134 datasets tested in 2022 were 81.25 and 82.50%,respectively,showing a good generalization.Our proposed model works with the dynamic information of different rice growth stages and can efficiently diagnose different rice nutrient status levels at EPIS,which are helpful for making practical decisions regarding rational fertilization treatments at the panicle initiation stage.展开更多
BACKGROUND Acute myeloid leukemia(AML)is a disease in which immature hematopoietic cells accumulate in the bone marrow and continuously expand,inhibiting hematopoiesis.The treatment and prognosis of this disease have ...BACKGROUND Acute myeloid leukemia(AML)is a disease in which immature hematopoietic cells accumulate in the bone marrow and continuously expand,inhibiting hematopoiesis.The treatment and prognosis of this disease have always been unsatisfactory.AIM To investigate the correlation between vascular endothelial growth factor(VEGF)and transforming growth factor-β1(TGFβ1)expression and prognosis in older adults with AML.METHODS This study enrolled 80 patients with AML(AML group),including 36 with complete response(AML-CR),23 with partial response(AML-PR),and 21 with no response(AML-NR).The expression levels of VEGF and TGFβ1 were detected by reverse transcription polymerase chain reaction in bone marrow mononuclear cells isolated from 56 healthy controls.Kaplan-Meier analysis was performed to assess overall survival(OS)and progression-or disease-free survival(DFS).Prognostic risk factors were analyzed using a Cox proportional hazards model.RESULTS The AML group showed a VEGF level of 2.68±0.16.VEGF expression was lower in patients with AML-CR than those with AML-PR or AML-NR(P<0.05).TGFβ1 expression in the AML group was 0.33±0.05.Patients with AML-CR showed a higher TGFβ1 expression than those with AML-PR or AML-NR(P<0.05).VEGF and TGFβ1 expression in patients with AML was significantly correlated with the counts of leukocytes,platelets,hemoglobin,and peripheral blood immature cells(P<0.05);Kaplan-Meier survival analysis revealed that patients with high TGFβ1 expression had better OS and DFS than those with low TGFβ1 expression(P<0.05),whereas patients with low VEGF levels showed better OS and DFS than those with high VEGF levels(P<0.05).VEGF,TGFβ1,and platelet count were identified by the Cox proportional hazards model as independent risk factors for OS(P<0.05),while VEGF,TGFβ1,and white blood cell count were independent risk factors for DFS(P<0.05).CONCLUSION Decreased VEGF expression and increased TGFβ1 expression in patients with AML provide valuable references for determining and individualizing clinical treatment strategies.展开更多
Objective: To analyze the accuracy of serum prealbumin levels in predicting the prognosis of patients with critical respiratory illness. Methods: Fifty patients with critical respiratory illness admitted to our hospit...Objective: To analyze the accuracy of serum prealbumin levels in predicting the prognosis of patients with critical respiratory illness. Methods: Fifty patients with critical respiratory illness admitted to our hospital from October 2022 to September 2023 were selected and divided into an observation group and a control group after condition assessment, with 25 cases in each group. The results of cholinesterase (ChE), prealbumin (PALB), albumin (ALB), aspartate aminotransferase (AST), total protein (TP), and forced expiratory volume (FEV1)/Predicted (Pred) of the two groups were measured. Results: The ChE levels of the observation group were lower than those of the control group, while the PALB and ALB levels of the observation group were higher than those of the control group (P < 0.05). The AST, TP, and FEV1 /Pred levels of the observation group were higher than those in the control group (P < 0.05). Conclusion: Serum PALB levels can be used as the main indicator for prognosis in critically ill respiratory patients.展开更多
Background Increased levels of inflammatory markers have been documented in various settings of coronary artery disease. The vulnerability of coronary lesions in acute myocardial infarction(AMI) at the time of onset m...Background Increased levels of inflammatory markers have been documented in various settings of coronary artery disease. The vulnerability of coronary lesions in acute myocardial infarction(AMI) at the time of onset may be related to serum levels of C reactive protein(CRP) on admission, before CRP levels are affected by myocardial damage.Objective This study assessed the predictive value of CRP levels within six hours after the onset of acute anterior myocardial infarction with primary percutaneous coronary intervention(PCI).Methods The plasma CRP of 76 patients with first acute anterior myocardial infarction was measured within 6 hours after onset. They were divided into 2 groups: group 1( n =20) with elevated CRP( ≥0.3mg/dl ) on admission within 6 hours after onset and group 2( n =56) with normal CRP( <0.3mg/dl ) within 6 hours after onset. All patients were treated by primary PCI. The primary combined end points, including death due to cardiac causes, re MI related to the infarction artery(RIA) and repeat intervention of the RIA, and the restenosis rate were assessed in relation to CRP levels within 6 hours after onset. Left ventricular end diastolic volume index(EDVI),end systolic volume index(ESVI),and ejection fraction(EF) on admission and 6 month after the onset were assessed by left ventriculography. Changes in EDVI(ΔEDVI),ESVI(ΔESVI), and EF(ΔEF) were obtained by subtracting respective on admission values from corresponding 6 month follow up values. Results There were no significant differences in baseline characteristics between the two groups. The primary combined end points were significantly more frequent in group 1(20%) than those in group 2( 1.79% , P <0.01 ).In addition, restenosis rates were significantly higher in group 1 than in group 2(41.18% vs 16.07%, P<0.05). Group 1 showed greater increases in left ventricular volume and less improvement in EF compared with group 2(ΔEDVI 6.31 ±2.17 vs 3.29 ±9.46ml/m 2 , ΔESVI 5.92 ±2.31 vs 3.86 ±1.08ml/m 2 , ΔEF 1.92 ±0.47 vs 4.79 ±1.73% , P <0.05 , respectively).Conclusions CRP levels within 6 hours after the onset of AMI might predict adverse outcome after primary PCI and progressive ventricular remodeling within 6 month of AMI.展开更多
BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations ...BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.展开更多
BACKGROUND Acute ischemic stroke(AIS)is mainly caused by cerebral blood flow disorders,which further leads to ischemic brain necrosis or encephalomalacia.The role of homocysteine(Hcy),an independent risk factor for ca...BACKGROUND Acute ischemic stroke(AIS)is mainly caused by cerebral blood flow disorders,which further leads to ischemic brain necrosis or encephalomalacia.The role of homocysteine(Hcy),an independent risk factor for cardiovascular disease,in the development of atherosclerosis is gradually revealed.However,studies are still rare and little is known about the relationship of Hcy level with the prognosis.AIM To explore the relationship between Hcy level and prognosis in elderly patients with AIS after thrombolytic therapy with recombinant tissue plasminogen activator(rtPA).METHODS A total of 120 patients with acute ischemic stroke who were admitted to Jingzhou Central Hospital and underwent recombinant tissue plasminogen activator treatment were randomly selected from January 2017 to December 2018.They were divided into two groups according to the level of Hcy,with 60 patients in each group.Patients with Hcy≥18.54 umol/L were included into a high-level group and those with Hcy<18.54 umol/L were included into a low-level group.The outcomes were analyzed in the two groups after the treatment.RESULTS The National institute of Health Stroke Scale(NIHSS)scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment(P<0.05).There was no significant difference in NIHSS scores between the two groups at 12 and 24 h after the treatment(P>0.05).The Modified Rankin scale(MRS)scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment(P<0.05).There was no significant difference in MRS scores between the two groups at 12 and 24 h after the treatment(P>0.05).NIHSS and MRS scores were positively correlated with the prognosis after thrombolytic therapy(P<0.05).CONCLUSION The level of Hcy is closely related to the prognosis of elderly patients with acute ischemic stroke,and after rtPA treatment,the prognosis of elderly patients is improved significantly.展开更多
BACKGROUND Despite significant advancements in the medical treatment of primary hepato-cellular carcinoma(PHC)in recent years,enhancing therapeutic effects and im-proving prognosis remain substantial challenges worldw...BACKGROUND Despite significant advancements in the medical treatment of primary hepato-cellular carcinoma(PHC)in recent years,enhancing therapeutic effects and im-proving prognosis remain substantial challenges worldwide.AIM To investigate the expression levels of serum vascular endothelial growth factor(VEGF)and interleukin(IL)-17 in patients with PHC and evaluate their diagnostic value while exploring their relationship with patients’clinical characteristics.METHODS The study included 50 patients with confirmed PHC who visited Wuhan Han-yang Hospital from January 2021 to January 2022,and 50 healthy individuals from the same period served as the control group.Serum VEGF and IL-17 levels in both groups were measured by Enzyme-Linked Immunosorbent Assay,and their diagnostic value was assessed using receiver operating characteristic(ROC)curves.Pearson correlation analysis was performed to examine the relationship between serum VEGF and IL-17 levels.Pathological data of the PHC patients were analyzed to determine the relationship between serum VEGF and IL-17 levels and pathological characteristics.RESULTS Serum VEGF and IL-17 levels were significantly higher in the study group com-pared to the control group(P<0.05).No significant association was observed between serum VEGF and IL-17 levels and gender,age,combined cirrhosis,tumor diameter,or degree of differentiation(P>0.05).However,there was a significant relationship between clinical TNM stage,tumor metastasis,and serum VEGF and IL-17 levels(P<0.05).Correlation analysis revealed a positive correlation between serum VEGF and IL-17(P<0.05).ROC analysis demonstrated that both serum VEGF and IL-17 had good diagnostic efficacy for PHC.CONCLUSION Serum VEGF and IL-17 levels were significantly higher in PHC patients compared to healthy individuals.Their levels were closely related to pathological features such as tumor metastasis and clinical TNM stage,and there was a significant positive correlation between VEGF and IL-17.These biomarkers may serve as valuable reference in-dicators for the early diagnosis and treatment guidance of PHC.展开更多
AIM To evaluate the prognostic significance of perioperative carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) levels in stage Ⅱ/Ⅲ gastric cancer.METHODS From a multi-institutional retrospective da...AIM To evaluate the prognostic significance of perioperative carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) levels in stage Ⅱ/Ⅲ gastric cancer.METHODS From a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage Ⅱ/Ⅲ gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.RESULTS The prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival.Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.CONCLUSION The evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.展开更多
AIM: To develop an automatic tool on screening diabetic retinopathy(DR) from diabetic patients.METHODS: We extracted textures from eye fundus images of each diabetes subject using grey level co-occurrence matrix metho...AIM: To develop an automatic tool on screening diabetic retinopathy(DR) from diabetic patients.METHODS: We extracted textures from eye fundus images of each diabetes subject using grey level co-occurrence matrix method and trained a Bayesian model based on these textures. The receiver operating characteristic(ROC) curve was used to estimate the sensitivity and specificity of the Bayesian model.RESULTS: A total of 1000 eyes fundus images from diabetic patients in which 298 eyes were diagnosed as DR by two ophthalmologists. The Bayesian model was trained using four extracted textures including contrast, entropy, angular second moment and correlation using a training dataset. The Bayesian model achieved a sensitivity of 0.949 and a specificity of 0.928 in the validation dataset. The area under the ROC curve was 0.938, and the 10-fold cross validation method showed that the average accuracy rate is 93.5%.CONCLUSION: Textures extracted by grey level cooccurrence can be useful information for DR diagnosis, and a trained Bayesian model based on these textures can be an effective tool for DR screening among diabetic patients.展开更多
AIM: To examine the association of beta-catenin with the clinicopathologic features and prognosis of esophageal squamous cell carcinoma (ESCC). METHODS: Beta-catenin mRNA expression level in 40 ESCC patients (28 ...AIM: To examine the association of beta-catenin with the clinicopathologic features and prognosis of esophageal squamous cell carcinoma (ESCC). METHODS: Beta-catenin mRNA expression level in 40 ESCC patients (28 males and 12 females, age range 38-82 years, median 60 years) was analyzed by real- time PCR. Beta-catenin mRNA expression levels in tumor cells were categorized as weaker (level 1) or equal to or stronger (level 2) than those in endothelial cells. We examined the correlation between the beta-catenin expression and the clinicopathological factors and prognosis of ESCC patients. RESULTS: Level 2 beta-catenin expression was found in 29 patients. ESCC with level 2 expression had a higher rate of lymphnode metastasis (0.0776±0.0369 vs 0.3413±0.1803, P 〈 0.001) and deeper tumor invasion (0.0751±0.0356 vs 0.3667±0.1928, P 〈 0.001), and a poorer survival rate (P = 0.0024) than ESCC with level I expression. CONCLUSION: Beta-catenin expression in ESCC is of great importance.展开更多
AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (GroupsⅠand Ⅱ) t...AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (GroupsⅠand Ⅱ) the superior mesenteric artery (SMA) and vein (SMV) were explored, but not tied. In SMA groups (Groups Ⅲ and Ⅳ) the SMA was ligated, and in SMV groups (Groups Ⅴ and Ⅵ) the SMV was ligated. On re-laparatomy 2 mL of blood was drawn at 1 h in groupsⅠ, Ⅲ and Ⅴ, and at 3 h in groups Ⅱ, Ⅳ and Ⅵ. Plasminogen levels were assessed and comparisons were made between groups and within each group. RESULTS: The mean plasminogen activity in the SL group was significantly higher than SMA (25.1 ± 10.8 vs 11.8 ± 4.6, P < 0.001) or SMV (25.1 ± 10.8 vs 13.7 ± 4.4, P < 0.001) groups both at 1 h and at 3 h (29.8 ± 8.9 vs 15.1 ± 5.7, P < 0.0001; 29.8 ± 8.9 vs 14.2 ± 2.9, P < 0.0001). There were no significant differences between the values of SMA and SMV groups at 1 h (P = 0.28) and at 3 h (P = 0.71). In each group, plasminogen activity levels did not change significantly between the two measurements performed at 1 h and 3 h. CONCLUSION: We conclude that blood plasminogen activities decrease during early phases of both arterial and venous mesenteric ischemia which may be a useful marker for early diagnosis.展开更多
Understanding the properties of nuclei near the double magic nucleus^(40)Ca is crucial for both nuclear theory and experiments.In this study,Ca isotopes were investigated using an extended pairing-plus-quadrupole mode...Understanding the properties of nuclei near the double magic nucleus^(40)Ca is crucial for both nuclear theory and experiments.In this study,Ca isotopes were investigated using an extended pairing-plus-quadrupole model with monopole corrections.The negative-parity states of^(44)Ca were coupled with the intruder orbital g_(9/2)at 4 MeV.The values of E_(4+)/E_(2+)agree well with experimental trend from^(42)Ca to^(50)Ca,considering monopole effects between νf_(7/2)and νp_(3/2)(νf_(5/2)).This monopole effect,determined from data of^(48)Ca and^(50)Ca,supports the proposed new nuclear magic number N=34 by predicting a high-energy 2^(+)state in^(54)Ca.展开更多
Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Developme...Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states;up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%;secondary -10 (71%) states have > 70% at facilities;primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively;secondary 4 (<30%) states have in 1 or 2 facilities;none for primary facilities. In private health facilities, 79% of states have Smear microscopy at both primary and secondary facilities, and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic services across the health system.展开更多
Heavy Menstrual Bleeding is one of the common Gynaecological issues. There are several causes. Some of the women presented with these issues found to have underling thyroid abnormality which was not discovered earlier...Heavy Menstrual Bleeding is one of the common Gynaecological issues. There are several causes. Some of the women presented with these issues found to have underling thyroid abnormality which was not discovered earlier. This research tries to find the prevalence of the Thyroid Disorder among the women present with Heavy menstrual bleeding in Sri Lankan women.展开更多
Background: Infertility is characterized by the inability to conceive after a year of regular unprotected intercourse. Aims: This study aimed to investigate the diagnostic value of sex hormone levels during different ...Background: Infertility is characterized by the inability to conceive after a year of regular unprotected intercourse. Aims: This study aimed to investigate the diagnostic value of sex hormone levels during different physiological periods in the diagnosis of infertility patients. Methods: From December 2019 to May 2021, a total of 93 infertility patients were admitted and selected as the observation group. Among them, 31 cases were in the follicular stage, 31 cases in the ovulation stage, and 31 cases in the luteal stage. Ninety-three healthy women for fertility evaluation due to male infertility were selected as the control group. The control group included 31 women in the follicular phase, 31 women in the ovulatory phase, and 31 women in the luteal phase. The levels of sex hormones (prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), testosterone (T), and progesterone (P)) during different physiological phases were compared between the observation and control groups. Results: The follicular phase showed no significant difference in LH levels between the observation group and the control group. The observation group showed higher levels of PRL and P compared to the control group, while the levels of FSH, E2, and T were lower in the observation group compared to the control group. The ovulation phase showed no significant difference in PRL levels between the two groups. The observation group showed lower levels of LH, FSH, E2, T, and P compared to the control group. The luteal phase showed no statistical difference in E2 levels between the two groups. The observation group showed higher levels of PRL, LH, and FSH compared to the control group, while the levels of T and P were lower in the observation group compared to the control group. Conclusion: Infertile women show variations in hormone levels compared to the normal levels during the follicular phase, ovulatory phase, and luteal phase.展开更多
Manganese-based perovskite is popular for research on ferromagnetic materials,and its spectroscopic studies are essential for understanding its electronic structure,dielectric,electrical,and magnetic properties.In thi...Manganese-based perovskite is popular for research on ferromagnetic materials,and its spectroscopic studies are essential for understanding its electronic structure,dielectric,electrical,and magnetic properties.In this paper,the M-edge spectra of La ions and the M-edge,L-edge,and K-edge spectra of Mn ions in LaMnO3 are calculated by considering both the free-ion multiplet calculation and the crystal field effects.We analyze spectral shapes,identify peak origins,and estimate the oxidation states of La and Mn ions in LaMnO3 theoretically.It is concluded that La ions in LaMnO3 predominantly exist in the trivalent state,while Mn ions exist primarily in the trivalent state with a minor presence of tetravalent ions.Furthermore,the calculated spectra are in better conformity with the experimental spectra when the proportion of Mn3+is 90%and Mn4+is 10%.This article enhances our comprehension of the oxidation states of La and Mn within the crystal and also provides a valuable guidance for spectroscopic investigations of other manganates.展开更多
Our study aims to determine diagnostic reference levels (DRL) for chest front examination in postero anterior (PA) for optimizing patient entrance surface dose (ESD) and dose-area product (DAP) of patients in west of ...Our study aims to determine diagnostic reference levels (DRL) for chest front examination in postero anterior (PA) for optimizing patient entrance surface dose (ESD) and dose-area product (DAP) of patients in west of Côte d’Ivoire. 90 patients from three hospitals undergoing conventional radiology were considered. The ESD and DAP for each patient were obtained during chest radiography (PA) examination. The measurements were performed with the device call Dose-Area Product-meter (DAP-meter) with brand Diamentor M4-KDK, type 11017. The DRL were obtained in applying the 75th percentile statistical method to the obtained ESD and DAP. The obtained DRL in ESD for chest radiography for all rooms is 0.40 mGy and in DAP is 54.85 cGy·cm2. Our DRL for ESD is higher than those obtained in Abidjan District and in other countries like UK and Cameroon. Our DRL for DAP is higher than those from Abidjan and all other countries for which a similar study was made. The comparison of these values to those from Abidjan and other countries, shows us that radiology technicians can make efforts to choose radiological parameters to reduce ESD. They must use convenable the X-rays tube to reduce DAP by reducing the patient exposure surface.展开更多
基金supported by the National Key Research and Development Program of China(2022YFD2300700)the Open Project Program of State Key Laboratory of Rice Biology,China National Rice Research Institute(20210403)the Zhejiang“Ten Thousand Talents”Plan Science and Technology Innovation Leading Talent Project,China(2020R52035)。
文摘Nitrogen(N)and potassium(K)are two key mineral nutrient elements involved in rice growth.Accurate diagnosis of N and K status is very important for the rational application of fertilizers at a specific rice growth stage.Therefore,we propose a hybrid model for diagnosing rice nutrient levels at the early panicle initiation stage(EPIS),which combines a convolutional neural network(CNN)with an attention mechanism and a long short-term memory network(LSTM).The model was validated on a large set of sequential images collected by an unmanned aerial vehicle(UAV)from rice canopies at different growth stages during a two-year experiment.Compared with VGG16,AlexNet,GoogleNet,DenseNet,and inceptionV3,ResNet101 combined with LSTM obtained the highest average accuracy of 83.81%on the dataset of Huanghuazhan(HHZ,an indica cultivar).When tested on the datasets of HHZ and Xiushui 134(XS134,a japonica rice variety)in 2021,the ResNet101-LSTM model enhanced with the squeeze-and-excitation(SE)block achieved the highest accuracies of 85.38 and 88.38%,respectively.Through the cross-dataset method,the average accuracies on the HHZ and XS134 datasets tested in 2022 were 81.25 and 82.50%,respectively,showing a good generalization.Our proposed model works with the dynamic information of different rice growth stages and can efficiently diagnose different rice nutrient status levels at EPIS,which are helpful for making practical decisions regarding rational fertilization treatments at the panicle initiation stage.
基金the Ethic Committee of Suzhou Hospital of Anhui Medical University(Approval No.C2024003).
文摘BACKGROUND Acute myeloid leukemia(AML)is a disease in which immature hematopoietic cells accumulate in the bone marrow and continuously expand,inhibiting hematopoiesis.The treatment and prognosis of this disease have always been unsatisfactory.AIM To investigate the correlation between vascular endothelial growth factor(VEGF)and transforming growth factor-β1(TGFβ1)expression and prognosis in older adults with AML.METHODS This study enrolled 80 patients with AML(AML group),including 36 with complete response(AML-CR),23 with partial response(AML-PR),and 21 with no response(AML-NR).The expression levels of VEGF and TGFβ1 were detected by reverse transcription polymerase chain reaction in bone marrow mononuclear cells isolated from 56 healthy controls.Kaplan-Meier analysis was performed to assess overall survival(OS)and progression-or disease-free survival(DFS).Prognostic risk factors were analyzed using a Cox proportional hazards model.RESULTS The AML group showed a VEGF level of 2.68±0.16.VEGF expression was lower in patients with AML-CR than those with AML-PR or AML-NR(P<0.05).TGFβ1 expression in the AML group was 0.33±0.05.Patients with AML-CR showed a higher TGFβ1 expression than those with AML-PR or AML-NR(P<0.05).VEGF and TGFβ1 expression in patients with AML was significantly correlated with the counts of leukocytes,platelets,hemoglobin,and peripheral blood immature cells(P<0.05);Kaplan-Meier survival analysis revealed that patients with high TGFβ1 expression had better OS and DFS than those with low TGFβ1 expression(P<0.05),whereas patients with low VEGF levels showed better OS and DFS than those with high VEGF levels(P<0.05).VEGF,TGFβ1,and platelet count were identified by the Cox proportional hazards model as independent risk factors for OS(P<0.05),while VEGF,TGFβ1,and white blood cell count were independent risk factors for DFS(P<0.05).CONCLUSION Decreased VEGF expression and increased TGFβ1 expression in patients with AML provide valuable references for determining and individualizing clinical treatment strategies.
文摘Objective: To analyze the accuracy of serum prealbumin levels in predicting the prognosis of patients with critical respiratory illness. Methods: Fifty patients with critical respiratory illness admitted to our hospital from October 2022 to September 2023 were selected and divided into an observation group and a control group after condition assessment, with 25 cases in each group. The results of cholinesterase (ChE), prealbumin (PALB), albumin (ALB), aspartate aminotransferase (AST), total protein (TP), and forced expiratory volume (FEV1)/Predicted (Pred) of the two groups were measured. Results: The ChE levels of the observation group were lower than those of the control group, while the PALB and ALB levels of the observation group were higher than those of the control group (P < 0.05). The AST, TP, and FEV1 /Pred levels of the observation group were higher than those in the control group (P < 0.05). Conclusion: Serum PALB levels can be used as the main indicator for prognosis in critically ill respiratory patients.
文摘Background Increased levels of inflammatory markers have been documented in various settings of coronary artery disease. The vulnerability of coronary lesions in acute myocardial infarction(AMI) at the time of onset may be related to serum levels of C reactive protein(CRP) on admission, before CRP levels are affected by myocardial damage.Objective This study assessed the predictive value of CRP levels within six hours after the onset of acute anterior myocardial infarction with primary percutaneous coronary intervention(PCI).Methods The plasma CRP of 76 patients with first acute anterior myocardial infarction was measured within 6 hours after onset. They were divided into 2 groups: group 1( n =20) with elevated CRP( ≥0.3mg/dl ) on admission within 6 hours after onset and group 2( n =56) with normal CRP( <0.3mg/dl ) within 6 hours after onset. All patients were treated by primary PCI. The primary combined end points, including death due to cardiac causes, re MI related to the infarction artery(RIA) and repeat intervention of the RIA, and the restenosis rate were assessed in relation to CRP levels within 6 hours after onset. Left ventricular end diastolic volume index(EDVI),end systolic volume index(ESVI),and ejection fraction(EF) on admission and 6 month after the onset were assessed by left ventriculography. Changes in EDVI(ΔEDVI),ESVI(ΔESVI), and EF(ΔEF) were obtained by subtracting respective on admission values from corresponding 6 month follow up values. Results There were no significant differences in baseline characteristics between the two groups. The primary combined end points were significantly more frequent in group 1(20%) than those in group 2( 1.79% , P <0.01 ).In addition, restenosis rates were significantly higher in group 1 than in group 2(41.18% vs 16.07%, P<0.05). Group 1 showed greater increases in left ventricular volume and less improvement in EF compared with group 2(ΔEDVI 6.31 ±2.17 vs 3.29 ±9.46ml/m 2 , ΔESVI 5.92 ±2.31 vs 3.86 ±1.08ml/m 2 , ΔEF 1.92 ±0.47 vs 4.79 ±1.73% , P <0.05 , respectively).Conclusions CRP levels within 6 hours after the onset of AMI might predict adverse outcome after primary PCI and progressive ventricular remodeling within 6 month of AMI.
基金National Natural Science Foundation of China,No.72101236China Postdoctoral Science Foundation,No.2022M722900+1 种基金Collaborative Innovation Project of Zhengzhou City,No.XTCX2023006Nursing Team Project of the First Affiliated Hospital of Zhengzhou University,No.HLKY2023005.
文摘BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.
文摘BACKGROUND Acute ischemic stroke(AIS)is mainly caused by cerebral blood flow disorders,which further leads to ischemic brain necrosis or encephalomalacia.The role of homocysteine(Hcy),an independent risk factor for cardiovascular disease,in the development of atherosclerosis is gradually revealed.However,studies are still rare and little is known about the relationship of Hcy level with the prognosis.AIM To explore the relationship between Hcy level and prognosis in elderly patients with AIS after thrombolytic therapy with recombinant tissue plasminogen activator(rtPA).METHODS A total of 120 patients with acute ischemic stroke who were admitted to Jingzhou Central Hospital and underwent recombinant tissue plasminogen activator treatment were randomly selected from January 2017 to December 2018.They were divided into two groups according to the level of Hcy,with 60 patients in each group.Patients with Hcy≥18.54 umol/L were included into a high-level group and those with Hcy<18.54 umol/L were included into a low-level group.The outcomes were analyzed in the two groups after the treatment.RESULTS The National institute of Health Stroke Scale(NIHSS)scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment(P<0.05).There was no significant difference in NIHSS scores between the two groups at 12 and 24 h after the treatment(P>0.05).The Modified Rankin scale(MRS)scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment(P<0.05).There was no significant difference in MRS scores between the two groups at 12 and 24 h after the treatment(P>0.05).NIHSS and MRS scores were positively correlated with the prognosis after thrombolytic therapy(P<0.05).CONCLUSION The level of Hcy is closely related to the prognosis of elderly patients with acute ischemic stroke,and after rtPA treatment,the prognosis of elderly patients is improved significantly.
文摘BACKGROUND Despite significant advancements in the medical treatment of primary hepato-cellular carcinoma(PHC)in recent years,enhancing therapeutic effects and im-proving prognosis remain substantial challenges worldwide.AIM To investigate the expression levels of serum vascular endothelial growth factor(VEGF)and interleukin(IL)-17 in patients with PHC and evaluate their diagnostic value while exploring their relationship with patients’clinical characteristics.METHODS The study included 50 patients with confirmed PHC who visited Wuhan Han-yang Hospital from January 2021 to January 2022,and 50 healthy individuals from the same period served as the control group.Serum VEGF and IL-17 levels in both groups were measured by Enzyme-Linked Immunosorbent Assay,and their diagnostic value was assessed using receiver operating characteristic(ROC)curves.Pearson correlation analysis was performed to examine the relationship between serum VEGF and IL-17 levels.Pathological data of the PHC patients were analyzed to determine the relationship between serum VEGF and IL-17 levels and pathological characteristics.RESULTS Serum VEGF and IL-17 levels were significantly higher in the study group com-pared to the control group(P<0.05).No significant association was observed between serum VEGF and IL-17 levels and gender,age,combined cirrhosis,tumor diameter,or degree of differentiation(P>0.05).However,there was a significant relationship between clinical TNM stage,tumor metastasis,and serum VEGF and IL-17 levels(P<0.05).Correlation analysis revealed a positive correlation between serum VEGF and IL-17(P<0.05).ROC analysis demonstrated that both serum VEGF and IL-17 had good diagnostic efficacy for PHC.CONCLUSION Serum VEGF and IL-17 levels were significantly higher in PHC patients compared to healthy individuals.Their levels were closely related to pathological features such as tumor metastasis and clinical TNM stage,and there was a significant positive correlation between VEGF and IL-17.These biomarkers may serve as valuable reference in-dicators for the early diagnosis and treatment guidance of PHC.
文摘AIM To evaluate the prognostic significance of perioperative carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) levels in stage Ⅱ/Ⅲ gastric cancer.METHODS From a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage Ⅱ/Ⅲ gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.RESULTS The prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival.Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.CONCLUSION The evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.
基金Supported by the Priming Scientific Research Foundation for the Junior Researcher in Beijing Tongren Hospital,Capital Medical University
文摘AIM: To develop an automatic tool on screening diabetic retinopathy(DR) from diabetic patients.METHODS: We extracted textures from eye fundus images of each diabetes subject using grey level co-occurrence matrix method and trained a Bayesian model based on these textures. The receiver operating characteristic(ROC) curve was used to estimate the sensitivity and specificity of the Bayesian model.RESULTS: A total of 1000 eyes fundus images from diabetic patients in which 298 eyes were diagnosed as DR by two ophthalmologists. The Bayesian model was trained using four extracted textures including contrast, entropy, angular second moment and correlation using a training dataset. The Bayesian model achieved a sensitivity of 0.949 and a specificity of 0.928 in the validation dataset. The area under the ROC curve was 0.938, and the 10-fold cross validation method showed that the average accuracy rate is 93.5%.CONCLUSION: Textures extracted by grey level cooccurrence can be useful information for DR diagnosis, and a trained Bayesian model based on these textures can be an effective tool for DR screening among diabetic patients.
文摘AIM: To examine the association of beta-catenin with the clinicopathologic features and prognosis of esophageal squamous cell carcinoma (ESCC). METHODS: Beta-catenin mRNA expression level in 40 ESCC patients (28 males and 12 females, age range 38-82 years, median 60 years) was analyzed by real- time PCR. Beta-catenin mRNA expression levels in tumor cells were categorized as weaker (level 1) or equal to or stronger (level 2) than those in endothelial cells. We examined the correlation between the beta-catenin expression and the clinicopathological factors and prognosis of ESCC patients. RESULTS: Level 2 beta-catenin expression was found in 29 patients. ESCC with level 2 expression had a higher rate of lymphnode metastasis (0.0776±0.0369 vs 0.3413±0.1803, P 〈 0.001) and deeper tumor invasion (0.0751±0.0356 vs 0.3667±0.1928, P 〈 0.001), and a poorer survival rate (P = 0.0024) than ESCC with level I expression. CONCLUSION: Beta-catenin expression in ESCC is of great importance.
文摘AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (GroupsⅠand Ⅱ) the superior mesenteric artery (SMA) and vein (SMV) were explored, but not tied. In SMA groups (Groups Ⅲ and Ⅳ) the SMA was ligated, and in SMV groups (Groups Ⅴ and Ⅵ) the SMV was ligated. On re-laparatomy 2 mL of blood was drawn at 1 h in groupsⅠ, Ⅲ and Ⅴ, and at 3 h in groups Ⅱ, Ⅳ and Ⅵ. Plasminogen levels were assessed and comparisons were made between groups and within each group. RESULTS: The mean plasminogen activity in the SL group was significantly higher than SMA (25.1 ± 10.8 vs 11.8 ± 4.6, P < 0.001) or SMV (25.1 ± 10.8 vs 13.7 ± 4.4, P < 0.001) groups both at 1 h and at 3 h (29.8 ± 8.9 vs 15.1 ± 5.7, P < 0.0001; 29.8 ± 8.9 vs 14.2 ± 2.9, P < 0.0001). There were no significant differences between the values of SMA and SMV groups at 1 h (P = 0.28) and at 3 h (P = 0.71). In each group, plasminogen activity levels did not change significantly between the two measurements performed at 1 h and 3 h. CONCLUSION: We conclude that blood plasminogen activities decrease during early phases of both arterial and venous mesenteric ischemia which may be a useful marker for early diagnosis.
基金supported by the National Natural Science Foundation of China(Nos.12175199,U2267205,12475124)the ZSTU intramural grant(22062267-Y)。
文摘Understanding the properties of nuclei near the double magic nucleus^(40)Ca is crucial for both nuclear theory and experiments.In this study,Ca isotopes were investigated using an extended pairing-plus-quadrupole model with monopole corrections.The negative-parity states of^(44)Ca were coupled with the intruder orbital g_(9/2)at 4 MeV.The values of E_(4+)/E_(2+)agree well with experimental trend from^(42)Ca to^(50)Ca,considering monopole effects between νf_(7/2)and νp_(3/2)(νf_(5/2)).This monopole effect,determined from data of^(48)Ca and^(50)Ca,supports the proposed new nuclear magic number N=34 by predicting a high-energy 2^(+)state in^(54)Ca.
文摘Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states;up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%;secondary -10 (71%) states have > 70% at facilities;primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively;secondary 4 (<30%) states have in 1 or 2 facilities;none for primary facilities. In private health facilities, 79% of states have Smear microscopy at both primary and secondary facilities, and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic services across the health system.
文摘Heavy Menstrual Bleeding is one of the common Gynaecological issues. There are several causes. Some of the women presented with these issues found to have underling thyroid abnormality which was not discovered earlier. This research tries to find the prevalence of the Thyroid Disorder among the women present with Heavy menstrual bleeding in Sri Lankan women.
文摘Background: Infertility is characterized by the inability to conceive after a year of regular unprotected intercourse. Aims: This study aimed to investigate the diagnostic value of sex hormone levels during different physiological periods in the diagnosis of infertility patients. Methods: From December 2019 to May 2021, a total of 93 infertility patients were admitted and selected as the observation group. Among them, 31 cases were in the follicular stage, 31 cases in the ovulation stage, and 31 cases in the luteal stage. Ninety-three healthy women for fertility evaluation due to male infertility were selected as the control group. The control group included 31 women in the follicular phase, 31 women in the ovulatory phase, and 31 women in the luteal phase. The levels of sex hormones (prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), testosterone (T), and progesterone (P)) during different physiological phases were compared between the observation and control groups. Results: The follicular phase showed no significant difference in LH levels between the observation group and the control group. The observation group showed higher levels of PRL and P compared to the control group, while the levels of FSH, E2, and T were lower in the observation group compared to the control group. The ovulation phase showed no significant difference in PRL levels between the two groups. The observation group showed lower levels of LH, FSH, E2, T, and P compared to the control group. The luteal phase showed no statistical difference in E2 levels between the two groups. The observation group showed higher levels of PRL, LH, and FSH compared to the control group, while the levels of T and P were lower in the observation group compared to the control group. Conclusion: Infertile women show variations in hormone levels compared to the normal levels during the follicular phase, ovulatory phase, and luteal phase.
基金Project supported by the National Natural Science Foundation of China(Grant No.11974253).
文摘Manganese-based perovskite is popular for research on ferromagnetic materials,and its spectroscopic studies are essential for understanding its electronic structure,dielectric,electrical,and magnetic properties.In this paper,the M-edge spectra of La ions and the M-edge,L-edge,and K-edge spectra of Mn ions in LaMnO3 are calculated by considering both the free-ion multiplet calculation and the crystal field effects.We analyze spectral shapes,identify peak origins,and estimate the oxidation states of La and Mn ions in LaMnO3 theoretically.It is concluded that La ions in LaMnO3 predominantly exist in the trivalent state,while Mn ions exist primarily in the trivalent state with a minor presence of tetravalent ions.Furthermore,the calculated spectra are in better conformity with the experimental spectra when the proportion of Mn3+is 90%and Mn4+is 10%.This article enhances our comprehension of the oxidation states of La and Mn within the crystal and also provides a valuable guidance for spectroscopic investigations of other manganates.
文摘Our study aims to determine diagnostic reference levels (DRL) for chest front examination in postero anterior (PA) for optimizing patient entrance surface dose (ESD) and dose-area product (DAP) of patients in west of Côte d’Ivoire. 90 patients from three hospitals undergoing conventional radiology were considered. The ESD and DAP for each patient were obtained during chest radiography (PA) examination. The measurements were performed with the device call Dose-Area Product-meter (DAP-meter) with brand Diamentor M4-KDK, type 11017. The DRL were obtained in applying the 75th percentile statistical method to the obtained ESD and DAP. The obtained DRL in ESD for chest radiography for all rooms is 0.40 mGy and in DAP is 54.85 cGy·cm2. Our DRL for ESD is higher than those obtained in Abidjan District and in other countries like UK and Cameroon. Our DRL for DAP is higher than those from Abidjan and all other countries for which a similar study was made. The comparison of these values to those from Abidjan and other countries, shows us that radiology technicians can make efforts to choose radiological parameters to reduce ESD. They must use convenable the X-rays tube to reduce DAP by reducing the patient exposure surface.