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Challenges from administrative support, scanners' heterogeneity, patient size variation, and protocol mapping hinder CT protocol and dose management. We present a holistic approach to overcome these challenges. A dose tracking software was selected with two key requirements: intelligent protocol mapping and customizable dose threshold settings according to the patient size. A multifaceted workflow was carefully implemented. It included patient size–dependent dose thresholds for e-mail alerts, a base protocol archive on a website with a unified format using an in-house developed reformat software upon protocol export, prompt dose alert follow-up, and well-controlled protocol changes. The thresholds were iteratively updated following protocol changes or review of dose statistics. The program outcome was evaluated using 11 protocols from January 2020 to May 2023 (N = 148,678) in comparison to ACR's achievable dose (AD) and dose reference levels (DRLs). The 75th percentile dose data were lower than the ACR's DRL on average, ranging from −4.9% to −36%. The median doses were in a range of −23% to 19% on average in comparison with the ACR's AD. The median value from pulmonary embolism scans initially showed 36% higher than the AD but was gradually reduced to nearly 3% lower than the AD. The percentage of unjustified alerted cases decreased from 80% in first half year of 2020 to 17% in the first 5 months of 2023. The results showed that our holistic approach to protocol and dose management has been effective. The impact to practice has been prompt and sustainable. [Display omitted] [ABSTRACT FROM AUTHOR]

From the actor-network theory perspective, this study aims to explore how e-waste online recycling platforms build their business ecosystems through symbiotic strategies. A double-case comparative research has been conducted based on the two selected typical e-waste online recycling platforms in China. The study's findings show that translation plays a significant role in the process of symbiotic strategies promoting the construction of e-waste online recycling business ecosystems. This research proposes that translation is an important action for the implementation of the symbiotic strategy. The different symbiotic strategies need to be implemented in different translation ways. Platforms derived from an Internet company (PDICs), which prefer a mutualistic symbiotic strategy, usually adopt value cocreation translation through the following four steps: scenario definition, benefit sharing, emotional connection, and digital empowerment. Platforms derived from a recycling company (PDRCs)with a predatory symbiotic strategy adopt value capture translation through four steps: pain point identification, benefit allocation, the reputation effect, and rule reconstruction. We found that the difference in translation action triggers a difference in the structural elements of the business ecosystem. Then, two types of e-waste online recycling business ecosystems, embedded and central, are constructed. • The process of e-waste online recycling business ecosystem construction through a symbiotic strategy was revealed. • Translation patterns and actions of e-waste online recycling platform's symbiotic strategy are described in detail. • The types of actors and network structure in e-waste online recycling business ecosystem are described quantitatively. • Management suggestions for e-waste online recycling platform enterprises to construct business ecosystems were provided. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery during an empty beating heart state has proven to be beneficial in myocardial protection. Based on this, we hypothesized that maintaining this state for donor heart preservation would have the same efficacy and a prolonged preservation period. Methods: Part 1: 12 pigs were divided into two groups (n = 6 per group). Donor hearts were preserved in group A by perfusion with leukocyte-depleted blood in the beating state, and in group B, in the traditional hypothermic static state with University of Wisconsin solution. After 8 hours, myocardial samples were obtained to detect myocardial edema, adenosine triphosphate, and ultrastructure. Part 2: 12 donor-recipient swine pairs were randomly allocated to either beating heart preservation with perfusion (group C) or traditional static preservation (group D). Donor hearts were stored for 8 hours after isolation, followed by implantation into recipient animals. Implanted hearts recovered for 120 minutes in an empty and beating state followed by 30 minutes in a working state, after which cardiac function was measured. Results: After preservation, myocardial adenosine triphosphate levels in group A were significantly higher than in group B. However, myocardial water content was not significantly different between these two groups. The damage of myocardial ultrastructure in group A was slight compared with that of group B. The experimental transplant group C showed excellent heart function after implantation when compared with group D. Conclusions: Our study reveals greater effects of donor heart preservation in a beating state rather than simply with hypothermic storage in University of Wisconsin solution. [Copyright &y& Elsevier]

Background: Beating-heart surgery with warm blood perfusion, instead of cardioplegic solution, has been widely accredited to be a feasible technique in the cardiac operation. However, few studies have addressed the efficacy and safety of on-pump beating-heart surgery, especially with large numbers of patients. In this study, the efficacy and safety of on-pump beating-heart surgery was evaluated by surveying 701 patients with cardiac disease. Methods: Preoperative risk factors, intraoperative techniques, and postoperative complications were documented and evaluated in 701 consecutive patients (from January 1, 2002, to December 30, 2006) who underwent beating-heart surgery with continuous antegrade or retrograde warm blood perfusion at The People''s Hospital of Guangxi Zhuang Autonomous Region. Results: Among the 701 patients with beating-heart surgery, antegrade perfusion was used in 556 patients (79.32%); retrograde perfusion was used in 40 patients (5.71%); and retrograde perfusion followed by antegrade perfusion was performed in 93 patients (13.27%). Cardioplegic arrest was required in 12 patients (1.71%) for inadequate visualization. In 4 of 701 patients (0.57%) low cardiac output syndrome occurred. Hemoglobinuria occurred in 16 patients (2.28%). No air embolization or permanent high-degree atrioventricular block occurred in these patients. The crude mortality of the surveyed patients was 2.43% (17 of 701). Conclusions: Our results indicate that on-pump beating-heart surgery is a relatively safe and reliable technique for treatment of cardiac diseases. [Copyright &y& Elsevier]

Rationale and objectives: There are well-known limitations to the use of visual estimation to assess the severity of coronary artery disease and luminal stenosis. This is especially true in the case of an intermediate coronary lesion (30%–70% diameter stenosis), where coronary arteriography is very limited in distinguishing ischemia-producing intermediate coronary lesions from non-ischemia-producing ones. For this reason, a functional measure of stenosis severity is desirable. The goal of this study is to validate a video densitometry technique for quantitative assessment of regional volumetric coronary blood flow.Materials and methods: Coronary arteriography was performed in eight swine (body weight, 25–50 kg) after power injection of contrast material into the left main coronary artery. Phase-matched subtracted images were used to quantify regional coronary blood flow using a video densitometry technique. The in vivo regional flow measurements were validated using a transit time ultrasound flow probe.Results: In 44 measurements, the ultrasound (QUS) and video densitometry (QVD) regional flow measurements were related by QVD = 0.98 QUS + 0.11 mL/min (r = 0.98). The results of mean regional coronary blood flow measurements for repeated coronary arteriograms of the first (QVD1) and second (QVD2) measured flows were related by QVD1 = 1.04 QVD2 + 0.05 mL/min (r = 0.97).Conclusions: A video densitometry technique for quantification of regional coronary blood flow was validated using a swine animal model. The results demonstrated the feasibility and potential utility of the video densitometry technique for accurate measurement of regional coronary blood flow, in vivo. This study provides an angiographic method that can potentially be used to evaluate intermediate coronary lesions during routine coronary arteriography. [Copyright &y& Elsevier]

Background: It is challenging to differentiate major depressive disorder (MDD) from bipolar disorder (BD) in depression and remission. To exclude the potential influence of depressive episodes, we compared the white matter (WM) network between MDD and BD patients in remission to find disease-specific alterations in MDD and BD, and then distinguish these two affective disorders.Methods: We recruited 33 patients with remitted MDD (rMDD), 54 patients with remitted BD (rBD), and 60 healthy controls (HCs). Diffusion tensor imaging and high-resolution 3D T1-weighted image were acquired. Global and nodal topological parameters were used to depict the alterations of the whole-brain WM network.Results: We found that rMDD displayed increased global network efficiency (Eglob) and local network efficiency (Eloc) compared with HCs, whereas we found no significance between rBD and HCs. Compared with rBD and HCs, patients in the rMDD group showed increased nodal degree and nodal efficiency, and decreased nodal shortest path length in the four cerebral regions, including the right calcarine fissure (CAL.R), right cuneus (CUN.R), left lingual gyrus (LING.L), and left middle occipital gyrus (MOG.L). We did not find any rBD specific changes of nodal topological metrics.Limitations: The main limitation is the possible effects of medication and BD subtypes on the results.Conclusions: Our findings indicate that rMDD exhibited elevated global properties compared with HCs group, and increased nodal properties in the CAL.R, CUN.R, LING.L, and MOG.L specifically compared with rBD and HCs, which may underlie the distinction of the two affective disorders in remission. [ABSTRACT FROM AUTHOR]

"Internet + waste electrical and electronic equipment (WEEE) collection" business ecosystems have attracted considerable attention from industry circles, and they are widely used in practice. However, the construction mechanism of "Internet + WEEE collection" business ecosystems has not been explored. In this paper, based on the mode of entry, "Internet + WEEE collection" platforms are divided into two types: platforms derived from an Internet company (PDICs) and platforms derived from a recycling company (PDRCs), and two typical corresponding platforms are analyzed using a double-case study to explore the interaction and mechanism between dominant platform capability, symbiotic strategy and business ecosystem construction. The results show the following: (1) different types of "Internet + WEEE collection" platforms have different dominant platform capabilities and then construct different business ecosystems based on their capabilities. PDICs take digital capability as the dominant platform capability and prefer to form an embedded business ecosystem, while PDRCs usually take network capability as the dominant platform capability and try to build a central business ecosystem. (2) PDICs and PDRCs prefer different symbiotic strategies, and the strategies affect the construction of business ecosystems. The strategy of mutualism symbiosis is adopted by PDICs, and it promotes them to build an embedded business ecosystem. PDRCs prefer the strategy of predation symbiosis, and they choose to construct a central business ecosystem. (3) Dominant platform capability can also affect the construction of business ecosystems through the symbiotic strategy. This study contributes to revealing the internal logic of "Internet + WEEE collection" business ecosystems construction in theory and helps platforms achieve sustainable development in practice. [ABSTRACT FROM AUTHOR]

Background Bipolar depression (BD) is easily misdiagnosed as unipolar depression (UD) or major depressive disorder (MDD) because the depressive symptoms can overlap. Regional homogeneity (ReHo), a measure commonly used for analyzing resting-state fMRI data, has been applied to the study of various neuropsychiatric disorders. However, to date, studies directly comparing BD and UD using ReHo have been relatively scarce. Further investigation is needed to study the latent pathophysiological mechanisms of BD and UD. Methods Fifty-five patients with BD and 76 patients with UD, as well as 113 healthy controls (HC), underwent resting-state functional magnetic resonance imaging (fMRI). We compared the voxel-wise ReHo across the whole brain for subjects in each of the three groups. Results Significant differences were found in the left frontal cluster (LFC) across the three groups. There were differences between BD and UD in the LFC and left temporal cluster (LTC). In addition, differences between UD and HC existed in the LFC and the occipital cluster (OC). When comparing BD subjects with HC subjects, significant differences were found in all three clusters. No correlations were observed between the 17-item Hamilton Depression Rating Scale (HDRS-17) scores or sub-scores and the ReHo values of BD or UD patients. Conclusion ReHo values in the LFC differed significantly among BD, UD, and HC subjects. ReHo in the LTC showed significant differences between BD and UD that might serve as neuroimaging markers of BD. Further, BD and UD shared ReHo changes in the cuneus, suggesting that the cuneus might provide a depressive state neuroimaging marker of BD and UD patients. [ABSTRACT FROM AUTHOR]

Background Bipolar disorder (BD) is one of the most complex mental illnesses, characterized by interactive depressive and manic states that are 2 contrary symptoms of disease states. The bilateral amygdala and prefrontal cortex (PFC) appear to play critical roles in BD; however, abnormalities seem to manifest differently in the 2 states and may provide further insight into underlying mechanisms. Methods Sixteen participants with first-episode depressive and 13 participants with first-episode manic states of bipolar disorder as well as 30 healthy control (HC) participants underwent resting-state functional magnetic resonance imaging (fMRI). Resting-state functional connectivity (rsFC) between the bilateral amygdala and PFC was compared among the 3 groups. Results Compared with depressive state participants of the BD group, manic state participants of the BD group showed a significant decrease in rsFC between the amygdala and right orbital frontal cortex (p < 0.05, corrected). In addition, rsFC between the amygdala and left middle frontal cortex was significantly decreased in depressive and manic state participants of the BD group when compared with the HC group (p < 0.05, corrected). Conclusions Our findings suggest that mood state during the first episodes of BD may be related to abnormality in hemispheric lateralization. The abnormalities in amygdala- left PFC functional connectivity might present the trait feature for BD, while deficits in amygdala- right PFC functional connectivity might be specific to manic episode, compared to depressive episode. [ABSTRACT FROM AUTHOR]

Abstract: Structural magnetic resonance imaging (MRI) studies have provided evidence for corpus callosum (CC) white matter abnormalities in bipolar disorder (BD) and schizophrenia (SZ). These findings include alterations in shape, volume, white matter intensity and structural integrity compared to healthy control populations. Although CC alterations are implicated in both SZ and BD, no study of which we are aware has investigated callosal subregion differences between these two patient populations. We used diffusion tensor imaging (DTI) to assess CC integrity in patients with BD (n=16), SZ (n=19) and healthy controls (HC) (n=24). Fractional anisotropy (FA) of CC subregions was measured using region of interest (ROI) analysis and compared in the three groups. Significant group differences of FA values were revealed in five CC subregions, including the anterior genu, middle genu, posterior genu, posterior body and anterior splenium. FA values of the same subregions were significantly reduced in patients with SZ compared with HC. FA values were also significantly reduced in patients with BD compared to the HC group in the same subregions, excepting the middle genu. No significant difference was found between patient groups in any region. Most of the alterations in CC subregions were present in both the BD and SZ groups. These results imply an overlap in potential pathology, possibly relating to risk factors common to both disorders. The one region that differed between patient groups, the middle genu area, may serve as an illness marker and is perhaps involved in the different cognitive impairments observed in BD and SZ. [Copyright &y& Elsevier]

Purpose: Population dose has been a concern with coronary artery calcium scoring CT since it is performed in adults with borderline risk. Lower tube voltage acquisitions are appealing but there are no agreed schemes for reduced dose determination. Moreover, conventional scoring cannot be used without changing the multiple Agatston thresholds.Methods: By applying consistent calcium contrast-to-noise ratio to two anthropomorphic heart phantoms (medium and large) with 3-cm hydroxyapatite (HA) inserts, scanned using a dual-source CT, the relationship was derived between the volume CT dose index (CTDIvol) at lower tube voltages and the baseline CTDIvol at 120 kVp. The baseline CTDIvol was obtained using the noise thresholds from the images acquired at 120 kVp. To preserve the conventional Agatston thresholds, down-scaling with the found factors was applied to images acquired at lower voltages with a dynamic heart module and 1.2-5 mm inserts (50-400 mg/cc) on the coronary tracks. Scores were evaluated on the scaled images by six readers.Results: The CTDIvol at lower voltages was related to the baseline CTDIvol following a power form of the voltage (index 1.246), regardless of the phantom size. The baseline CTDIvol was 1.5 and 4.5 mGy, for the medium and large phantoms, respectively. Correspondingly, the reduced CTDIvol at 100-70 kVp were 1.28-0.76 mGy, and 3.57-2.32 mGy. The downscaling factors were 0.88-0.63. The calcium scores at lower voltages were found within 12 % of the ground-truths.Conclusion: A vendor-independent approach was established to obtain the reduced dose and correct coronary calcium scores at lower tube voltages. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) and bipolar disorder (BD) are major affective disorders associated with high risk for suicide. Neural mechanisms underlying suicide attempts are poorly understood in MDD and BD but likely relate to the structural abnormalities in brain regions. In this study, we explored structural alterations in MDD and BD with prior suicide attempts (SA) using diffusion tensor imaging (DTI). Participants consisted of 27 MDD patients with prior SA (men: 9; age means±sd: 28.04 ± 11.06 years), 49 MDD patients without prior SA (men: 11; age means±sd: 30.03 ± 0.91 years), 25 BD patients with prior SA (men: 7, age means±sd: 27.08 ± 8.40 years), 49 BD patients without prior SA (men: 26, means±sd: 27.69 ± 9.97 years)，and 49 healthy controls (HC) (men: 18, means±sd: 31.12 ± 9.95 years). All participants underwent DTI to examine fractional anisotropy (FA) in brain regions. FA in several major white matter (WM) bundles including bilateral inferior fronto-occipital fasciculus (IFOF), bilateral uncinate fasciculus (UF), and the corpus callosum (CC) was shown in MDD with prior SA, compared to MDD without prior SA and HC. Decreased FA was also found in bilateral IFOF, bilateral UF, and CC, as well as other WM bundles, in BD with prior SA, compared to BD without prior SA and HC. Significant diagnostic group by SA effects were shown in bilateral thalami with lowest mean FA values in MDD with prior SA. Our findings support the involvement of structural alterations in suicide attempts in major affective disorders. Shared and distinct structural alterations were shown in MDD and BD with prior SA, suggesting common and differential neural pathways for suicide among major affective disorder. • The findings support the involvement of structural alterations in suicide attempts in MDD and BD. • Shared alterations between SA in MDD and BD suggest common pathways for suicide in mood disorders. • The differentiating marker for SA in MDD versus BD may be associated with SA features specific to MDD and BD. [ABSTRACT FROM AUTHOR]