Volume 95  ·   Issue 03  ·  2015

The prevention of birth defects is a worldwide problem. To achieve the goal of completely overcoming birth defects, we need to do a good job persistently. Pre-pregnancy eugenic health examination is one of the key measures for the primary prevention of birth defects, and it is the first line of defense to prevent and control birth defects. Pre-pregnancy eugenics health examination is carried out before pregnancy. It mainly screens whether there are risk factors affecting eugenics in pregnant couples from environmental and genetic factors, and provides guidance and intervention, including extensive and sustained social publicity and health education activities, popularizing eugenics scientific knowledge, checking and evaluating the health status of target populations, and conducting eugenics consultation, treatment referral and follow-up for key populations, which greatly helps to reduce the risk of birth defects and the occurrence of common and major birth defects and disabilities.

Preventing birth defects and improving the quality of birth population are one of the important issues that our government has been paying attention to. In 2006, the State Council of the People's Republic of China promulgated the National Medium-and Long-Term Science and Technology Development Plan (2006 – 2020), which listed birth defect prevention as a priority theme in the key area of population and health^[1]。 Eugenic health examination before pregnancy is the key link to prevent birth defects and an important means of primary prevention of birth defects. It can not only reduce the risk of birth defects, but also reduce the risk of adverse pregnancy outcomes and improve the quality of the birth population. According to the data released by the Ministry of Health of the People's Republic of China (now National Health and Family Planning Commission) in 2012, the incidence of birth defects in China is 5.6%, and the number of new birth defects is about 900,000 every year. Birth defects have become a prominent public health and social problem in China^[2]。 Birth defects not only affect children's life health and quality of life, but also affect the quality of the entire national population. Carrying out free pre-pregnancy eugenics health examination can reduce the exposure of risk factors of birth defects from the source, minimize the risk of birth defects, improve the quality of birth population, change China's population pressure into human resource advantages, and create a good population environment for the coordinated and sustainable development of economy and society.

Since oral folic acid before pregnancy can prevent neural tube malformation, cardiovascular malformation and other diseases, the concept of pre-pregnancy examination and pre-pregnancy health care has gradually formed^[1]。 In 2006, the U.S. Centers for Disease Control and Prevention (CDC) proposed the concept of pre-pregnancy care: before pregnancy, use prevention and intervention methods such as changing the biomedical, behavioral habits and social environment of expectant couples to change the pregnancy outcome^[2]。 Therefore, it is further proposed to use the "knowledge, attitudes and behaviors (KAB) model" to improve the health care status of couples of childbearing age before pregnancy. Specifically, all pre-pregnant couples are screened for relevant risk factors, health promotion and possible interventions. However, there is no systematic and actionable intervention strategy and method for all couples of childbearing age.

With the development of medicine, laboratory medicine has changed from simple prompting in the past to multi-faceted evaluation at present, which makes it no longer just post-facto and passive in the past, but an important discipline with forward-looking, foreseeable and active. The test results are an important objective indicator for clinical medical staff to diagnose diseases, formulate treatment plans, evaluate curative effects and evaluate prognosis. It is an important basis for patients to understand the disease condition and diagnosis and treatment results, and for healthy people to understand all aspects of their own functions and metabolic status. It is also an important indicator for evaluating physical health status in special physiological stages such as pregnancy, pregnancy and postpregnancy. The accuracy and stability of clinical test results are the premise for the application of test results, but the accuracy of test results is affected by many factors, which is closely related to the professional level of inspectors, standard operation, instruments and reagents and other testing systems. Therefore, it is very necessary to establish the quality assurance system of the national free pre-pregnancy eugenics health examination program. Now, the methods and results of establishing the national free pre-pregnancy eugenics health examination program quality assurance system are introduced as follows.

To evaluate the prepregnancy nutritional status and analyze its trend in Chinese women of reproductive age during the period of 2010-2012.

Analyses of prepregnancy nutritional indicators were conducted for a total of 2 120 131women of reproductive age (aged 21-49 years) from 220 pilot counties of 31 provinces who participated in National Free Prepregnancy Health Examination Project from January 1, 2010 to December 31, 2012. The nutritional indicators involving body mass index (BMI), hemoglobin (HB) concentration and fasting plasma glucose (FBG) were statistically analyzed with SPSS 17.0 software.

There were a sustained increase in prepregnancy HB concentration and declined levels of prepregnancy BMI and FBG during 2010-2012. The clinical data were categorized into 4 subgroups. The data of age composition showed the age group of 25-34 years was the largest proportion of the cohort. The prevalence in prepregnancy low-BMI population subgroup increased from 10.4% in 2010 to 14.14% in 2012. The prepregnancy obesity and overweight subgroups revealed the lowest prevalences of 10.65% and 2.32% respectively in 2012. A decreased prevalence of prepregnancy low FBG subgroup occurred from 5.45% in 2010 to 5.23% in 2012. The prevalences of prepregnancy impaired fasting plasma glucose and diabetes subgroups decreased year-on-year from 3.17% and 1.64% in 2010 to 2.71% and 1.05% in 2012 respectively. The prevalences of prepregnancy mild and severe anemia subgroups decreased from 12.29% and 0.95% to 9.62% and 0.78% respectively during the period 2010-2012. High hemoglobin concentration subgroup also exhibited a decreasing prevalence. Statistical analysis indicated significant differences (P<0.001) in the evaluation and trend analysis of prepregnancy nutrition in Chinese women of reproductive age.

Chinese women of reproductive age show a fair status of prepregnancy nutrition. And there are decreasing prevalences in obesity, anemia and diabetes.

To assess the exposure status of preconception health risk of Chinese males aged 21-49 years in 31 provinces and analyze the changes of their exposure status during 2010-2012.

The "Core Indicators of Preconception Health Risk Exposure Status in Chinese reproductive couples" were used to evaluate the preconception health risk of males aged 21-49 years who participated in National Free Preconception Health Examination Project. From January 1, 2010 to December 31, 2012, a total of 2 030 083 males were recruited from 220 pilot counties of 31 provinces. The risks involved three aspects closely correlated with offspring health: behavioral risk, infectious risk and genetic risk.

The overall smoking rate of Chinese rural males aged 21-49 years was 31.19%(622 837/1 997 051). They smoked a daily average of 10 cigarettes. The median number of cigarettes smoked was 10 per day and it increased with age. The overall drinking rate was 31.81%(634 556/1 994 925). Meanwhile, median alcohol consumption increased with age. The rate of males with a history of birth defect, family inbreeding and familial genetic disease accounted for 0.12%(2 344/1 994 324), 0.20%(4 043/1 997 707) and 0.94%(18 736/2 000 005) respectively. The rates of males with a history of hepatitis B and sexually transmitted diseases were 0.67%(13 317/1 988 904) and 0.05%(912/1 988 904) respectively. HBsAg positive rate was 6.32%(124 274/1 965 821). And the positive screening rate of Treponema pallidum was 0.37%(7 169/1 947 021). Among three types of risks, the highest risk was behavioral risk while the lowest risk genetic risk. Behavioral risk, genetic risk and sexually transmitted diseases in infectious risk were all lowest in 2012 while HBV infection in infectious risk was lowest in 2010.

The general status of preconception health is fair for rural males aged 21-49 years in 31 provinces. However, there are still some behavior, genetic and infectious risks. The preconception health risk of rural males showed an overall declining trend during 2010-2012.

To assess the exposure status of preconception health risk of Chinese reproductive women and analyze the changes of their exposure status during 2010-2012.

The "Core Indicators of Preconception Health Risk Exposure Status in Chinese reproductive couples" were used to evaluate the preconception health risk of women during reproductive period (aged 21-49 years) who participated in National Free Preconception Health Examination Project. From January 1, 2010 to December 31 2012 a total of 2 120 131 women were recruited from 220 pilot counties of 31 provinces. The risks involved the following eight aspects: genetic risk, reproductive risk, chronic disease risk, infectious risk, nutritive risk, behavioral risk, environmental risk and psychosocial risk.

The overall rate of preconception health risk in Chinese reproductive women (aged 21-49 years) was 54.63%(1 124 552/2 058 648). Among all age groups, the lowest rate was 53.05%(262 646/495 092) in 21-24 age group while the highest rate 66.94% (7616/11379) in 45-49 age group. The top three risks were nutritive risk [35.74% (726 826/2 033 730)], infectious risk [10.16% (206 983/2 037 022)] and chronic disease risk [6.96% (142 130/2 042 110)]. From 2010 to 2012, the rate of preconception health risk in Chinese reproductive women (aged 21-49) were 55.35%(182 087/328 991) (2010), 56.03%(502 888/897 511) (2011) and 52.82%(439 577/832 146) (2012) respectively. In different years, the rates of nutritive, infectious, behavioral and genetic risks were all highest in 2011. And the rates of eight types of risks were all lowest in 2012. In different age groups, all eight risks were lowest in 21-24 age group and highest in 45-49 age group. And the preconception health risk increased with age.

The general status of preconception health of reproductive women is fair. However, there are still some risks. The preconception health risk in Chinese reproductive women showed a declining trend during 2010-2012.

To explore the value of diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) in identifying benign and malignant renal masses and differentiating the histological types of renal masses.

Fifteen healthy volunteers and 46 patients with renal masses proven by pathology, including clear cell carcinomas (n=18), papillary carcinomas (n=8), chromophobe carcinomas (n=7) and angiomyolipomas (n=13), were examined with DWI and PWI scan at 3.0 T MRI. ANOVA was employed to compare the values of transfer constant (K^trans), rate constant of backflux (K_ep) and extra-vascular extra-cellular space fractional volume (V_e) proceeded by PWI and the value of ADC resulted from DWI between normal kidney and different histological types of renal masses. Receiver operating characteristics (ROC) curve was used to analyze and compare the diagnostic value of the methods of PWI and DWI in differentiating benign and malignant renal masses.

The ADC value of normal renal parenchyma was (2.10±0.24)×10^-3 mm²/s, which was statistically higher than benign and malignant renal masses (P<0.05). The ADC value of benign masses was statistically higher than that of all histological types of malignant masses (P<0.05). Among three histological types of malignancies, clear cell carcinoma showed the statistically highest ADC value (P<0.05). But the difference between papillary carcinoma and chromophobe carcinoma had no statistical significance (P>0.05). Values of K^trans, K_ep and V_e between normal renal parenchyma and different histological types of renal masses had statistical differences. Values of K^trans and V_e in three histological types of malignant renal masses were statistically higher than those of benign renal masses. K_ep value of clear cell carcinoma was significantly higher than that of benign renal masses (P<0.05). However, other histological types of malignant masses had no significant difference with benign masses. For three malignant masses, K^trans of clear cell carcinoma, papillary carcinoma and chromophobe carcinoma were (0.85±0.27), (0.51±0.04) and (0.39±0.05)/min respectively. All values gradually reduced. And the differences were statistically significant (P<0.05). The V_e value of renal clear cell carcinoma was statistically higher than that of papillary carcinoma (P<0.05). ROC curve was used to analyze and compare the diagnostic value of PWI versus DWI in differentiating benign and malignant renal masses. The K^trans of benign and malignant renal masses had the largest AUC (AUC=0.937) at a threshold of 0.38/min. And there were a sensitivity of 87.9% and a specificity of 85.7%. The AUC of ADC was 0.823, sensitivity 72.7% and specificity 92.9%. The ADC threshold for differentiating benign from malignant masses was 1.40×10^-3mm²/s; AUC of V_e 0.803, sensitivity 78.8% and specificity 71.4%, a threshold of 0.29/min; K_ep showed lower diagnostic value.

3.0T MRI DWI and PWI can effectively differentiate benign and different histological types of malignant renal masses. And PWI is superior to DWI in differentiating benign and malignant renal masses. K^trans with the largest AUC showed the highest diagnostic value. And ADC is also irreplaceable in providing the information of cellular structural features and the movement of water diffusion.

To comparatively analyze the dynamic contrast-enhanced (DCE) characteristics and its clinical value between stage-Ⅰ endometrial carcinomas versus polyps with 3.0T magnetic resonance imaging (MRI).

A retrospective analysis was performed for DCE-MRI manifestation in 27 patients with histopathologically proved endometrial masses. There were stage-Ⅰ endometrial carcinomas (n=14) and polyps (n=13). The signal intensity of solid component was measured and time-intensity curves (TIC) was obtained. TIC of lesions were divided into 4 subtypes. The time-to-peak (TTP) and signal intensity (SI) were determined from TICs. The arterial phase relative signal increase ratio (ARSIR), maximal relative signal increase ratio (MRSIR), signal enhancement ratio (SER) and signal intensity difference values (D) of each phase were calculated based on TIC curves respectively.

The TIC of 14 stage-Ⅰ endometrial carcinomas included type Ⅰ (n=4), type Ⅱ (n=6) and type Ⅳ (n=4). The TIC of 13 polyps included type Ⅲ (n=3) and type Ⅳ (n=10). The D values in each phase of 14 stage-Ⅰ endometrial carcinomas were lower than normal muscle layers. There were statistic differences (P<0.05) of each phase including 32, 48, 64, 109, 154, 199 s. For stage-Ⅰ endometrial carcinomas, MRSIR and TTP were lower (P<0.01) than normal muscle layers while SER was higher (P<0.01) than normal muscle layers . The each phase of D of stage-Ⅰ endometrial carcinomas were lower than polyps, and there were statistic differences (P<0.05) of each phase including32, 48 , 64 , 109, 154, 199 s. The MRSIR and TTP of stage-Ⅰ endometrial carcinomas were lower (P<0.01) than those of polyps while SER was higher (P<0.01) than polyps.

DCE-MRI can reflect enhanced features of stage-Ⅰ endometrial carcinomas and polyps during different phases quantitatively. Parameters of DCE-MR and TIC are helpful in the diagnosis and differential diagnosis of stage-Ⅰ endometrial carcinomas versus polyps.

To analyze the age-related characteristics of volumes, signal intensities (SIs) of T₁-weighted images (T₁WI), T₂-weighted images (T₂WI) and apparent diffusion coefficients (ADCs) of three major salivary glands.

A total of 300 subjects with normal salivary glands were divided into 4 different age groups and examined with a 1.5 T magnetic resonance (MR) unit. T₁WI, T₂WI and diffusion-weighted MR images (DW MRI) were obtained and bilateral parotid, submandibular and sublingual glands segmented manually. The volumes, T₁WI, T₂WI SIs and ADCs of three major salivary glands were measured. And the relative SIs (RSIs) were assessed by comparing with cerebrospinal fluid.

The volumes, T₁WI and T₂WI RSIs of parotid glands were significantly correlated with age (P<0.01) and showed similar significant tendencies of growing from minority to middle age and decreasing slightly after old age. Significant differences existed between minority and middle age groups in all above-mentioned parameters (P<0.01). The ADCs of submandibular glands also showed that there was a significant difference between the minority and middle age groups (P<0.01).

MRI may be applied for studying the morphological and functional changes of normal major salivary glands with aging. Thus clinical rationales can be provided for assessing the subjects of any age during salivary gland imaging and aging-related researches.

To determine the relationship between apparent diffusion coefficient (ADC) and histopathological differentiation of hepatocellular carcinoma (HCC).

Magnetic resonance examinations of magnetic resonance imaging (MRI) plain scan, LAVA dynamic enhanced scan and diffusion weighted imaging (DWI)(1.5 T, b values: 0 and 600 s/mm²) were retrospectively reviewed for 229 surgically resected HCCs. Histopathology revealed 34 well, 170 moderately and 25 poorly-differentiated HCCs. The incidence of each ADC value was measured. The relationship between ADC and histopathological differentiation was also evaluated.

The ADC value of well-differentiated HCCs (1.68±0.13×10^-3 mm²/s) was significantly higher those of moderately HCCs (1.31±0.16×10^-3 mm²/s) (P<0.05) and poorly-differentiated HCCs (1.08±0.11×10^-3 mm²/s) (P<0.05). There was a significant positive correlation between ADC value and differentiation of HCCs (r=0.693, P<0.05). ROC analysis showed that the optimal cutoff point of ADC value was 1.500×10^-3 mm²/s in diagnosing well-differentiated HCCs. A cutoff ADC value equal to or under 1.5×10^-3 mm²/s was used to differentiate well-differentiated HCC from moderately and poorly-differentiated ones with a sensitivity of 100% and a specificity of 94.36%. ROC analysis showed that the optimal cutoff point of ADC value was 1.235×10^-3 mm²/s in diagnosing poorly-differentiated HCCs. A cutoff ADC value equal to or above 1.235×10^-3 mm²/s was used for differentiating poorly-differentiated HCC from well and moderately-differentiated ones with a sensitivity of 73.5% and a specificity of 96%.

In clinical practice, ADC value is important for predicting histopathological differentiation of HCC and improving its diagnostic accuracy.

To explore the modes of medium failures after total hip arthroplasty (THA) in China and compare our results with foreign countries.

Retrospective reviews were conducted for the causes of medium failures of 137 revision THAs between January 2007 and December 2013. The causes of failure included infection, aseptic loosening, dislocation, periprosthetic fracture, implant-related failure, heterotopic ossification and liner wear.

The causes in a decreasing order were aseptic loosening (55.5%, 76/137), infection (31.4%, 43/137), liner wear (6.6%, 9/137), periprosthetic fracture (5.1%, 7/137) and dislocation (1.5%, 2/137).

The top three domestic causes of medium failure after primary THA are aseptic loosening, infection and liner wear.

To explorer the efficacies of continuous high volume hemofiltration (CHVHF) in severe sepsis patients with multiple organ dysfunction syndrome (MODS).

A total of 80 cases of severe sepsis patients with MODS treated at our center from 2011 January to 2013 October were selected and assigned to receive CHVHF (n=42) and continuous volume hemofiltration (CVHF, n=38). The changes of vital signs, acute physiology & chronic health evaluationⅡ(APACHEⅡ) scores, MODS evaluation scores, hemodynamics, liver & kidney function parameters, arterial blood lactate and procalcitonin (PCT) were observed before and after treatment.

After treatment, their temperatures and heart rates improved and the scores of APACHEⅡand MODS were significantly lower (P<0.05). Hemodynamics significantly improved at 48 and 72 h post-treatment. The values of mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI) and systemic vascular resistance index (SVRI) became stabilized as compared with pre-treatment. There were significant differences (P<0.05). The parameters of liver and kidney function gradually improved after CHVHF. And arterial blood lactate and PCT returned to normal at 24, 48 and 72 h post-treatment (P<0.05).

CHVHF may stabilize vital signs and improve hemodynamics, organ function and tissue perfusion in septic patients with MODS.

To evaluate the sleep quality and explore the manifestations of sleep disorders for 62 essential tremor (ET) patients, 60 normal controls and 62 Parkinson's disease (PD) patients.

A total of 62 ET patients, 60 normal controls and 62 PD patients from June 2009 to December 2013 were recruited. All of them were outpatients at Second Affiliated Hospital, Soochow University and Hospital of Changshu Hospital of Traditional Chinese Medicine. Sleep was assessed with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS).

The global PSQI score was 4.7±2.5 in controls, 6.0±4.0 in ET cases and 7.4±3. 7 in PD cases. PD cases had the highest PSQI score, followed by ET (intermediate) and lowest scores in controls (F=9.022, P=0.000). A poor quality of sleep was observed in normal controls (23/62, 38.3%) compared to ET cases (34/62, 54.8%) and PD cases (40/62, 64.5%) (χ²=8.555, P=0.014 when comparing all three groups and χ ²=1.206, P=0.272 when ET vs PD). The ESS score increased from normal controls (4.4±2.5) to ET cases (6.3±4.8) and PD cases (8.2±4.2). An ESS score ≥10 (an indicator of greater than normal levels of daytime sleepiness) was observed in 6 (10.0%) normal controls, compared to ET cases (16, 25.8%) and PD cases (20, 32.3%) (χ²=9.047, P=0.011 when comparing all three groups and χ ²=0.626, P=0.429 when ET vs PD). For normal controls, ET and PD patients, the factor scores of subjective sleep were 0.6±0.7, 0.8±0.8 and 1.1±0.7; the factor scores of quality sleep latency 0.6±0.7, 0.9±0.9 and 1.1±1.0; the factor scores of sleep duration 0.6±0.8, 0.7±1.0 and 1.0±0.9; the factor scores of sleep efficiency 0.6±0.8, 0.9±0.9 and 1.0±1.0; the factor scores of sleep disturbances 1.2±0.6, 1.2±0.5 and 1.7±0.7; the factor scores of daytime dysfunction 1.2±1.0, 1.3±1.0 and 2.0±1.1 respectively. There were inter-group statistical differences in subjective sleep (F=7.709, P=0.001), quality sleep latency (F=4.414, P=0.013), sleep duration (F=4.464, P=0.013), sleep efficiency (F=3.201, P=0.043), sleep disturbances (F=12.594, P=0.000) and daytime dysfunction (F=9.022, P=0.000). However, no inter-group statistical differences existed in use of sleeping medication (F=1.200, P=0.304). There were statistical differences in subjective sleep (P<0.05), sleep efficiency (P<0.05) and daytime dysfunction (P<0.05) between ET and PD patients.

Some sleep scores in ET are intermediate between those of PD cases and normal controls. And it suggests that a mild form of sleep dysregulation may be present in ET.

To explore the effects of docosahexaenoic acid (DHA) on palmitate-induced insulin resistance in C2C12 cells.

Differentiated C2C12 myotubes were used. The gene expression of inflammatory cytokine and insulin signaling pathway were evaluated by quantitative polymerase chain reaction (qPCR) and Western blot. And glucose uptake was measured by [³H]-2DG uptake. The levels of reactive oxygen species (ROS) were evaluated by DCF fluorescence. And the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were measured with a glutathione assay kit.

Palmitate-induced cellular insulin resistance was clarified by reduced [³H]-2DG uptake and impaired gene expression of insulin signaling pathway (GLUT4, p-IRβ and p-IRS-1). DHA decreased the expression of palmitate-caused pro-inflammatory cytokines (MCP-1, IL-6 and iNOS) and oxidative stress and increased the gene expression of insulin signaling pathway (Glut4 and p-IRβ).

Palmitate-induced insulin resistance is accompanied by elevated pro-inflammatory cytokines, oxidative stress and impaired gene expression of insulin signaling pathway. And DHA decreases inflammation and oxidative stress and increases glucose uptake in C2C12 cells. Thus DHA attenuates palmitate-induced insulin resistance.

To explore the CX43-hemichannels effects on rat hippocampus neuron damage after ischemia-reperfusion.

A total of 128 Sprague-Dawley male rats were randomly divided into 4 groups of sham-operated group (sham), no treatment (I/R), connexin 43 mimetic peptide (I/R+ Gap26) and normal saline (I/R+ NS) (n=32 each). TTC staining was used to examine each brain infarct volume after 24 h reperfusion. The levels of connexin 43 and astrocyte activation (glial fibrillary acidic protein) were assessed with Western blot and immunohistochemistry. And neuronal morphology of hippocampus was examined by Nissl stain and immunohistochemistry.

As compared with sham group, brain infarction volume [(132±7) mm³ vs 0] and the expressions of astrocytic CX43 and GFAP protein in I/R group increased [CX43: (2.45±0.56) vs (1.15±0.43); GFAP: (146±11) vs (76±5), P<0.05). And the damage of neuron increased versus I/R+ NS group, brain infarction volume [(76±6) vs (140±10) mm³] and the expressions of astrocytic CX43 and GFAP were lower in I/R+ Gap26 group [CX43: (0.43±0.16) vs (2.15±0.73); GFAP: (57±6) vs (140±9), P<0.05] and neuronal damage lessened.

Blocking CX43-hemichannel may reduce astrocytic activation and lessen the damage of hippocampus neurons after cerebral ischemia-reperfusion injury.

To explore the effects of hypertonic saline (7.5% NaCl) pre-injection on postoperative cognitive function in senile rats.

A total of 60 healthy male Sprague-Dawley rats, aged 18 months, weighting 450-500 g, were randomly divided into 3 groups of control (C); model (M) and hypertonic saline (HS) (n=20 each). At 30 min pre-operation, the rats of groups C and HS received an injection of 7.5% hypertonic sodium 4 ml/kg via tail vein. And the same volume of saline was injected in group M. Rats of groups M and HS were anesthetized by inhaling 3% sevoflourane and underwent splenectomy while group C inhaled merely pure oxygen. Escape latency and frequency of crossing original platform were assessed by Morris water maze on 1 day pre-operation and 1, 3, 7 days post-operation. The rats were randomly taken for detecting the intracellular [Ca²⁺]i and apoptotic rate of hippocampal neuron with flow cytometry. And ultrastructures of hippocampal neurons were observed with transmission electron microscope at 1 day pre-operation and 1, 7 days post-operation.

Compared with pre-dosing value, escape latency was significantly prolonged, the frequency of crossing original platform decreased and apoptotic rate and [Ca²⁺]i increased at each timepoint post-operation in groups M and HS. And no significant changes were found in the above-mentioned parameters in group C. Compared with group M, escape latency was significantly shortened, the frequency of crossing original platform increased and apoptotic rate and [Ca²⁺]i decreased at each timepoint post-operation in group HS. Pathological changes were found in groups M and HS and the damage was more severe in group M than that in group HS. And no significant pathological change was found in group C.

Infusing 7.5% hypertonic saline can improve postoperative cognitive function of senile rats. And it may be due to a decreased apoptotic rate of hippocampal neurons.

computer assisted navigation system (computer assisted navigation system) uses X-ray, CT, MRI and other image information to combine spatial stereoscopic positioning system, computer image processing and visualization technology with clinical surgery to display human anatomical structure, dynamically track the relative positional relationship between surgical instruments and anatomical structure during surgery, so as to realize frameless stereoscopic positioning, avoid important anatomical structures and ensure the safety of surgery. According to the different establishment of navigation images, the current navigation systems used in spinal surgery mainly include four types: preoperative CT imaging navigation, intraoperative X-ray two-dimensional imaging navigation, intraoperative three-dimensional C-arm (ISO-C 3D) imaging navigation and intraoperative O-arm imaging navigation.

stiff person syndrome (SPS) is a rare disease, which is typically characterized by axial and lower extremity muscle tissue rigidity, muscle spasm and pain. Moersch and Woltman^[1]It was first reported as "stiff person syndrome" in 1956. The discovery of anti-glutamate decarboxylase antibodies (anti-GADAb) indicates that SPS is an autoimmune disease^[2]。 1976 Whiteley et al.^[3]Two cases of encephalomyelitis with rigidity and myoclonus (PERM) were reported, associated with stiff person syndrome (SPS) and subacute myoclonus spinal neuronitis. They were classified as stiff person superposition syndrome and later confirmed as progressive encephalomyelitis with rigidity and myoclonus (PERM). PERM is a serious life-threatening autoimmune disease characterized by rigidity, muscle pain and spasm, deep and superficial sensory impairment and brainstem and spinal cord symptoms, autonomic function, dyspnea, sudden spontaneity, and stimulation-induced myoclonus. However, SPS and PERM are closely related, and over the years SPS may develop into PERM with occult development of new symptoms and signs such as chorioretinopathy, weakness, positive Pap sign, or sensory impairment^[4]。 This paper summarizes the development status and research progress of PERM, aiming at strengthening the understanding of PERM and providing reference for better diagnosis and treatment.

The receiver operating characteristic (ROC) curve is a curve drawn according to a series of different binary classifications, with sensitivity (true positive rate) as the ordinate and 1 – specificity (false positive rate) as the abscissa. ROC curve analysis is a commonly used statistical analysis method, which is mainly used in medical research to evaluate the efficacy of diagnostic tests^[1]。 With the deepening of ROC curve analysis in medical diagnosis, this method has been widely paid attention to and used by medical imaging researchers^[2]。 A large number of studies and practices have shown that ROC curve analysis is the most effective method to evaluate whether there are differences in the performance of two or more medical imaging diagnostic systems^[3]。 Therefore, this paper summarizes and summarizes ROC curve analysis from its development history, necessity, classification, main evaluation indicators and clinical application, and gives the commonly used ROC curve analysis tools and the advantages and disadvantages of each tool, in order to provide convenient and comprehensive resources for researchers who need to use ROC curve analysis in the future.