Volume 94  ·   Issue 29  ·  2014

CT is widely used in clinical practice, playing an increasingly important role in early, accurate diagnosis and efficacy evaluation of diseases, and promoting the development of medical cause. At the same time, due to the expansion of its indications and the increase of its use frequency, it has gradually become the main source of iatrogenic ionizing radiation^[1]。 The possibility of carcinogenesis caused by CT radiation has become the focus of attention and may become a social and public health problem. In addition, the expansion of CT application range, accompanied by the sharp increase of iodine contrast agent injection, has become the third leading cause of hospital-acquired nephropathy. Studies have shown that nephropathy caused by iodine contrast agent is related to the amount of contrast agent used^[2]。 Nowadays, with the continuous development of CT technology and broad application prospect, how to reduce the radiation dose and contrast agent dosage of CT as much as possible on the premise of ensuring image quality has become the common research direction of medical workers and various manufacturers.

CT utilizes an X-ray source for imaging, so the subject inevitably receives X-ray radiation during CT examination. In recent years, the number and frequency of CT examination every year in China has increased obviously. The ensuing challenge is that the human body receives a significant increase in the dose of X-ray radiation. For example, the radiation dose for coronary CT angiography has reached (17.96 ± 1.71) mSv^[1]。 The radiation dose of abdominal phase 3 dynamic enhanced CT scan was also close to 15 mSv^[2]。 In 2011, Li et al.^[3]It is reported that 7% of patients have a 1% increased risk of cancer due to CT scans. Patient care for CT examination is reflected in the premise of obtaining excellent image quality, lower radiation dose and lower iodine intake (iodine load).

In recent years, more and more attention has been paid to the harm of CT radiation and contrast agent nephropathy (CIN). Low-dose CT angiography (CTA), especially "double-low" scanning technology, has gradually become a hot spot in recent years. The so-called double low refers to the combination of low radiation dose (mainly low kVp and low keV techniques) and low iodine concentration contrast agent. Double low scanning combined with iterative reconstruction technique can ensure that the image quality meets the diagnosis premise, and reduce the radiation dose and iodine intake of patients during CT examination.

In recent years, the problem of radiation dose has attracted more and more attention^[1]In daily life, background radiation in nature accounts for about 50% of the average radiation, and medical imaging accounts for 50% of the average annual radiation exposure. Among them, CT radiation accounts for the main part, about 24%, which has a certain relationship with the imaging principle of CT and its more and more widespread clinical application^[2]。 Brenner and Hall in 2007^[3]According to the review report, the radiation dose of CT scan is 30~90 mSv, which will increase the risk of tumors. 1.5% ~2.0% of tumors in the United States may be caused by CT examination every year, and about 62 million people undergo CT examination every year in the United States. The radiation damage caused by it cannot be ignored, so reducing radiation dose has become a hot issue in the clinical application of CT. Enhanced scanning is an important scanning method in CT examination. Combined with ordinary scanning, it can be more conducive to finding lesions or more clearly show the scope and nature of lesions, and provide valuable information for qualitative diagnosis of lesions and tumor staging. However, the accompanying allergic reactions, thyroid toxicity, cardiovascular reactions, contrast nephropathy (CIN), etc. also seriously threaten the health of patients^[4]。

With the development of CT technology, its use frequency is also steadily increasing. Therefore, increasing attention is paid to the assessment of X-ray radiation risk. Major manufacturers have also done a lot of research and development work on this, from a series of processes such as radiation generation, radiation path, detector acquisition and iterative reconstruction technology have done targeted research, so that various low-dose technologies are constantly appearing^[1]。

To assess the impact of low concentration contrast media on the degree of vascular enhancement, image quality and radiation dose in coronary CT angiography(cCTA) studies when using a combination of iterative reconstruction and low tube voltage.

120 patients who underwent cCTA were randomly divided into two groups. The patients in group A received iopromide 370 were scanned using the conventional tube output, and images were reconstructed using filtered back projection (FBP). The patients in group B received iodixanol 270 were scanned using the low tube output, and images were reconstructed using iterative reconstruction technique (SAFIRE, Siemens Healthcare). CT attenuation was measured in the coronary arteries, great arteries, interventricular septum and left ventricular cavity. Noise, subjective image quality scores and effective radiation dose were compared between the two groups.

There was no significant difference in the mean CT attenuation achieved, image noise and mean image quality score at each anatomic site between iomeprol 270 group and iopromide 370 group. The effective radiation dose were 0.44±0.25 mSv and 0.94±0.42 mSv for iomeprol 270 and iopromide 370 in low weight subgroups, and 1.17±0.30 mSv and 2.37±0.66 mSv in high weight subgroups, respectively, reflecting dose savings of 53.2% (P<0.01) and 50.6% (P<0.01), respectively.

The results demonstrate that with a combination of iterative reconstruction and a low tube voltage , a low iodine concentration of 270 mgI/ml still improves the contrast enhancement without impairing image quality, as well as significantly lowers effective radiation dose.

To evaluate the clinical diagnostic value of low concentration of iodixanol used in CT angiography (CTA) of lower extremity arteriosclerosis obliterans (LEASO).

42 patients which were suspect diagnosed with LEASO were divided to A group (270 mgI/ml iodixanol, tube voltage 100 kV) and B group (350 mgI/ml iohexol, tube voltage 120 kV), 21 patients in each group. Measure the body mass index (BMI) before the CTA of lower extremity. CTA results were analyzed with the digital subtraction angiography (DSA) as the "gold standard" .

There were no statistical difference of age, gender, BMI and CT value of the bifurcation of profunda femoral artery and superficial femoral artery, upper segment of anterior tibial artery and posterior tibial artery between A and B group. The diagnostic sensitivity and specificity of A and B groups of CTA were 97.0%, 99.1% and 98.3%, 99.5% for occlusion. Regard artery more than moderate stenosis (include moderate stenosis) as the overall statistics, the diagnostic sensitivity and specificity of A and B groups of CTA were 99.2%, 99.3% and 99.1%, 99.3%, the accuracy were 92.9% and 93.0%, the positive predictive and negative predictive value were 96.9%, 99.3% and 96.6%, 99.3%, respectively. The kappa value of A and B groups of CTA and DSA consistency test were 0.930 and 0.927, respectively.

The CTA with low concentration of iodixanol combine with low tube voltage can achieve superior conventional scanning imaging features, and has great clinical value in the diagnosis of LEASO, also is an effective method for the inspection, evaluation and follow-up.

To evaluate image quality of low-voltage coronary artery computed tomographic (CT) angiography with low contrast agent in comparison with image quality.

Forty-five patients underwent coronary artery computed tomographic (CT) angiography. They were randomly assigned to 3 groups, group A(n=15)were scanned in 120 kVp with 350 mgI/ml iodinated contrast agent mode, group B(n=15)were scanned in 100 kVp with 350 mgI/ml iodinated contrast agent mode, group C(n=15)were scanned in 100 kVp with 270 mgI/ml iodinated contrast agent mode. Then measured CT attenuation value of three main branches(RCA, LAD and CX) of coronary artery, And compare the SNR, CNR, the effective radiation dose(ED) and iodine intake. The Kappa test were used to quantify inter- and intra-reader agreement in detecting quality of the images under different scanning solutions.

Three groups of coronary artery CT image quality was no statistically significant differences (all P values >0.05), Good inter- and intra-reader agreement ( k= 0.754, P<0.05) for the detection of noise in all the patients. There was significant difference in the CT attenuation of RCA, LAD and CX among the 3 groups (P<0.05), the CT attenuation was the highest in group B, the CT value of RCA, LAD and CX were 537±90, 505±90, 484±75 HU, respectively. the CT attenuation was the lowest in group C, the CT value of RCA, LAD and CX were 357±126, 360±95, 378±121 HU, respectively. There was no significant difference in the SNR and CNR among the 3 groups (P>0.05). There was significant difference in the ED among the 3 groups (P<0.05). The ED value of the group A was bigger than the value of the group B and C. There was no significant difference between the group B and C. Compared the group A and B, the iodine intake of the group C had fallen by 23%.

The coronary artery CT angiography using 100 kVp with 270 mgI/ml iodinated contrast agent provide similar objective or subjective image quality compared with the (350 mgI/ml)and the 100 kVp(350 mgI/ml), thus enabling effective dose and iodine intake reduction without loss of diagnostic information.

To evaluate the feasibility of low radiation exposure and low contrast medium volume for coronary CT angiography with High- pitch spiral acquisition mode of dual source CT.

135 patients whose BMI <23 kg/m ² and heart rates <65 bpm selected from 291 patients diagnosed of suspected CHD at our institution from September 2013 to February 2014 were randomly divided into 3 groups before CCTA, and there were 45 patients in each group. 80 kV , Iodixanol(320 mgI/ml)and sinogram affirmed iterative reconstruction(SAFIRE)were used in A group. 80 kV , Iopamidol (370 mgI/ml)and SAFIRE were used in B group. 100 kV, Iodixanol and filtered back projection(FBP)were used in C group. Two radiologists assessed image quality with 5-piont scale subjectively and double-blind. Independent-Sample Test was used to analyze statistical significance of image quality including signal to noise ratio(SNR) and contrast to noise ratio(CNR) between A and B group or between A and C group. At the same time, Contrast medium dose statistical significance between A and B group and mean effective Radiation dose (ED)statistical significance between A and C were analyzed by the same way.

There were no significant difference of image quality including SNR and CNR of aortic root (AO), left main coronary artery (LM), left anterior descending artery (LAD), circumflex coronary artery (CX) and right coronary artery (RCA) Between A and B group (P=non-significant for all comparison), whereas Iodine intaken of A group decreased 14%(17 600 mg vs 20 350 mg). There were no significant difference of image quality including SNR and CNR of AO, LM, LAD, CX and RCA Between A and C group (P=non-significant for all comparison), whereas mean ED of A group decreased 50%(0.41±0.05 mSv vs 0.79±0.15 mSv).

The double low dose application which use High-pitch spiral mode, 80 kV, SAFIRE, and Iodixanol(320 mgI/ml)can be used in those patients whose BMI <23 kg/m ² and heart rates <65 bpm to reduce the burden of radiation and contrast medium significantly, without compromising the image quality.

According to Hennekens'"Schizophrenia Increases the Risk of Cardiovascular Disease" published in the American Heart Journal in 2005 and Osborn DP' s "British Research Database Statistics on the Relative Risk of Cardiovascular Disease and Cancer Mortality with Severe Mental Disease" published in the General Psychiatry Literature in 2007, the research shows that the risk of coronary heart disease in mental patients is 2 to 5 times that of the general population, and the mortality rate is 2 to 3 times that of the general population. However, the relationship between antipsychotics and the risk of acute myocardial infarction (AMI) remains unclear because of methodological flaws in many early analyses, such as residual confounding, limited statistical efficacy and external authenticity. Recently, Dr. Lin Shuaiting and his team from Kaixuan Hospital in Kaohsiung, Taiwan, studied 56 910 patients with schizophrenia, affective disorders or dementia who visited the emergency department or were hospitalized for the first time for AMI from 1999 to 2009. The relationship between antipsychotic therapy and AMI risk in patients with mental disorders was explored, and its findings were published on May 16, 2014 inCirculationOn.

To explore the clinical outcomes of transforminal lumbar interbody fusion (TLIF) technique in treatment of lumbar spondylolisthesis.

From June 2009 to June 2006, 42 patients underwent TLIF. There were 18 males and 24 females with an average age of 48 (30-68) years. The preoperative diagnoses included lumber degenerative spondylolisthesis (n=16) and lumbar isthmic spondylolisthesis (n=26). According to the Meyerding standard, 28 cases were classified as degreeⅠ, 12 as degree Ⅱ and 2 as degree Ⅲ. Posterolateral fixation with pedicle screw and decompression, interbody fusion through TLIF technical plus cage for distraction reduction were employed. The evaluation standards of visual analog scale (VAS) and Oswestry disability index (ODI) were applied to evaluate the therapeutic outcomes. Intervertebral height and bone fusion were observed by radiology.

All patients underwent surgery safely without any severe complication. The average follow-up period was 19.4 (9-36) months. Compared with preoperative parameters (7.07±0.92), the postoperative scores of VAS decreased significantly (2.52±1.37) and at the final follow-up (2.26±1.61) (P<0.05); compared with preoperative parameters (68.43±12.81), the postoperative scores of ODI decreased significantly (24.19±11.44) and at the final follow-up (20.86±9.97)(P<0.05) and no significant difference in VAS or ODI score existed between post-operation and last follow-up (P>0.05). Compared with preoperative parameters (8.25±1.27), the postoperative height of intervertebral space increased significantly (9.68±1.62) and at the final follow-up (9.33±1.25) (P<0.05). And intervertebral height decreased at the final follow-up. There was significant difference between post-operation and last follow-up (P=0.001). At the follow-up of 6.5 months postoperatively, all operated segments achieved fusion standard and no broken screw. There was 1 case of cage dislocation.

TLIF may be performed easily and safely with fewer complications. And its efficacies are satisfactory for patients with lumbar spondylolisthesis.

To distinguish the expressions of matrix metallo-poteinase and aquaporin in peritumor edematous zone and normal brain tissue for different pathological levels of glioma and explore the relationship of glioma cell invasiveness and brain edema.

The immunohistochemical method of SP was employed to detect the expressions of aquaporin-4 (AQP-4), matrix metallo-proteinase-2 (MMP-2) and matrix metallo-proteinase-14 (MMP-14) in glioma and normal brain tissue. Due to a rarity of glioma Grades Ⅰ and Ⅱ, grades Ⅰ and Ⅱ glioma were pooled into low malignancy group (LMG) and grades Ⅲ and Ⅳ into high malignancy group (HMG). The software program SPSS 11.0 was used for Kolmogorov-Smirnov test of independent samplets. The differences were detected between normal brain tissue and LMG and HMG. Also the relationship of AQP4, MMP-2 and MMP-14 was analyzed.

With the advancing pathological grades of glioma, the expression of AQP-4, MMP-2 and MMP-14 were higher in positive areas. There were significant deviations among 3 groups.

The expressions of AQP-4, MMP-2 and MMP-14 in normal brain tissue and all levels of glioma edema are positively correlated. And there is a close correlation between glioma invasiveness and edema extent.

To explore the individual surgical treatment of various performance types of craniocervical junction malformation.

From January 2011 to December 2013, 112 patients with craniocervical junction malformations were treated at our department, including Chiari malformation (n=65) (syringomyelia, n=58 and without syringomyelia, n=7), basilar invagination disease (n=35) (with cerebellar tonsillar herniation malformation or occipitocervical fusion) and complex craniocervical malformation (n=22) (atlantoaxial dislocation with occipitocervical fusion or with chiari malformation or cervical insufficiency sub-section). All of them had the symptoms of upper cervical nerve damage. For those with Chiari malformation, we evaluated atlanto-occipital joint stability preoperatively. If atlanto-occipital joint was stable, we performed small occipital bone window decompression, partial removal of cerebellar tonsils, loosening of posterior fossa, upper cervical adhesions, artificial dura appropriate sutured dural repair expanding neck pillow. For patients with basilar invagination, if nerve compression performance was in the rear, posterior decompression was performed. For those with complex craniocervical malformation with atlantoaxial dislocation, neck traction under anesthesia or traction after anterior release, then pillow neck fixation and fusion were performed.

During follow-ups, the symptoms improved significantly (n=98, 87.51%). There were no symptomatic change (n=10, 8.93%), postoperative neurological deterioration (n=3, 2.67%) and death (n=1, 0.89%).

According to specific clinical manifestations of craniocervical junction malformation patients, the best treatment is to perform individualized surgeries after thorough preoperative evaluations.

To evaluate the efficacy and safety of draiange after primary total knee arthroplasty (TKA).

Comparative studies between with and without drainage after primary TKA were retrieved from Cochrane Library, PubMed, Medline, EMASE, CBM, Highwire, CNKI, VIP and Digital Periodicals in Wanfang Data. All randomized controlled trials were included for meta-analysis with RevMan 5.1.5 software.

A total of 9 studies involving 7 in foreign languages and 2 in Chinese were identified. There were knee replacement (n=706), drainage (n=359) and non-drainage (n=347). The results of meta-analysis indicated that no inter-group statistical difference existed in the counts of wound infection, deep venous thrombosis, hemoglobin value decrease at Day 7 post-operation, knee pain at Days 7 and 14 post-operation, post-operative knee range-of-movement or length of hospital stay(P>0.05). And there were statistical differences with respects to total blood loss, count of blood transfusions, count of skin ecchymosis, increasing rate of knee circumference at Day post-operation(P<0.05).

Non-routine placement of drainage after primary uncomplicated TKA may be preferred. However, for extensive release and primary orthopedics, drainage is still necessary. And a surgeon should weigh its pros and cons.

To explore the change and possible role of blood lipids during the course of plaque formation induced by diabetes mellitus in patients with ischemic cerebral vascular disease.

A total of 1 464 hospitalized patients with a diagnosis of ischemic cerebral vascular disease at our department from February 2008 to May 2012. They were distinguished as plaque (n=332) or not (n=132) based on carotid artery intima-media thickness (IMT) on B-mode ultrasound. And there were diabetics (n=153) and non-diabetics (n=311). Also blood glucose, blood lipids and new infarction or not were recorded. Comparisons of positive carotid artery plaque and the level of blood glucose and lipids were made between diabetics and non-diabetics. And the level-risk relationship between plaque formation and diabetes mellitus or blood lipids were performed through Logistic regression.

The positive rate of carotid artery plaque was higher in diabetics versus non-diabetics (80% vs 67%, P=0.003), OR(95%CI, P value) was 2.001(1.258-3.182, 0.001) through Logistic regression; after adjusting for cerebral infarction, 1.875(1.172-3.000, 0.009). It had a lower level of high-density lipoprotein-cholesterol (HDL-C) in diabetics versus non-diabetics (1.1±0.3 vs 1.2±0.3 mmol/L, P=0.001). HDL-C was correlated with plaque formation while OR (95%CI, P value) was 0.416(0.210-0.823, 0.012) through Logistic regression. And there has no correlation between plaque formation and other subtypes of blood lipids.

A decrease of HDL-C may play an important role in the course of carotid artery plaque induced by diabetes mellitus in patients with ischemic cerebral vascular disease.

To explore the association between β-site APP-cleaving enzyme 2 gene exon polymorphisms with sporadic Alzheimer disease (AD) in a north Chinese Han population.

The exon regions of β-site APP-cleaving enzyme 2 gene were sequenced randomly in 10 sporadic AD patients and 10 healthy controls from Beijing and Qinhuangdao, Hebei province during 2000-2008. Using SnaPshot or direct sequencing, we genotyped these polymorphisms of 348 sporadic AD patients and 294 healthy controls in a Chinese Han population. By genetic statistical assay, we studied the association between these polymorphisms and the risks for sporadic AD.

The sequencing of all exon regions of β-site APP-cleaving enzyme 2 gene revealed three polymorphisms of rs2252576C/T, rs1046210C/T and rs12149C/T. No association was detected between these three polymorphisms and sporadic AD even after statistical adjustments for age, gender and ApoEε4 status.

There is not a linkage between exon region polymorphisms of β-site APP-cleaving enzyme 2 gene and sporadic AD in a Chinese Han population.

To observe the early wound healing of orthopedic surgery in human immunodeficiency virus (HIV) carrier patients treated with optimized auxiliary treatments.

During a period of 48 months, according to the inclusion and exclusion criteria plus CD4⁺ T lymphocyte count, the patients scheduled for orthopedic surgery (including HIV positive and negative) were divided into group A (HIV positive, CD4<500/ml) with optimized auxiliary treatments, group B (HIV positive, CD4≥500/ml) and group C (HIV negative) on prophylactic antibiotic therapy alone. Wound healing of 3 groups were observed postoperatively. The rates of clinical wound infection were compared among 3 groups.

A total of 471 cases (n=79, HIV+ ; n=392, HIV-) were selected due to fresh fracture (n=544, 77.28%), fracture of spine (n=57, 12.31%), mal-union (n=13, 2.76%), aseptic necrosis (n=15, 3.18%) and osteoarthritis (n=21, 4.46%). During surgery, early open reduction and plate screw internal fixation (group A, n=23; group B, n=21; group C, n=274); pedicle screw internal fixation (group A, n=5; group B, n=6; group C, n=47); total joint replacement (group A, n=3; group B, n=4; group C, n=8); interlocking intramedullary nail fixation (group A, n=7; group B, n=4; group C, n=35) and other operations (group A, n=3; group B, n=3; group C, n=28). For infections, 2 cases (4.88%) were observed in group A, 3 (5.26%) in group B and 26 (6.63%) in group C. The differences were statistically insignificant.

Reasonable perioperative adjuvant treatments, including use of antibiotic, nutritional supports, immunomodulators and anti-retroviral drugs, are offered to HIV infected patients undergoing orthopedic surgery. Their risks of postoperative wound infection may be controlled.

To explore the characteristics of three-dimensional motion of lumbar instability segmental in vivo under physiological weight bearing so as to establish three-dimensional diagnostic criteria for degenerative lumbar segmental instability (DLSI).

Eight patients aged 29-65 years with DLSI at L3/4 were studied as instability group (L3/4), 9 patients aged 51-60 years with DLSI at L4/5 as instability group (L4/5) and 10 healthy volunteers aged 26-51 years as normal group. Three-dimension (3D) reproductions by matching lumbar spine models were reconstructed from thin-section computed tomography scans. Spine motions were then reproduced by matching lumber spine models and images from dual fluoroscopic imaging system (DFIS). The models were matched to the osseous outlines of images from two orthogonal views to determine the SD position of vertebrae for each pose. From local coordinate systems at end plates, the motion of cephalad vertebrae relative to cauddal vertebrae was calculated for vertebrae levels.

The motion pattern at L3/4 was altered. During flexion-extension, migration was significantly larger than normal group along sagittal axis (P<0.05); rotation was significantly larger than normal group along vertical axis; migration was significantly smaller than normal group along vertical axis; during left-right twisting, rotation was significantly larger than normal group along vertical axis (P<0.05). The motion pattern at L4/5 was also altered. During flexion-extension, migrations was significantly larger than normal group along sagittal axis (P<0.05). During left-right twisting, migration and rotation were significantly smaller than normal group along vertical axis (P<0.05). Rotation was significantly larger than normal group along sagittal axis. During left-right bending, rotation was significantly larger than normal group along sagittal axis (P<0.05).

Lumbar instability segments were significantly different compared with normal lumbar segments. And lumbar instability segments (at L3/4) were also different from lumbar instability segments (at L4/5). Different three-dimensional diagnostic criteria should be formulated for different lumbar instability segments.

To explore the effects of Kuntai Capsules on endometrial thickness and the expressions of leukemia inhibitory factor (LIF) and epidermal growth factor (EGF) in mouse after controlled ovarian hyperstimulation.

Healthy Sprague-Dawley mice were randomly allocated into 4 groups of control (group A), controlled ovarian hyperstimulation [COH (group B)], COH plus low-dose Kuntai Capsules (group C) and COH plus large-dose Kuntai Capsules [2x low-dose (group D)]. The controlled ovarian hyperstimulation model was established. The endometrial thickness was measured by computerized multi-functional image analyzer. And the expressions of LIF and EGF in proliferating endometrium were examined by immunohistochemistry.

The endometrial thickness of groups C and D were higher than that of groups A and B. And there were significant differences (P<0.05). The expression levels of LIF protein in proliferating endometrium was weaker than implantation window phase, the expression levels of EGF and LIF in group B was weaker than group A, groups C and D stronger than groups B and D was stronger than group C. And there were significant differences (P<0.05).

Kuntai Capsules can promote the growth of endometrium and enhance the expression levels of EGF and LIF in mice. And it may improve the ability of endometrial receptivity through optimized microenvironment. And a larger dose of Kuntai Capsules yields better outcomes.

To explore the application of temperature measurement technique by ¹H magnetic resonance spectroscopy (MRS) in an ischemia monkey model.

A MRI-compatible thermostatic control system was developed. And the equation was corrected between brain temperature and the chemical shift of N-acetyl-L-aspartic acid (NAA) through in vitro experiment. The normal brain temperature of monkey brain was measured. And a monkey model of middle cerebral artery occlusion (MCAO) and reperfusion was established. MR diffusion weighted imaging (DWI), perfusion weighted imaging (PWI), T2 weighted imaging and ¹H MRS were performed at artery occlusion stage, 1h, 3h, 6h, 12h and 24h post-recanalization. The brain temperatures of different ischemic regions were calculated by the modified brain temperature-chemical shift equation.

The modified equation was as follows: T=37+ 100(CS_NAA-2.039). The normal brain temperature was 37.16 ℃. The models were successfully established in 4 monkeys. During arterial occlusion stage, the brain temperature of different ischemic tissue was higher than the contralateral hemisphere (P<0.05), including infarct core, ischemic penumbra (IP) and oligemic region. And the highest temperature was in IP. After recanalization, the brain temperature of infarct core decreased rapidly during an early stage and was accompanied by a subsequent increase. However, the brain temperature of IP and oligemic region decreased slowly to normal.

¹H MRS may be used to measure brain temperature noninvasively so as to gauge ischemic degree.

To explore the effect of high resting heart rate (RHR) on the stability of carotid artery plaque in a middle and advanced aged population.

During 2010-2011, a total of 5 852 participants were selected randomly from 101 510 workers of a Tangshan Kailuan company. RHR was measured and carotid artery ultrasound performed to detect the carotid artery plaque. Logistic regression was performed to analyze the influencing factors of carotid artery stable and unstable plaque.

There were 4 894 subjects aged 40-95 years, including 2 945 males and 1 949 females. The detection rates of carotid artery stable and unstable plaque were 25.7% and 25.4% in low RHR group versus 23.8% and 33.2% in high RHR group. Compared with low RHR group, the risk of carotid artery unstable plaque increased to 29% in high RHR group after adjusting for all influencing factors. The odds ratio was 1.290(95% CI 1.039-1.062).

High RHR can increase the risk of carotid artery unstable plaque in middle and advanced aged population.

To explore the population characteristics of women undergoing induced abortions and determine high-risk populations for reproductive health services in China's metropolises.

Study subjects were all women undergoing induced abortions at a large service center for family planning between January 2010 and December 2011 in Beijing. Relevant information was extracted from unified registration forms for induced abortions developed by the Ministry of Health, including age, permanent residency (Beijing/floating population in Beijing), marital status (single/married) and pregnancy history. The population characteristics were described. They were then divided into 3 groups according to marital status and reproductive history: unmarried, married without children and married with children. The population characteristics were further compared among three groups, including age, permanent residency, number of abortion and time interval between current induced abortion and previous one.

A total of 18 745 women were identified, including 9 601 women undergoing an induced abortion in 2010 and 9 144 in 2011. The average age was (27±6) (14-49) years. The women under 20 years accounted for 4.5% (845/18 745), floating women 63.1% (11 829/18 745), unmarried 45.0% (8 437/18 745) and women with repeated abortion 54.2% (10 161/18 745). Among women with repeated abortion, the women whose time interval between current abortion and previous one was under 1 year accounting for 26% (2 639/10 161) and those with induced abortions more than thrice (39.4%, 4 006/10 161). The percentage of floating women was the highest in unmarried group (P<0.01). And the percentage for those time interval between current abortion and previous one was less than 1 year. And it was also the highest in unmarried women among three groups (P<0.01).

In Chinese metropolitan areas, two-thirds of women with induced abortions is from floating population. Approximately a half are unmarried, over a half have induced abortions and time interval is the shortest in unmarried women. It suggests that reproductive health services for floating and unmarried women should be strengthened.

hypothalamic psychosyndrome refers to intracranial lesions, such as craniopharyngioma, which lead to impaired hypothalamic function, clinical manifestations such as overeating, short-term memory decrease, attention disorder, motivation disorder, eating disorder, depression, aggressive behavior, irritation, and difficulty in controlling emotions, which seriously affect the quality of life of patients and hinder patients from returning to society to study and work. It is more common in children. There are many domestic studies on the changes of endocrine function after craniopharyngioma surgery in children, but less attention is paid to the cognitive and mental changes. Four cases of postoperative hypothalamic psychiatric syndrome in patients with craniopharyngioma were summarized in the Neurosurgery Clinic of Yuquan Hospital of Tsinghua University and Haidian Hospital of Beijing from January to December 2012, and the reports are as follows.

In the past, there have been many reports on the relationship between the increase of progesterone on the day of human chorionic gonadotropin (hCG) injection and the implantation rate of embryo in vitro fertilization (IVF)^[1,2,3,4]In 2013, a meta-analysis including 60,000 cycles showed that elevated serum progesterone on the day of hCG injection could lead to a decrease in IVF embryo implantation rates^[5]。 At present, it is speculated that the possible reason is that the increase of progesterone on the day of hCG injection affects the normal growth of intima, impairs the receptivity of intima, and further leads to the decrease of embryo implantation rate^[1,4]。 However, the exact effect of hCG daily high progesterone injection on the endometrium during implantation remains unclear. Although previous scholars have studied the changes of intimal tissue morphology during IVF stimulation cycle^[6,7]However, no research has been reported on the correlation between serum progesterone concentration and intimal histomorphology score results on the day of hCG injection during IVF stimulation cycle. This study focused on the relationship between progesterone level and endometrial tissue morphology during implantation during IVF stimulation cycle.

Pain is a common non-motor symptom in Parkinson's disease (PD), and related studies have gradually increased in recent years. The incidence of pain in patients with Parkinson's disease ranges from 40% to 85%^[1]All of them were higher than the control group of the same age. Different literature^[1,2,3,4,5]All showed that compared with the pain-free group of the same age, the onset of Parkinson's disease was earlier and the course of disease was longer, and the UPDRS Ⅲ score, H-Y stage, HRSD, HAMA score and levodopa dose were higher than those of the pain-free group. The difference was statistically significant. However, compared with a large number of epidemiological data, domestic reports on clinical diagnosis and treatment are scattered. In order to increase clinicians' understanding of pain in Parkinson's disease, this article focuses on three aspects: clinical manifestations, diagnosis and treatment.

Hemangiopericytoma (HPC), also known as hemangiopericytoma, is a grade II ~ III tumor defined by the World Health Organization (WHO), which rarely occurs in the ventricle. We collected 2 cases of ventricular HPC confirmed by clinical operation and pathology in the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2010 to February 2013, and reported as follows.