Objective To investigate the effects of levothyroxine (Levo-thyroid hormone,L-TH4) in pregnancy subclinical hypothyroidism (SCHT), and study the relationship between L-TH4 with thyroid peroxidase (TPO) and glucose metabolism. The research could provide theoretical basis for the treatment of SCHT. Methods Sixty pregnant women were selected and signed the medical informed consent. The pregnancy were divided into three groups, 20 cases in each group.Normal control group: pregnancy underwent routine thyroid function normal; SCHT group: SCHT pregnancy patients who did not use drugs to treat SCHT; L-TH4 group: SCHT pregnancy patients given L-TH4 treatment. The blood was taken to test the contents of glucose level and HbA1c were observed; the activity of TSH and TPO were tested by ELISA method; HE staining method was used to observe the changing of placenta tissue. Results Compared with normal control group, the glucose and HbA1c were significantly increased in SCHT group (P<0.05). However, L-TH4 could decrease these index, compare with the SCHT group, and reduce the level of TSH and the activity of TPO, the difference was statistically significantly (P<0.05). Moreover, L-TH4 could improve the changing of placenta tissue. Conclusion L-TH4 could reduce blood glucose and HbA1c levels, also reduced the level of TSH and the activity of TPO in SCHT. L-TH4 could improve the changing of placenta tissue.

Aim To investigate the effects of endocrinal petptide urocortin on subthalamic nucleus (STN) neuron''s discharge, also observe the convergence effect of UCN with dopamine (DA) and glutamate (GLU), so as to understand the regulation effects of UCN and its mechanism in Parkinson''s disease (PD).Methods Forty Sprague-Dawley rats were used in this experiment.Nerve electrophysiology method-microiontophoresis was used to observe the effects of UCN on STN neuron firing rates and firing wave.Astressin (AST, the blocker of CRF receptor 2), protein kinase A (PKA) were used to observe the effects of UCN whether via CRF-2R and PKA signal pathway.Moreover, given UCN during the period of DA and GLU, the effects of UCN on DA and GLU in STN neurons were determined.Results During the period of using the UCN, UCN could inhibit the firing rate of 82％ (27/33) STN neuron (P<0.01), and the firing discharge rates were reduced from(3.65±0.27)Hz to (2.05±0.33) Hz (P<0.01).However, the inhibitory effects of UCN in STN could be antagonized by AST.Given UCN during the period of microiontophoresis of inhibitory neurotransmitter (DA) and excited neurotransmitter (GLU), UCN could enhance the effects of DA and attenuate the excitatory effects of GLU (P<0.01).Conclusion UCN and GLU/DA in STN, UCN play inhibitory and regulated effects on STN neurotransmitters(DA and GLU)via CRF-2 receptor and PKA signal pathway.

Objective To explore the personality change in patients with epilepsy during the interictal period and the correlation between clinical features and personality change. Methods One hundred and fifteen patients with idiopathic or cryptogenic epilepsy were chosen as the epileptic group and 42 age- and sex-matched healthy subjects served as controls. All participants were evaluated by Mini Mental Status Examination and Brief Psychiatric Rating Scale to ensure the normality of cognition and mental state.Personality was evaluated by adult version of Eysenck Personality Questionnaire (EPQ)in interictal epilepsy patients and healthy controls.Scores of psychoticism (P),extraversion (E),neuroticism (N) and lie (L)were obtained using computer software. Pearson correlation analysis and logistic regression were used to investigate the scores of EPQ and influential factors.Results P and N scores were significantly elevated in epilepsy patients compared with controls ( P scores:50.48 ± 9.55 vs 46.59 ± 7.28,N scores:51.13 ±12.89 vs 46.83 ± 9.40 ; t =2.374,2.266,both P ＜ 0.05 ),while E scores were significantly decreased (51.74 ± 10.74 vs 60.37 ± 9.84;t =- 4.511,P ＜ 0.01 ).There were no significant differences in L scores.Multivariate analysis showed that disease duration was independently correlated to P scores (β =0.043,P＜0.05),while education was correlated to E scores (β =0.109,P ＜ 0.05 ).There were no significant correlations between personality scores,patient age,gender,age of onset,frequency,seizure type,National Hospital Seizure Severity Scale scores,family history,history of status epilepticus and antiepileptic drugs usage.Conclusions High psychoticism and neuroticism and low cxtraversion scores are correlated to patients with epilepsy during the interictal period.Disease duration is an independent risk factor for psychoticism personality,and education level is an independent risk factor for extraversion personality in epilepsy patients.

Intracranial aneurysms will lead to subarachnoid hemorrhage, which has a high mortality and morbidity risk. Screening high-risk aneurysms for preventive intervention has a positive effect, considering the widespread presence of unruptured aneurysms in the general population, this article reviews the risk factors of aneurysm rupture from the aspects of epidemiology, pathology, morphology and hemodynamics. In terms of epidemiology, smoking history, hypertension, age, gender and family inheritance are all closely related to the risk of aneurysm rupture. In terms of pathology, inflammation on the wall of intracranial aneurysm may be related to the risk of aneurysm rupture. In imaging, the size of intracranial aneurysms, location, the characteristics of the artery wall and some morphological and hemodynamic parameters can be used as evaluation index of fracture risk factors, at the same time the growth of intracranial aneurysm is one of the high risk indicators, the indicators for us in the future to establish intracranial unruptured aneurysms rupture risk factors evaluation model is of great significance.

Objective To clarify the relationship between intracranial pressure monitoring and prognosis of patients with traumatic brain injury after decompressive craniectomy.Methods From December 2015 to December 2017,48 head-injured patients in Affiliated Suzhou Hospital of Nanjing Medical University were enrolled,who were underwent decompressive craniectomy in this retrospective study.The patients were subdivided into 2 groups based on whether postoperative was monitored (n =19) or not (n =29).The prognosis was evaluated by Glasgow Outcome Scale score,with 1 point of prognosis death,2 to 3 points of poor prognosis,and 4 to 5 points of good prognosis.Count data were expressed as a percentage (％).Count data were expressed as percentage (％).The chi-square test was used to compare the difference in the rate of good prognosis and mortality between the two groups.Results The mortality of monitoring group (10.5％) was significantly lower than that of control group (37.9％) (x2 =4.365 5,P =0.036 7) during hospitalization,The rate of good prognosis in the monitoring group (68.4％) and the control group (44.8％) was not statistically significant (x2 =2.573 8,P =0.108 6).Condusion The study showed that continuous monitoring in patients with severe craniocerebral injury could reduce the mortality of patients during hospitalization,but had no significant effect on the improvement of prognosis.

Objective:To explore and analyze the selection of surgical methods for supratentorial intracerebral hemorrhage.Methods:A total of 260 patients with spontaneous intracerebral hemorrhage who underwent surgery in Department of Neurosurgery, Suzhou Hospital Affiliated to Nanjing Medical University from January 2017 to December 2021 were included in the study by retrospective case analysis. According to different surgical methods, they were divided into three groups: large bone flap group ( n=116), conventional bone flap group( n=89)and stereotactic group( n=55). The large bone flap group underwent standard supratentorial large bone flap craniotomy, the conventional bone flap group underwent conventional bone flap craniotomy, and the stereotactic group underwent stereotactic hematoma puncture suction + drainage. Clinical indicators such as operation time, intraoperative bleeding, pulmonary infection, length of hospital stay, and Glasgow outcome scale (GOS) at 6 months of postoperative follow-up, and the proportion of good prognosis (GOS 4-5) were calculated. Measurement data with normal distribution were expressed as mean±standard deviation( ± s), count data were expressed as cases and percentages (%). Results:In the large bone flap group, the operation time, intraoperative bleeding, hospital stay, pulmonary infection, postoperative rebleeding were(193±24) min, (625±65) mL, (46±11) d, 102 patients(87%), 9 patients(7.8%), and (124±17) min, (297±35) mL, (32±9) d, 29 patients(33%), 4 patients(4.4%)in the conventional bone flap group, and (73±11) min, (53±15) mL, (21±4) d, 10 patients(18%), 2 patients(3.6%)in stereotactic group. All patients were followed up for 6 months, and 165 patients (63.5%) had good prognosis (GOS 4-5), including 36 patients (31%) in the large bone flap group, 82 patients (93.2%) in the conventional bone flap group, and 47 patients (85.5%) in the stereotactic group.Conclusion:Standard large craniectomy has sufficient effect of decompression, and is suitable for serious life threatening hematoma; Conventional craniotomy has advantages in the treatment of secondary intracerebral hemorrhage. Stereotactic surgery has the characteristics of short operation time, less intraoperative bleeding, short hospital stay and low incidence of pulmonary infection, which is worthy of promotion in the treatment of primary intracerebral hemorrhage.

Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.