Objective:To evaluate the feasibility of low radiation dose and low contrast dosage in coronary CT angiography (CCTA) of class I obese patients.Methods:This prospective study enrolled 57 patients (male/female, 50/7, age, 25-77 years) with body mass index (BMI) of 30-38 kg/m 2 and body weight of 85-119 kg scheduled for CCTA from August 2022 to March 2023 in our hospital. The patients were divided into two groups: control group (group A, n = 20) and low-dose group (group B, n = 37). Group A employed a standard-dose protocol: tube voltage 120 kVp and IDR 2.2 g I/s, while group B were scanned using the low-dose protocol: tube voltage 100 kVp and IDR 1.5 g I/s. Images in Group A and Group B were reconstructed with hybrid iterative reconstruction (HIR) at strength 4 and 8, respectively. Other scanning and reconstruction parameters were the same in two groups. Methods:The image quality was assessed by measuring the CT values and noise in the aortic root, left anterior descending artery and right coronary artery, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated for vessels according to the 18-segment classification system using a 4-point scale (1. poor, 4. excellent). The effective dose E and contrast dosage were compared. Statistical analysis was performed using independent samples t-test, Mann-Whitney U test or χ 2 test. Results:The BMI of groups A and B were 31.89 (30.77, 33.81) and 31.22 (30.46, 32.83) kg/m 2, respectively ( P>0.05). No statistically significant differences in CT values, noise, SNR, CNR were noticed between the two groups (all P>0.05). The mean subjective score of all coronary artery segments in the two groups were not less than 3, meeting the requirement of clinical diagnosis. There was no statistically significant difference in the overall subjective image quality between the two groups ( P>0.05). The radiation dose E in groups A and B were 7.58 and 4.49 mSv, respectively ( Z=-5.46, P<0.05). The contrast dosage in groups A and B were 66 and 45 ml, respectively. The radiation dose E and contrast dosage in group B were 41% and 32% lower than that in group A, respectively. Conclusions:For class I obese patients, it was feasible to use a low tube voltage (100 kVp) and low IDR (1.5 gI/s) protocol in CCTA. Radiation dose and contrast dosage can be reduced reasonably without compromising the CCTA image quality.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Objective:To analyze the clinical diagnosis, treatment ，and surgical timing of otogenic intracranial complications. Methods:The clinical data of 11 patients with intracranial complications with ear symptoms as the first manifestation in Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University（Qingdao） from December 2014 to June 2022 were collected, including 8 males and 3 females, aged from 4 to 69 years. All patients had complete otoendoscopy, audiology, imaging and etiology examination, and the diagnosis and treatment plan was jointly developed through multidisciplinary consultation according to the critical degree of clinical symptoms and imaging changes. Among the 11 patients, 5 cases were treated with intracranial lesions first in neurosurgery department and middle ear lesions later in otolaryngology, 3 cases of meningitis, were treated with middle ear surgery after intracranial infection control, 1 case was treated with middle ear lesions and intracranial infection simultaneously, and 2 cases were treated with sigmoid sinus and transverse sinus thrombosis conservatively. They were followed up for 1-6 years. Descriptive statistical methods were used for analysis. Results:All the 11 patients had ear varying symptoms, including ear pain, pus discharge and hearing loss, etc, and then fever appeared, headache, disturbance of consciousness, facial paralysis and other intracranial complication. Otoendoscopy showed perforation of the relaxation of the tympanic membrane in 5 cases, major perforation of the tension in 3 cases, neoplasia in the ear canal in 1 case, bulging of the tympanic membrane in 1 case, and turbidity of the tympanic membrane in 1 case. There were 4 cases of conductive hearing loss, 4 cases of mixed hearing loss and 3 cases of total deafness. Imaging examination showed cholesteatoma of the middle ear complicated with temporal lobe brain abscess in 4 cases, cerebellar abscess in 2 cases, cholesteatoma of the middle ear complicated with intracranial infection in 3 cases, and sigmoid sinus thrombophlebitis in 2 cases. In the etiological examination, 2 cases of Streptococcus pneumoniae were cultured in the pus of brain abscess and cerebrospinal fluid, and 1 case was cultured in streptococcus vestibularis, Bacteroides uniformis and Proteus mirabilis respectively. During the follow-up, 1 patient died of cardiovascular disease 3 years after discharge, and the remaining 10 patients survived. There was no recurrence of intracranial and middle ear lesions. Sigmoid sinus and transverse sinus thrombosis were significantly improved. Conclusion:Brain abscess, intracranial infection and thrombophlebitis are the most common otogenic intracranial complications, and cholesteatoma of middle ear is the most common primary disease. Timely diagnosis, multidisciplinary collaboration, accurate grasp of the timing in the treatment of primary focal and complications have improved the cure rate of the disease.
Female ; Humans ; Male ; Brain Abscess/therapy* ; Cholesteatoma ; Deafness/etiology* ; Hearing Loss/etiology* ; Lateral Sinus Thrombosis/therapy* ; Retrospective Studies ; Thrombophlebitis/therapy* ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cholesteatoma, Middle Ear/therapy* ; Central Nervous System Infections/therapy* ; Sinus Thrombosis, Intracranial/therapy* ; Ear Diseases/therapy*

To investigate the relationship between serum retinol-binding protein 4(RBP4) and gestational diabetes mellitus (GDM) in Chinese Han pregnant women.195 (23-42 years) pregnant women were recruited (July 2005 to December 2007) from the Department of Gynecology and Obstetric in Ruijin Hospital during their visiting for routine prenatal examination.99 subjects belonged to GDM group,and 96 belonged to the group with normal glucose tolerance (NGT).65 non-pregnant healthy women served as control.Serum RBP4 was measured using sandwich enzyme linked immunosorbent assay (ELISA).Pregnant women had higher level of serum RBP4 than that of non-pregnant control.The concentration of serum RBP4 was significantly increased in GDM group as compared with NGT group[(43.04±1.85 vs 33.84±2.17) rag/L,P<0.01].Multiple stepwise regression analysis showed that triglycerides and homeostasis assessment for insulin resistance (HOMA-IR) were independent variables of RBP4 (r2 =0.165) in pregnant women.The results suggest that serum RBP4 level is significantly increased in pregnant women.Women with GDM had even higher RBP4 level than that of normal pregnant women,and RBP4 levele was positively correlated with triglycerides and HOMA-IR.

Objective To evaluate the relationship between interleukin-18(IL-18) and insulin resistance, measured by euglycemic hyperinsulinemic clamp, in women with polycystic ovary syndrome (PCOS). Methods Forty-two young women with PCOS and 38 age-and body mass index (BMI)- matched control women were recruited in this study. A complete hormonal assay was performed and serum IL-18 level was determined in each subject. And euglycemic hyperinsulinemic clamp test was completed in 41 of the above subjects. Results Serum IL-18 levels were increased in the PCOS women, as compared with the control (P=0.033). When all subjects were divided into lean and obese groups, the IL-18 levels were slightly increased in the obese subjects (P=0.902). IL-18 levels were negatively correlated with all the clamp parameters [mean glucose infusion rate (M), M-to-insulin ratio (M/I) and glucose metabolic clearance rate (MCRg), r =-0.419,-0.396,and-0.405,P=0.006,0.010 and 0.009 respectively], but were positively associated with HOMA-β index(r=0.334, P=O.035). Conclusion Serum IL-18 level was significantly increased in PCOS women and was strongly associated with the parameters obtained from the euglycemic hyperinsulinemic clamp, indicating that IL-18 may be an important mediator between inflammation and insulin resistance.

Objective To study insulin sensitivity and first-phase insulin secretion in obese subjects with impaired glucose regulation (ICR) in Shanghai. Methods A total of 129 subjects [38 lean controls and 91 obese subjects with ICR including 64 isolated impaired glucose tolerance (IGT) ,8 isolated impaired fasting glucose (IFC) and 19 IFC + ICT] underwent 75 g oral glucose tolerance test and insulin-modified reduced sample number (n = 12) of Bergman's minimal model method with frequently sampled intravenous glucose tolerance test (FSIGTT). Insulin resistance was determined from the insulin sensitivity index (S1) of the FSIGTT. Insulin secretion was determined during the FSIGTT by the acute insulin response to glucose (AIRg). The disposition index (DI) , the product of AIRg and S1, was used to determine whether AIRg was adequate to compensate for insulin resistance. Results (1) Compared with normal controls, the value of S1 was significantly decreased in 3 groups with ICR (all P